Harm Reduction in Moscow: Successes and Challenges

By Ivan Varentsov

“We began outreach at 7:30pm. As always, it was cold and windy in the outreach area. Right away, a guy came up smiling and asked for alcohol swabs and a pack of insulin syringes. Those who came later weren’t so modest. Everybody wanted ointments, but we had little of them. Once they asked me for condoms and lamented that we didn’t have Contex – we only had something called “Love”. Anyway, they took those. Three people asked about naloxone with two of them telling us how it had helped them save people from overdoses – three people saved at once. They asked for our contact details to get some consultations on treatment, including for HIV. One girl talked to Max for a long time telling him about her tribulations with treatment and drug clinics; he gave her some advice. Overall we had about 15 people approach us this time. In general, in spite of the foul weather outreach work went well…”     

                         

This is a description of a regular workday of the Harm Reduction Moscow project’s outreach team. The project is implemented by the Andrey Rylkov Foundation. The goal of this project is to help people using injectable drugs - who for various reasons are not ready to quit immediately- reduce all kinds of harmful consequences of drug use such as overdoses or vein problems. It helps them obtain necessary health and social support to impact the spread of infectious diseases such as hepatitis C and HIV infection. Our outreach teams work practically every day in various areas of the city. Our services are in great demand – just in the period between July 1 and December 31, 2013, 938 requests for services were registered. However, the project can cover only a small part of those who need its services in a mega-city. And unfortunately there are few such projects in Russia. They are usually implemented by non-governmental and non-profit organizations (NGOS), while the government does not support them at all.

The Andrey Rylkov Foundation for Health and Social Justice (or ARF) was established in June 2009. Its mission is to promote and develop humane drug policy based on tolerance, protection of health, dignity and human rights. The Foundation’s activities rely on voluntary support from representatives of the drug users’ community in the implementation of its projects. Through their involvement the Foundation builds the PUD community’s capacity to engage in advocacy and service provision.

Aside from direct services for people who use drugs, advocacy for access to Opioid Substitution Therapy (OST) in Russia is another key direction for the Foundation. While substitution therapy is one of today’s most widespread and effective methods of addressing opioid dependency, as well as HIV prevention among injecting drug users, Russia does not implement substitution therapy programs. This is because of a legal ban, conservative drug policy in the country, and the lack of support for substitution therapy from drug treatment specialists and law enforcement agencies.

As part of its advocacy, the Foundation engages in strategic litigation at the domestic and international levels, and aims to change the current legislation and practices. As a recent success, the EU Court of Human Rights has communicated with the Russian authorities about the complaints made by three Russian citizens using injectable opiate drugs, in relation to the denial of substitution therapy with methadone and buprenorphine. Two of the complaints (by Irina Teplinskaya from Kaliningrad and Ivan Anoshkin from Togliatti) were prepared and submitted to the ECHR with support from the Andrey Rylkov Foundation. The Russian government must respond to the ECHR’s questions about this case by September 22, 2014, after which Russia’s objections will be sent to the complainants for review and a date for a court hearing will be assigned.

Recently, the Foundation began to develop the work of street lawyers as a new direction. Many participants of the harm reduction projects face various legal problems for which they need help.  The goal of the Street Lawyers Project is to enable outreach workers, social workers, and PUD volunteers of the Foundation to provide legal support to the participants of the harm reduction project independently, without support from professional lawyers, with regard to rights protection, including by representing them in courts, state and healthcare facilities, etc.

                     

The slogan of the IDPC campaign, “Support. Don’t Punish” campaign is very close to our organization, and we understand it well. Not only do we work with drug users on the streets of Moscow on a daily basis, but also for many of us, drug users are our friends and colleagues - and they are us. In our work and life, we constantly face problems related to the criminalization of drug use, as well as the stigma and discrimination directed at drug users. These problems could be avoided if the Russian drug policy was based on a humanitarian approach rather than on repression.

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Stoking the harm reduction debate while lawmakers stall decriminalization

By Pablo Cymerman, Intercambios (Argentina)

In August 2013, Intercambios organized the 11th National Conference on Drug Policy at the Argentine Senate in Buenos Aires, highlighting debates surrounding laws on drug use. Progress appears to be stalled as key lawmakers seems torn between the current punitive approach on drug-use, on the one hand and a rehabilitative approach, on the other hand. 

 

Horacio Pietragalla of the Addiction Prevention and Drug Trafficking Control Commission was vocal about the pressure from some segments of society, despite sharing the views of several civil society organizations: “We have decided not to move forward with decriminalization because relatives of those with problematic drug use have told us, ‘You want to legalize when it is the only resource we have to treat our children.’”

Intercambios is convinced that the amendment of Narcotics Act No. 23,737, which continues persecuting and criminalizing drug users, and whose regulations were declared unconstitutional by the Supreme Court more than three years ago, should be discussed urgently. The position that proclaims that "there must be guaranteed treatment first" implies that the decriminalization of possession increases consumption, a statement refuted by the statistics of the countries where it is already applied. There must be broad, comprehensive, diverse, public and free care services across the country, as a basic human right for all people, inclusive of people who use drugs. And people should not have to risk being approached by law enforcers, whilst accessing these same health services.

Although in its last report UNAIDS said that since the beginning of the millennium, global rates of new HIV infections remain stable, we must not forget the significant rate of the human immunodeficiency virus (HIV) transmitted by sharing injection equipment, especially in the eighties and nineties in the south of Latin America.

Since the curve of infections among injecting cocaine users related to sharing injecting equipment began to decline in Argentina - whether it was because they had transformed their practices with new care measures, or because of a change in the way of using drugs - the idea of focusing on HIV prevention among people who inject drugs began to spread.

At the same time, studies were conducted with non-injecting cocaine users (consumption via inhalation), which resulted in an average of 5% HIV prevalence in this population, which is certainly a higher percentage compared to the prevalence of the general population measured in blood banks.

Although this evidence has been around for at least ten years, there are still few public health initiatives aimed at reducing the harm of cocaine or other drugs that are not injected. Moreover, the non-injecting category has not been incorporated in epidemiological surveillance of HIV/AIDS, in spite of the recognition of most Latin American countries of a growing problematic use of coca paste or 'crack'.

Intercambios has been campaigning for the decriminalization of drug-use and institutionalization of a Comprehensive National Program on Care for Drug Users. The latter facilitates universal health access and services for drug users and provides resources for prevention, treatment, rehabilitation, harm reduction and social integration. In its position paper, Intercambios explained that a National Program of Comprehensive Care for Drug Users must have adequate budget and human resources which will allow the integration of diverse and related services such as universal and selective prevention, low-threshold services, crisis aid, outpatient services, detoxification centers, day centers, therapeutic communities, and services for social support, education, and labor.

Prior to the 2013 elections, Intercambios ran a survey among politicians, mapping their positions on drug-use policy. Each candidate was asked two questions.

The first one was if he/she would support the approval of a law decriminalizing drug possession for personal use. 85% of the respondents were in favor of decriminalization.

The second question was if he/she considered that the bill proposing the creation of a National Program of Comprehensive Care for Drug Users -approved by the Chamber of Deputies- should be passed. 70% of the respondents answered that they supported the initiative.

There was an almost unanimous agreement that drug use should be approached as a public health issue and not as a criminal one. Regarding the creation of a National Program of Comprehensive Care for Drug Users, there was majority support, but the need of improving the bill was highlighted by several candidates. Major concerns included the need to pay more attention to imprisoned populations, lack of existing treatment options according to the type of substance, and the importance of promoting greater involvement of civil society.

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