Editor’s Note: This article is a part of the “Journalism of Tolerance” project by the Kyiv Post and its affiliated non-profit organization, the Media Development Foundation. The project covers challenges faced by sexual, ethnic and other minorities in Ukraine, as well as people with physical disabilities and those living in poverty. This project is made possible by the support of the American people through the U. S. Agency for International Development and Internews. Content is independent of the donors.
Georgiy Gaidamaka from Crimea began taking drugs at the age of 15. Having started with soft drugs, by 2006, when he was 21, he was addicted to hard drugs. It was then that he first sought help in a clinic.
Two years later, in 2008, he became one of the first patients in Ukraine to undergo opioid substitution therapy (OST) on Ukraine’s Crimean Peninsula.
OST replaces illicit opioids, such as heroin or opium, with a longer-acting but less damaging, and legal substitutes. These include methadone or buprenorphine, the most common OST opioids, which are taken under medical supervision and help an addict overcome the physical pain of withdrawal while not giving the user an addictive high.
But when Russia annexed Crimea in 2014, and unleashed its war in Ukraine’s Donbas, the situation changed drastically for the OST patients who lived in the affected territories. That’s because Russian legislation, which is now being enforced by the occupying authorities, prohibits OST.
So Gaidamaka, together with another 805 OST patients, had to move to territories controlled by Ukraine’s government.
Some of them were able to find a place to live in and a job, but some weren’t.
“Those people returned to Crimea. A lot of them are dead now,” Gaidamaka says.
According to the International Charitable Foundation Alliance for Public Health, a non-government organization that supports people with HIV/AIDS, tuberculosis, viral hepatitis, and OST patients, in 2014 there were 1,398 OST patients in Donetsk and Luhansk Oblasts.
But by 2016 there were only 579 patients left – those who were living in the Ukrainian-controlled parts of Donetsk and Luhansk oblasts, meaning that some 800 recipients of OST lost access to the therapy. No one accounts for these patients and no one knows how many moved to Ukraine to continue the treatment.
Ukraine has been providing opioid substitution therapy for 12 years, with financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, technical support from UNAIDS and through key partnerships with civil society organizations.
About 9,615 people were getting OST treatment in Ukraine as of early 2017. This year, Ukraine’s state budget has disbursed about Hr 18 million for opioid substitution therapy.
Will to change
Andriy Yaroviy, who works in Alliance for Public Health, has been on opioid substitution therapy himself for eight years. Now he tries to help others rid themselves of drug addiction.
“In Ukraine people simply do not understand what OST is,” says Yaroviy. “They think it means handing out drugs on legal grounds. But OST has changed my life.”
Yaroviy said there comes a time in the life of every drug addict when he takes drugs not for pleasure but to stop withdrawal symptoms, and that’s when OST is necessary. Society does not understand that one cannot just stop taking drugs without medical supervision, he says.
But the most important component of OST that patients have the will to change their lives, and will go through a certain amount of suffering in order to get better, Yaroviy says.
“Mothers bring their sons to OST centers asking us to start the therapy,” recalls Yaroviy. “I look at these boys and instantly understand that they’re not ready… It will take at least three to five years before the drugs wear out their bodies and they start craving for a change.”
And not everyone wants to make a change though. Some continue taking drugs, increasing the dosage day by day, until one day they overdose, and die.
“You have no idea what it feels like for a drug addict to live without a fix,” says Yaroviy. “In a couple of years this filthy habit forces your body to stop producing serotonin – the hormone responsible for the sense of happiness. After that, you take drugs simply not to be depressed.”
Occupied territories
While most OST patients moved to Ukraine from Kremlin-controlled territories, those left have no other options but to start taking drugs again. But now they have to be twice as careful.
In Ukraine, those convicted of producing, possessing and buying drugs face fines of up to Hr 1,700 ($66), community service of up to two years, or a jail sentence of up to eight years, depending on the severity of the offence.
According to Russian legislation, the punishment for possessing drugs ranges from a $130 fine to a jail sentence of up to 10 years. The prison sentence for producing or selling drugs is up to 20 years.
However, according to Yaroviy, people on the occupied territories may not even face justice.
“You may simply not live long enough to attend your hearing,” he said.
What should a drug addict do if he needs medical help in the occupied territories of the Donbas?
“The best option in Donetsk and Luhansk (oblasts) is to die quietly,” Yaroviy says.
If a patient comes to a hospital in the occupied territories, he will receive only a minimum help, for example, will be prescribed high doses of clophelinum, which lowers heartbeat, causes drowsiness, dizziness and very often – lightheadedness and a trance-like state. It also sedates people and suppresses the pain of withdrawal.
However, this is only a temporary fix. Usually a full dose of such medication is prescribed for up to 10 days, and then the dosage is then slowly reduced. Once treatment ends, drug addicts start to feel sick again, the drug cravings return, and without professional medical supervision and proper substitution therapy the patient will likely return to using street drugs.
