On 25 June, Georgian Prime Minister Irakli Kobakhidze of the Georgian Dream party announced the closure of all private facilities offering Opioid Agonist Treatment (OAT, also known as OST), claiming that only the state should be responsible for people’s drug treatment. Kobakhidze added that private drug treatment clinics are purposefully distributing drugs to keep patients addicted and financially dependent on them. This move was followed by Kobakhidze’s request for the Ministry of Health to remove publicly run OAT treatment centres from “densely populated spaces in the shortest possible time” as their presence allegedly causes “thorough dissatisfaction” among locals.
The shift will potentially impact thousands of people’s access to stable medical treatment. Disguised as a public health move, this decision is in fact a dangerous ideological shift, one that increasing aligns Georgia with Russia’s punitive approach towards drugs.
Thousands impacted
Updated information on the number of people currently in OAT are hard to come by. In 2018, there were an estimated 12,179 people involved in OAT programmes across Georgia – the majority using methadone. What’s clear is that patients lack a variety of treatment options. Buprenorphine/naloxone combination treatment is available only to a small subset of people through the public system; nearly 380 people estimated to use buprenorphine/naloxone through the public system. Most receive it through the private sector. While exact numbers of patients in private OAT programmes are not published, a director of a private treatment clinic confirmed to me that there are around 3,000 people receiving buprenorphine/naloxone. With four of the only five clinics offering buprenorphine/naloxone for opioid use being privately run, ending this treatment pathway could spell disaster for thousands.
Having multiple treatment options is a benefit for any country’s health system. For opioid addiction – as with many conditions – one size treatment does not always fit everyone’s needs or desires. Research shows that patients are best served when there’s a variety of medications available for them, as people respond differently to treatment due to their individual and biological differences. Ending this lifeline will not only deny people access to a globally evidence-based medication – it may come to cost their lives.
This decision raises many questions. Does the Georgian government have the capacity, funds and space to integrate all these new patients into the public system without disrupting their medication? Speaking to Giorgi Gogua, someone in long term recovery from opioid use who received buprenorphine/naloxone treatment in the public system, I learned that enrolment is extremely challenging, time-consuming and does not guarantee a spot.
Was there any consideration given to people’s access to health and choice when this decision was taken, seemingly out of nowhere? Or is it simply feeding into a punitive rhetoric towards people in OAT, denying people of their access to health under the guise of freeing people of the “chains” of private treatment?
This announcement comes just a year after the Georgian Dream government, widely seen as pro-Russian, passed the controversial “Foreign Agent Registration Act,” a near-copy of Russia’s 2012 legislation designed to stifle civil society and foreign-funded NGOs. Now, addiction treatment is the latest target in a campaign to remake Georgian health and human rights policy in Moscow’s image.
The policy change offered by the government is neither scientific nor compassionate. It reflects a deeper, systematic move to emulate the Soviet-style eugenic rhetoric still partially present today in Russia, where addiction is a moral failing rather than a treatable medical condition. At its core, this approach dehumanises and demonises individuals with substance use disorders, denies them access to proven, evidence-based care and lags behind contemporary scientific understanding of this healthcare issue.
The Russian playbook in Ukraine
The deadly consequences of treatment discontinuation are clear in Crimea.
After Russia annexed the Ukrainian peninsula in 2014, one of its first moves was to ban access to methadone and dismantle OAT programmes, a decision described as a demonstration of “sovereign authority and… political control”. More than 800 patients were cut off overnight.
Within a year, dozens were dead of overdoses, suicide, or preventable illness such as HIV and hepatitis C. Internationally funded antiretroviral (ARV) programmes were shuttered, causing surges in bloodborne virus transmissions.
Today, Ukraine has become one of the nations with the highest rates of HIV prevalence in the region, its health system deteriorated by war and occupation. A once-commendable health infrastructure was gutted in a political display of sovereignty.
What we’re seeing in Georgia is the early stage of the same playbook.
Across the world, OAT medications are endorsed by international agencies like the World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and countless other experts. There’s ample evidence that incarceration or moral judgment in treatment is extremely ineffective and often deadly. OAT access reduces overdose deaths, lowers HIV and hepatitis C transmission, and improves long-term recovery outcomes for people dependent on opioids.
The human cost of no treatment
Alignment with the Russian drug treatment system could be fatal to thousands. There, global evidence of methadone and buprenorphine’s efficacy is irrelevant as both substances are highly criminalised. Using them in treatment is portrayed as giving “narkomans” (a derogatory term meaning “addicts”) free drugs. Non-profit addiction treatment organisations are considered “foreign agents” and risk closure if receiving international funding.
Despite high overdose death rates and rampant HIV transmissions, Russia persists with a punitive model for treatment – one that, like Georgia’s, focuses on criminalisation over care. In 2019, over a quarter of incarcerated Russians were serving drug-related sentences. During the pandemic, around 7,300 people died from drug overdoses in 2021, a 60% increase from the previous year. The Russian criminalised approach to drugs can be deadly for those using them. Its harms will only increase with other nations adopting the same framework.
Russia has used addiction policy not just as domestic social control, but as a tool of geopolitical domination. In the lead-up to the 2016 UN General Assembly Special Session on drugs, Moscow lobbied to discredit methadone as “murderous” and aligned itself with states like Uzbekistan and Turkmenistan – both nations identified by the UNODC as strong opponents to OAT-based treatment programmes.
This same logic may soon be implemented in Georgia, which could be a dangerous move for existing OAT patients, and the start of more and more dangerous future policy shifts.
Georgia had been making great strides in OAT access for its patients: 2019 reports highlighted a seven-fold increase in patient coverage in the previous five years. However, addressing drug-related problems from a harm reduction, human rights respecting framework has been a challenge in post-Soviet nations. Closing private treatment centres will provide patients with no legal options to access their medication. Their choices will be to emigrate or access the unregulated drug supply, which can have serious repercussions to people’s lives, stability, and finances.
What’s more is that the Georgian “dream” (no pun intended) to enter the European Union (EU) may be hampered by this law. Concerns were already raised during the government’s harsh crackdown on those protesting the anti-foreign agent law in 2024; shutting down treatment options that are well-established and protected within the EU will only raise alarm bells about Georgia’s treatment of vulnerable communities.
What must be done
Georgia is choosing to put its opioid-dependent citizens through the same ordeal that Russian and occupied Ukrainians face. The international community, including the European Commission, the UNODC and WHO should condemn Georgia’s regression and their support for evidence-based treatment. Local and international civil society organisations must combat this government policy and highlight that Georgia’s international treaties should guarantee their citizens continued access to treatment programmes.
Georgia’s OAT patients face an uphill battle, particularly when they cannot rely on international allies. Addiction is a complex condition, not a tool for political bargaining. Limiting people’s access to treatment against global evidence is both cruel and potentially fatal. The world must stand with the Georgian public health community and with those now at the mercy of unregulated drug markets.