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Government Rolls Out Naloxone in Moscow, But Is it Enough?

Drug treatment centres in Moscow have reportedly begun distributing the overdose reversal drug naloxone to people who use heroin and other opiates.

Russia’s chief narcologist, Evgeny Brun, told news website m24.ru that treatment centres in the capital began providing naloxone in July this year, following the purchase of some 30,000 doses.  Brun says that the government will evaluate the naloxone initiative in spring 2017.  

Naloxone is an opioid antagonist that is contained within the World Health Organisation’s (WHO) list of essential medicines. It is administered – typically through an injection into the muscle – to someone who has suffered an opioid overdose; by immediately reversing the opioid’s effects, it reduces the likelihood of a fatality.

The medicine is considered a prescription drug in Russia – a classification which has restricted who can provide it and thus its rollout to those who need it most. Furthermore, while the Moscow initiative appears to be a step in the right direction, there are some significant limitations.

The Andrey Rylkov Foundation (ARF), a grassroots harm reduction group in Russia, told TalkingDrugs that there have been no efforts to provide naloxone to those on the street who need it but aren’t engaged in treatment.

ARF’s director, Anya Sarang, said that her NGO is the only one conducting outreach and providing naloxone outside of a treatment setting. “We are happy to say that we know of at least 417 lives that were saved with our naloxone in 2014-15. This is one of the best harm reduction interventions,” she added.

Russia operates a controversial drug treatment system that has been roundly criticised for demanding abstinence and for its refusal to incorporate evidence-based medications, including those used in opioid substitution therapy (OST). Methadone and buprenorphine, both of which are used in OST, are banned in the country. Such a treatment environment can have serious implications on whether people want to access it. In the case of Moscow naloxone provision, this raises further questions about just how many people it will reach, and thus how effective the initiative will be.

In recent years, UNAIDS has estimated there to be some 1.8 million people who inject drugs in Russia, while – in 2015 – state officials estimated there to be 1.7 million people who use heroin. The annual number of overdose deaths in the country tripled between 2012 and 2014, reaching around 100,000, though it is unclear exactly how many were opiate overdoses.

Russia’s obstinacy when it comes to considering evidence-informed approaches has come at an enormous cost – along with increasing overdose rates, the country’s number of HIV infections has been growing at an alarming rate of 10 per cent annually, according to the head of the state AIDS centre. There are now over 1 million people registered as living with HIV, with many new cases attributable to injecting drug use.

Despite the alarming figures, Russia has appeared unwilling to lift its ban on OST and implement more programs distributing sterile injecting equipment, both of which are proven counters to HIV transmission among people who inject drugs. 

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