Russia's Confused Methadone Drugs Laws
Viktor Ivanov, the Director of the Russian Federal Service for Drug Control repeatedly stressed in forums such as the U.N. that Russia is opposed to treating drug dependent individuals with methadone and that there is no scientific evidence for the efficacy of this therapy. Members of the medical profession in Russia do not concur that methadone treatment is inefficacious and there has been a debate on the issue in professional journals. For instance, the Independent Journal of Psychiatry features articles, which discuss the lack of a medical approach to the treatment of drug dependency in Russia, and urges the introduction of methadone treatment. Thus, members of the medical profession in Russia are not in the dark about the benefits of methadone.
What is of interest is that some Russian narcologists, psychiatrists and epidemiologists who use Western studies to support the official position of the Russian government on methadone either misconstrue the studies they rely on or fail to use up to date information. For instance, Iulia Shevzova, Nikolaj Koklugin and Anatoliy Berestov use Ullmann’s study published in the German journal Addiction Therapy (Suchttherapie) to maintain that drug dependent individuals who receive methadone treatment and attend needle exchange programs die at the same rate as those who do not. What Ulmann actually concluded was that withdrawal of methadone therapy considerably increases the numbers of individuals who are dependent on drugs, increases the rate of death among individuals who use drugs, and increases the rate of at which HIV and hepatitis infections spread. Furthermore, a study by American scientists Langendam, Giel, van Brussel, Coutinho and van Ameijden, published in the American Journal of Public Health corroborates that methadone treatment is strongly correlated to a decrease in mortality from natural cases and from overdose.
Another instance of Western data being misquoted by Russian medical practitioners opposed to the use of methadone is found in their reference to the Swedish study conducted by Gunne and Grönbladh and reported in the journal Drug and Alcohol Dependence. Shevzova and Koklugin use this study to maintain that methadone treatment does not help individuals to reintegrate into society. However, this study found that the opposite is true. When it comes to reporting on the relationship between methadone treatment, needle exchange programs and the rate at which viral infections such as HIV spread, Russian experts either cite out of date findings or misconstrue the studies. Shevzova, Koklugin and Berestov refer to a 1999 study by McGough, Thiede et al. which was reported in the American Journal of Epidemiology and which found that needle exchange programs do not halt the spread of hepatitis C. What the Russian experts omit to say is that McGough, Thiede et al. carried out another study in 2001, which they published in the American Journal of Public Health and in which they point out that their initial findings were wrong. According to the article published in 2001 by these authors, hepatitis C continued to spread among drug users who visited needle exchange programs because they continued to share equipment other than syringes such as cotton. An equally striking situation is that Russian experts refer to a study by Strathdee, Galai, Safaiean et. al. published in Archives of Internal Medicine in order to put forward that methadone treatment does not slow down the rate at which the HIV spreads. This study did not focus on the relationship between methadone and HIV but rather investigated what the risk factors for contracting HIV are. The study found that the risk factors are the age of drug users, education, sharing of needles with multiple partners, unprotected sex, daily injection, and shooting-gallery attendance.
Contrary to the position of Russia, drug dependent individuals find the administration of methadone beneficial. Ms. Afanasiadi is an HIV-positive injection drug user who lives in the Ukraine. Whilst speaking at the 2011 High Level Meeting on AIDS in New York, she described how methadone treatment changed her life and allowed her to raise her son, to participate in social life and to take steps to treat her HIV and hepatitis infections. Even countries that have a strong stance on drugs and have a history of executing drug dependent individuals such as Iran and China have implemented the methadone therapy. It is likely that the real reasons for the resistance of Russia to methadone therapy stem from policy considerations. As corruption pervades all areas of life in Russia, there is a fear that pharmacists and doctors will sell methadone instead of administering it free of charge. Another anxiety is that the availability of this therapy will create a black market in methadone because drug dependent individuals will sell a portion of methadone they are being prescribed. What is more, there is an apprehension that introduction of methadone therapy will lead society to view drug use as a licit activity. This in turn will pave the way for an impetus to legalise narcotics. These concerns are not well founded.
There is no evidence that introduction of methadone programs leads societies to regard drug consumption as a licit activity and to legalise drugs. Although the U.K. introduced a methadone program in the 1980s, it has kept a prohibitionist stance in relation to drugs. Moreover, Iran and China continue to shun drug consumption despite having introduced a methadone treatment program. Neither are there signs that permitting lawful consumption of certain drugs under specific prescribed circumstances will prompt the public to wish to consume drugs. The UN Children’s Fund found that the proportion of children under 15 who tried cannabis is lower in countries such as Netherlands, which have decriminalised the possession of drugs than in countries such as the U.S. Countries such as Norway, which have not decriminalised drug possession, have few children who try cannabis. A charity called Release used these findings to conclude that drug laws have little impact on drug use – social and cultural factors are much more influential.
Of course, the experience of countries such as the U.K., which have methadone programs, shows that recipients of methadone sell some of their methadone on the black market. However, these countries have judged the benefits of methadone administration of reduction of HIV, tuberculosis and hepatitis infections and of re-socialisation of drug users into society as outweighing the unwanted of permeation of methadone into the black market. Crucially, drug users will prefer to buy drugs other than methadone because methadone does not give them the quite the same euphoric sensation as heroin. Finally, Russia already has in reality an unregulated market in opioids. Although its pharmacists can dispense codeine only with a prescription, in practice many individuals are able to buy codeine-based medicines and to produce desomorphine (Krokodil), a homemade opioid.
There is no supporting evidence for Russia’s fear that pervasive corruption will undermine methadone programs. Countries such as India and Nepal started administering methadone to drug dependent individuals despite having high levels of corruption. Although corruption undermines all public health programs by virtue of doctors diverting medical resources from those for whom they are destined, there is nothing that stops Russia from tackling corruption. Naturally, programs for helping individuals with a drug dependency should be accompanied by additional measures. For instance, it is important to reduce unemployment and to create prosperity so that individuals do not resort to drugs out of feeling hopeless about their future. However, in the short term, Russia will benefit from legalising methadone by reducing the rate at which viral diseases such as HIV spread, facilitating participation of drug dependent individuals in social life, and removing the need for drug users to commit crimes to fuel their dependency. This in turn will reduce mortality among young people and will ameliorate the problem of the growth of an ageing population.