Methadone Quixote: The Battle for Harm Reduction in Russia

Methadone substitution therapy has been approved by the United Nations and widely used to treat drug addiction in many countries worldwide. In Russia, however, it remains illegal.

In response to applications filed with the European Court of Human Rights (ECtHR) by three Russian drug users alleging that the ban on methadone therapy in Russia amounts to torture and ill-treatment, the Russian authorities published a memorandum saying that such programs only increase the “masses of people addicted to methadone” who can “easily be incited to criminal activity and terrorism.”

According to Mediazone, Russia is trying to suppress the “methadone” applications to the ECtHR at the domestic as well as international level by mounting its pressure on the three applicants.

Detained for a beer 

On a hot summer evening of August 12, 2014, in Kaliningrad, local resident Irina Teplinskaya, returning form the Baltic Sea beach, was approached by two police officers. The reason was that she was holding a can of beer. The police were familiar: they had encountered Teplinskaya a few times before in the same place under the same circumstances. The patrol officers greeted her and asked to proceed to the nearest police station to draw up a report.

This article was first published by MediaZona. You can read the original here.

Having drawn up an administrative offense report and charged Teplinskaya the minimum established penalty for this type of offense, the officers completed yet another routine procedure of establishing Teplinskaya’s identity; their mood changed drastically once they checked on her in the law enforcement database.

“Sorry, we cannot let you go -- we need to take you to Baltiyskoe [police station],” Teplinskaya remembers them say. After taking her to Baltiyskoe in Kievskaya Street and making a record of it in the logbook, the officers drove Teplinskaya in a police UAZ van to Leningradskoye police station in Clinicheskaya Street. The police at Leningradskoye were unfamiliar to her. Past midnight, Teplinskaya says she was escorted to the front desk, where the duty officer did not record her details in the logbook, and then to the Criminal Investigation Unit.

“One of the officers pointed to a chair saying that I was going to spend the entire night in that chair. No one explained the reason why. I kept asking the officers on duty to at least allow me to use the toilet, but they refused. One of them sort of explained that I had to wait until morning to be interviewed by someone from the prosecutor’s office,” she said.

In the morning, the night shift at Leningradskoye changed, and a female officer allowed Teplinskaya to use the toilet. Realizing that they still would not let her go, Teplinskaya asked a social worker she knew to call lawyer Alexander Koss who had helped her before.

Back in 2011, Teplinskaya, a 48-year-old with more than 30 years of opiate addiction, was detained at the Khrabrovo airport in Kaliningrad where she arrived from Kyiv -- the FSB officers at the airport found an unidentified pill in one of her bags. On the next day, the pill was identified as methadone -- a synthetic drug allowed in Ukraine to be used in programs to alleviate drug addiction; Teplinskaya, an HIV activist, had been advocating for its legalization in Russia.

She was detained and faced charges under article 188 (2) of the Criminal Code (drug trafficking). Two weeks later, Koss was able to get the charges against Teplinskaya dropped. Prior to that incident, Irina had served five prison terms, a total of 16 years, for drug-related offenses.

Koss came to Leningradskoye, but had to wait outside the police station for an hour; he was not allowed inside, because Teplinskaya’s detention was not recorded in the logbook. Police explained to the lawyer that Teplinskaya was detained in order to be escorted to the Prosecutor of Leningrad District, Kaliningrad; they released the detainee upon the lawyer’s guarantee. Teplinskaya and Koss arrived at the prosecutor’s office where they were met by Assistant Prosecutor Ekaterina Semyak from the Public Relations Department.

“Apparently, she was not quite familiar with my biography. She explained that the District Prosecutor’s Office had received an instruction from the Prosecutor General’s Office to question me about my income. The reason was my application to the ECtHR where I had asked the Court to find violation of my rights in Russia’s ban on substitution therapy -- I stated in the application that my chronic drug addiction and the resulting HIV and TB had made me unable to work. And [the assistant prosecutor] also asked whether I had participated in the Euro Maydan,” Teplinskaya said.

Once Teplinskaya signed a written explanation (a copy of the document is available to Mediazone), she was released from the prosecutor’s office. She wrote that since January 2011, she had been working with Russian NGOs and was paid for publications and interviews,  earning a total of 20-30 thousand rubles annually.

“Between July 2012 and March 2014, I lived in Poltava, Ukraine, where being on a methadone program allowed me to live fully and work. In Ukraine, my monthly income ranged between $300 and $500, because I was on adequate treatment for my drug addiction,” Irina wrote in her explanation.

“He Shoots Up, but You Are Responsible”

Late in 2011, Teplinskaya took her case to the ECtHR complaining about Russia’s ban on substitution therapy.

“Due to her disease and the ban on effective treatment for this disease, the Applicant has spent more than 20 years struggling through withdrawals, forced to buy illicit drugs every day, risking arrest and imprisonment, and experiencing profound humiliation, powerlessness and hopelessness because she cannot stop using drugs, while effective treatment is prohibited and the state is intolerant towards drug users. Since effective treatment is banned in Russia, the Applicant’s entire life revolves around illegal drugs; therefore she cannot exercise their right to private and family life,” the application says.

Before taking her case to the ECtHR, Teplinskaya had requested the Russian Health Ministry to provide her with methadone or buprenorphine treatment, but received a formal response that since these substances were prohibited, they could not allow Teplinskaya to use them. The applicant appealed to the district and regional courts, but to no avail.

At the end of May 2014, the ECtHR combined Teplinskaya’s case with similar applications from two other Russians -- Alexey Kurmanaevsky from Kazan, and Ivan Anoshkin from Togliatti. Soon afterwards, in early July -- a month before Teplinskaya was detained and a few days after the application combining the three cases was communicated to the Russian Government -- Anoshkin and his employer were summoned to the Togliatti Prosecutor’s Office.

Ivan Anoshkin started injecting opiates in 1994 at the age of 14. Over the years of his addiction, he contracted TB and HIV and was convicted five times. Having learned about substitution therapy in 2012, he complained to the U.N. and then after a year to the ECtHR about its ban in Russia.

By that time, according to Anoshkin, he had stopped using opiates and was working for Project April, a small NGO in Togliatti helping vulnerable groups, with four full-time staff and 30-40 volunteers.

“Here in Togliatti, one in eight men aged 30 years and over are infected with HIV, and we are in fact the only organization in the city to reach out to vulnerable groups such as drug users, people with HIV, and also men who have sex with men. We also provide primary prevention services, give talks at schools and other educational institutions, conduct awareness-raising activities and publish booklets; we do outreach and help people who have been imprisoned on drug charges (article 228 if the Criminal Code) to reintegrate into society after their release,” says Tatiana Kochetkova, director of Project April.

In early July 2014, the Assistant Prosecutor of the Central District of Togliatti called Kochetkova on her mobile phone and asked her to come to the prosecutor’s office together with Anoshkin; the official also asked Kochetkova to bring documentary evidence that Anoshkin was officially employed by the NGO; Kochetkova’s request to postpone the visit so she could consult a lawyer about the papers was denied.

“I was the first to be interviewed by the Assistant Prosecutor; she was very straightforward and said:" 

'Anoshkin is your employee. You are a good organization, but he is giving you trouble. He is a drug addict, and he has filed an application to the ECtHR. So it turns out that he is shooting drugs, and you will be held responsible, your entire organization.'

"I disagreed with her, saying that he was an excellent employee with good expertise in his area and produced his employment contract confirming that he was on our payroll. The official started asking me about substitution therapy, what it is about and why it is good. I told her about the scientific evidence trying to explain it in simple terms,” Kochetkova reports.

The Assistant Prosecutor had a surprisingly calm reaction to Kochetkova’s explanation of substitution therapy, but when the interview seemed to be almost over, the official found an irregularity in Anoshkin’s employment papers. Although his salary was just 4,000 rubles per month, by Russian law this tiny amount had to be paid in two installments, while Project April paid him the entire sum at once. Assuring Kochetkova that the irregularity was too small to initiate proceedings, the Assistant Prosecutor let Kochetkova go and called Anoshkin in.

“They asked me about substitution therapy and whether I was shooting up, although I was not using at the time. They gave me a transcript of the interview to sign, and I asked for a copy. They refused, and I indicated this violation in the comments field. The Assistant Prosecutor did not like it at all. Then I left,” says Anoshkin.

On the next day, Kochetkova was once again summoned to the prosecutor’s office and asked to bring the same papers. According to the NGO director, the Assistant Prosecutor had changed her mind overnight and said that paying a salary once rather than twice a month was “a serious violation that merits an administrative investigation.” On the same day, Kochetkova received a phone call from the Ministry of Justice informing her that an unscheduled audit of her organization would start in a day.

According to Kochetkova, during the same week she was visited in her home by a local policeman, allegedly following “an anonymous phone call about drug dealing,” while officers from the Federal Drug Control Service came to Project April’s office to talk to the NGO staff on whether distributing clean syringes in the street can be considered promotion of banned substances.

A month later, the labor inspectorate issued a decision that the NGO should be fined 5,000 rubles for the violation found in Anoshkin’s papers. “They did not even hold a labor commission hearing on the issue, but just served us the text of the decision. Even though the fine was small, we complained to the district court, and the penalty was revoked. The prosecutor’s office refused to leave us alone and appealed the district court’s ruling in the regional court, but the finding was again in our favor. Later on the same afternoon that I came back from the regional court hearing, I received a phone call from the fire safety inspection who said they would visit our office to check compliance with fire safety requirements. The fire safety inspection started checking into us. During the same week, we found that a certain Maxim Bulgakov had filed complaints with various authorities, including the city, regional and federal prosecutors, FDCS, local police, and God knows who else that addicts were hanging around our office and we had boxes stored in the hallway that posed a fire hazard. All these authorities started checking into us. I still have no idea who that man was,” Kochetkova says.

All of the above, according to Kochetkova, effectively paralyzed April Project’s work for months. In addition to inspections triggered by “Bulgakov’s” complaints, an FSB officer responsible for supervision over NGOs started visiting their office every couple of months always asking the same questions: “Why are you filming videos for foreign television?” and, “Are you receiving foreign funding?”

According to Project April’s director, her NGO has never received foreign funding -- or any substantial contributions from Russian private or public donors for that matter. The salaries -- none of them exceeding 5,000 rubles per month -- of the project’s four paid staff have been financed from the Togliatti mayor’s harm reduction program for HIV-positive people. This year, however, the city authorities refused to include Project April in the list of funding recipients. The NGO’s lease of [subsidized] municipal office space expires in six months, unlikely to be renewed, according to Kochetkova.

Divergent Interests

Kochetkova is now trying to appeal in the regional court a 21,000 ruble fine imposed by the fire safety inspection for using the wrong model of smoke detectors. She says that Project April simply does not have the money to pay this fine. Meanwhile, a third applicant of the “methadone” case pending at the ECtHR -- Alexey Kurmanaevsky from Kazan -- has also reported pressure in connection with his application.

The local narcology clinic diagnosed Kurmanaevsky with “opioid addiction syndrome” in 1997 -- at a later date than the other two applicants. Since then, he has made more than 20 attempts to treat his addiction.

Starting in 2008, Alexey who was already living with HIV, became involved in programs to prevent the negative consequences of drug use, and has worked with non-profit organizations. Last May, Kurmanaevsky was admitted to Vershina Kazan drug rehabilitation center, one of the many private in-patient rehabilitation facilities funded by the Healthy Country Foundation that operates in partnership with the FDCS with substantial support from the government. Having completed a rehab course, Alexey decided to work for Vershina as a volunteer.

According to Kurmanaevsky, after eight months of internship, he was taken on as a substance addiction counselor. “I was involved in the rehab center’s everyday operation, worked in shifts helping the residents, organized activities, gave talks and provided one-on-one counseling.” Kurmanaevsky chose not to take formal employment with the rehab center, since he had long been on the staff of another organization and preferred to keep it that way; according to Kurmanaevsky, the rehab center paid him under a service contract.

Alexey reports that on March 18, he received a phone call from Adelia Usmanova, director of the Healthy Country branch in Kazan, saying that the “central administration [of the Foundation] would like to talk to him” and giving him the number of Healthy Country’s vice president Dmitry Valyukov.

“I phoned Valyukov. He was asking about my contacts with the ECtHR and my application concerning substitution therapy. I explained that I had worked in this field for many years, that I was trying to defend my own and others’ right to evidence-based treatment, that I could see a possibility of reform of drug treatment services in Russia, and that methadone, in my opinion, could contribute to harm reduction,” Kurmanaevsky recalls.

“Dmitry said that he was surprised at my opinion that the Healthy Country Foundation was opposed to a total ban on the use of any substance. I was in turn surprised at him saying so and explained that I viewed substitution therapy as a means of prevention and a chance to bring drug users from streets where they are out of reach into contact with doctors and other specialists, which could motivate them to go into rehab. Nothing of this kind is available today, and the only incentive [for drug users to go into treatment] is to avoid pressure from the law enforcement, the FDCS, and from their own families who also suffer continuous problems. It means that their motivation today is exclusively external, while I believe that it should come from the inside, from the user community. Valyukov responded that Healthy Country was strongly against methadone and that he was going to some government agency -- perhaps to the FDCS -- where he was invited to discuss my being part of the organization and how it was damaging for the Foundation’s reputation,” said Kurmanaevsky.

According Kurmanaevsky, their short conversation ended in an ultimatum: either he should publicly withdraw his application from the ECtHR and declare at a specially convened press conference that he had been profoundly mistaken regarding substitution therapy or else all his contacts with Healthy Country and Vershina must stop. Alexey chose the latter.

Valyukov has denied ever having this conversation and refused to give comments. However, Kurmanaevsky had to leave Vershina. On the evening of March 18, a full-time staff member of Vershina left a message on the center’s service chat (the log is available to Mediazone) for all employees saying “Do you believe that methadone programs are effective and would you like to have such programs in Russia? ALL staff—Please reply!”

Five participants of the chat answered “no” and one replied “yes,” but changed his response to negative ten minutes later saying that the first one was a joke. Kurmanaevsky was the only one who answered “yes” and added a few minutes later: “I want drug users to have better chances to survive, stay out of prison and stop financing the drug trade. Friends, I can understand you.”

For him, the chat ended in the following message from someone: “To my great regret, Alexey is no longer working at our center! I appreciate and respect you! But there is nothing I can do! Thank you for your work and your contribution.”

According to Kurmanaevsky, the author of this message must have been Usmanova, director of Healthy Country’s branch in Kazan.

Consequences of the Application

Since then, Kurmanaevsky and his wife Maria -- who used to be a full-time staff member at Vershina but resigned after Alexey had to go -- have been employed by the Timur Islamov Charitable Foundation.

“My current supervisors have their own ideas about things, including substitution therapy. They do not consider it appropriate to interfere with my personal views on things. But my biggest disappointment is that while working for Vershina I kept hearing that our main focus was on the team and the people, while in fact it turned out that their focus was on how they were viewed from the outside and on the possibility to receive government funding,” he says . Shortly after he left Vershina, every mention of substance addiction counselor Kurmanaevsky was removed from their website, although it  can still be found in the cache.

Things went worse for other applicants of the “methadone” case. Teplinskaya faced great difficulty in re-establishing her already tense relationship with her mother and grandmother that got much worse after repeated phone calls from the prosecutor’s office to their home.

“Both before and after the arrest, I received phone calls [from the authorities] urging me to come and talk to the prosecutor. I chose not to go because I did not think it was necessary. Then for a long time they continued calling my grandmother and mother in their home. [The authorities] caused major damage to my personal life by doing so -- we already had a strained relationship, and [after the phone calls, my mother and grandmother] got an idea that I was wanted for some terrible crime,” Teplinskaya says.

For Kochetkova, director of Project April, her confrontation with government agencies -- caused, in her opinion, by Anoshkin’s case in Strasbourg -- makes it likely that her organization will be closed. “I have no idea what we are going to do if they refuse to extend our lease of the municipal office space, which they will probably do as they have indirectly let me know. Our current lease expires in six months. We are now living from day to day. We cannot afford to rent a [commercial] office. Perhaps we will somehow try to find free venues for meetings, without a space of our own. Internally, we are prepared to operate on our own. The city has effectively abandoned us, although there is no one in Togliatti beside us [doing what we do],” she says.

According to Mikhail Golichenko, a lawyer who has helped all the applicants in preparing their applications for the ECtHR, if the Court finds Russia in violation of the applicants’ rights the Russian government will have to pay a compensation to Teplinskaya, Anoshkin and Kurmanaevsky and take steps to prevent similar violations in the future.

“It would mean that Russia must, as a minimum, stop preventing applicants from receiving opioid substitution therapy and lift the ban by changing the Federal Law on Narcotic Drugs and Psychotropic Substances. As a maximum, Russia would have to ensure access to opioid substitution therapy for the applicants, which means providing the therapy to all those who need it, as well as lifting the ban,” says the lawyer.

According to Golichenko, six Russians had planned to file “methadone” applications with the ECtHR. However, two of them -- Konstantin Proletarsky from St. Petersburg and Veronica Sintsova from Kaliningrad -- had died before they could exhaust the domestic remedies, while Dmitry Polushkin from Lesosibirsk could not file an application because he was sentenced to five years on drug charges. Polushkin was later acquitted on appeal, and now, with support from the Andrey Rylkov Foundation, is preparing to take his complaint against Russia’s ban on substitution therapy to the international level.