Russia’s treatment of its addicted citizens is characterised by cruelty, writes Max Daly. They are denied life-saving medicine. They are beaten, fitted up by the cops, raped and tortured. They are, according to Russian state-sponsored propaganda, subhuman scum whose schizophrenic minds need correcting with anti-psychotic drugs. Yet according to the country’s narcotics official, these are the luckiest drug addicts on the planet.
In Europe, America and Australasia, says Russia’s Chief Narcologist Evgeny Bruin, unfortunate addicts are fobbed off with a cheap, green poison, methadone, which turns them into homeless, dementia-ridden zombies with no livers in under five years. Some are even encouraged to take more drugs, with the provision of free, sterile injecting equipment. Luckily for Russian addicts, their motherland’s treatment system is, unlike in the West, a socially responsible one.
In the mixed-up world that is Russian drug policy, scientific evidence and compassion are concepts that have become twisted hideously out of shape. Despite that the Russian government is overseeing a rapidly unfolding health and human rights disaster, its solutions remain couched in Soviet-era repressive psychiatry, propaganda and wilful ignorance of widely accepted scientific truths.
At 1.8 million, Russia has one of the highest numbers of injecting drug users in the world. Most inject heroin, but more often now, drug users are injecting the even more damaging home-cooked synthetic opiate desomorphine, known as krokodil because of the scale-like effect it can create on the skin.
Crucially, the country’s long-term opposition to internationally accepted methods of harm reduction has laid the foundations for one of the world’s fastest growing HIV epidemics.
There were 100,000 people with the HIV virus in Russia a decade ago. Today, there are more than one million – three-quarters of whom are drug users. More than one in three injecting drug users in Russia has HIV, while the vast majority have hepatitis C. Estimates vary, but between 10,000 and 30,000 people suffer drug-related deaths each year in Russia.
Yet amid the growing devastation, Russia’s rulers belligerently continue to ignore what the rest of the world has found to be the most useful weapon against heroin epidemics: tried and tested harm-reduction measures such as methadone and needle exchange.
According to Mikhail Golichenko, a former UN drugs official in Russia who is now a senior policy analyst with the Canadian HIV/AIDS Legal Network, their attitude is: “We know that getting you off drugs is painful, it’s cruel, but if you do it, we will welcome you back to society.
If you are not ready, if you fail to kick the habit, then fuck you. You will be arrested and you will get disease. You are doomed to die.”
It’s the kind of tough, no-nonsense approach to drug addiction that is coveted by right wing libertarian politicians and authoritarian regimes the world over. But with the UN seemingly powerless to intervene and increasingly harsh policies being adopted across the border in Ukraine, it is a stance that is being viewed internationally with increasing unease.
As Damon Barrett, Deputy Director of Harm Reduction International, puts it, “Russia is the world’s cautionary tale on drugs and HIV. No other government is so willing to deny the evidence on harm reduction, silence open debate and witness the deaths of its own people.”
Russia’s heroin problem has snowballed since the end of the Cold War and collapse of the old Soviet Union. In the 1990s, traffickers made inroads across the former Soviet states, particularly along the Silk Road from Afghanistan via Russia’s vast southern border with Kazakhstan. At the same time, Russia was seeing a rise in unemployment and poverty, and for some, heroin became a way of dealing with life.
When she first started as an outreach worker handing sterile injecting equipment to Moscow’s heroin-injecting population in the late 1990s, Anya Sarang rarely saw a drug user with HIV. Now, in a city that has bizarrely claimed success in beating the virus, a person gets HIV every three hours. Today, Sarang’s campaigning organisation, the Andrey Rylkov Foundation for Health and Social Justice, remains a lone voice in calling for a humane drug policy and proven methods of harm reduction as a way of dealing with her country’s archaic treatment system.
Russia’s system relies on a two-pronged attack on addiction: detox and rehab. Problem drug users are expected to get drug free within three weeks at one of the country’s wide network of detox clinics. Methadone and buprenorphine are nowhere to be seen. The substances, used in the treatment of most of the world’s heroin addicts and deemed essential drugs by the World Health Organization (WHO), were banned until at least 2020 under the State Anti-Drug Policy Strategy of the Russian Federation, adopted in 2010.
Instead, detox is rooted in the kind of behaviour-correcting methods used to suppress the will of Soviet political prisoners in the 1960s. Patients are given a mixture of tranquillisers and antipsychotics such as the neuroleptic haloperidol, a drug more commonly used to treat schizophrenia and delirium. Then follows a course of psychotherapy. But the success rates are not good post-detox.
According to the Russian Federal Drug Control Agency (FSKN), over 90 percent of drug treatment patients resume the use of illegal drugs within a year.
Once a patient has gone through detox, they may enter Russia’s vastly overcrowded rehab system. There are three dedicated state rehab centres, assisted by more than 70 rehab wards, providing 2,231 beds for the treatment of alcoholism and drug addiction. But with two million registered alcoholics and 1.8 million injecting drugs users, getting a place in a state rehab is difficult.
Unfortunately, the ineffectiveness of the government’s own drug treatment system and the high demand for help has led to a plethora of dubious private rehab centres, often situated in remote areas. Charging at least $500 a month, this is where many middle class Russian families will send their drug-addicted sons and daughters.
But behind closed doors, for some lurks a dark world of pain and punishment. It’s a system riddled with what Dr Evgeny Krupitsky of the Department of Addictions at the Bekhterev Research Psychoneurological Institute in St Petersburg has dismissed as little more than “science-decorated shamanism”.
A report handed to, and later ignored by, the UN Committee on Torture in 2011 by Anya Sarang and other campaigners, Atmospheric Pressure: Russian Drug Policy as a Driver for Violations of the UN Convention against Torture, gave an account of hundreds of quack methods used to treat addiction in state and private rehabs, many in the form of patents lodged by the Russian Ministry of Health. It reads like a ‘how to’ manual for medieval dungeon masters and mad scientists.
Methods include punishment by starvation, long-term handcuffing to bed frames, ‘coding’ (hypnotherapy aimed at persuading the patient that drug use leads to death) and even the xeno-implantation of guinea pig brains. Out of 34 methods of opioid-dependence treatment, 18 were deemed by analysts in the report as being ‘life threatening’.
Yet casual violence and bullying has been one of the more popular methods used by private rehabs to try and get people off drugs. One 31-year-old man who attended the City Without Drugs private rehab centre in Ekaterinburg – raided by Police last year after the death of an inpatient – was interviewed for Atmospheric Pressure. He recalled:
“There is a couch... you lay down, get undressed... there were three people who beat me up at the same time. It’d be even worse if you tried to protect yourself. Then they hit you on the hands with shovels, clubs. So are you going to inject drugs again? Will you? – ‘No, I will not, I am not going to use drugs any more, stop, I swear, just stop flogging, don’t flog me any more please…’”
Professor Vladimir Mendelevich, a harm-reduction advocate who has been censored by the authorities for providing information on methadone treatment, sums up the philosophy of dealing with drug addiction in his country: “The Russian drug treatment system has a definition of treatment as edification. You suffer, and the next time you won’t do anything bad.”
But the abuse doesn’t just occur in private rehabs. Russian drug users, particularly those with physical signs of abuse such as track marks, can expect similar or worse at the hands of the Police.
“The daily life of drug users is characterised by a constant terror arising from the widespread illegal practices employed by law enforcement officials,” says Atmospheric Pressure, which details how the concept of ‘bespredel’ (lack of any limits for Police) results in “routine law enforcement tactics” against drug users.
“Detention without legal justification; planting clues to make an arrest or detention; extortion of money or drugs; or sexual violence targeting sex workers.
These can also be much more extreme practices, such as physical violence used to obtain a ‘confession’ or as torture-like punishment,” says the report.
It details the experience of a 23-yearold drug user from Moscow:
“And I didn’t sign [the confession]. They didn’t hit me at first. I was even surprised. And they say: ‘Go, have a smoke.’ And led me to some gloomy room. I smoke. And then the door opens. The bright light hits my eye, I inhale, and straight into the [cigarette] coal they just hit me on the face. And then it starts: bang, bang, bang, bang. And you just go: ‘Yes, yes, I confess to everything,’ and off you go to the prosecutor’s office.”
There is even a word, ‘subbotnik’, to describe the forced provision of free-of charge sexual services to Police officers by sex workers.
If, during their journey through the criminal justice system, in Police stations and in the country’s TB-ridden, Gulag-style prisons Russian drug users are beaten, tortured or just left to rot, then they only have themselves to blame. Russia’s Minister of Justice Alexander Konovalov summed up the prevailing attitude of the government to its most vulnerable citizens while discussing the inability of the prison service to cope with the large number of ill inmates.
Prison medical services, he said, “cannot cope with the flow of – if you allow me to use this word – ‘human material’ that ends up in the penitentiary facilities”.
That drug addicts are treated with so little regard by Police in Russia is no surprise.
Zero tolerance for drug users is actively promoted by the state. The FSKN has gone on record to clarify the government’s contempt for drug users.
“An addict degenerates as an individual. His intellect decreases fast, his interests become primitive, his mind weakens. He loses interest in life, his friends and relatives abandon him. His appearance becomes repulsive, bum-like. Moral and ethical norms do not exist for such persons.”
In February 2011, NTV, a federalchannel, aired a TV programme called How to beat the crap out of an addict. Meanwhile, the Russian clergy has adopted a fairly unsympathetic ‘out of sight, out of mind’ mindset in dealing with the country’s problem drug users. The head of the Synodal Unit for Collaboration with the Armed Forces and Law Enforcement, Arch-presbyter Dmitry Smirnov, said, “An addict either undergoes treatment or should be isolated from society. I’m not talking about prison. We have many islands in our country; in the north, in the far east.”
Stigma is not the word. Russia’s drug users, and the people who try and help them, are at the sharp end of what Anya Sarang calls “an ideological war” that is being waged by the state against what it deems as anti-Russian forces in society. It is the same war that saw last year’s jailing of the feminist punk rock band Pussy Riot for singing an anti-government protest song against Russian president Vladimir Putin at an Orthodox cathedral in Moscow.
Also last year, the Federal Drug Control Service decided to close down the Anfrey Rylkov Foundation (ARF)’s website. When asked why the site had been outlawed, the minister responsible accused the ARF of promoting the use of methadone. And like Pussy Riot, several drug activists who have been vocal in criticising the government have ended up in jail.
ARF lawyers are currently fighting eight legal cases involving activists or drug users who have suffered at the hands of the system. Among them, Ivan Anoshkin had drugs planted on him and was subsequently arrested and jailed, while Evgeniy Konyshev had drugs planted on him shortly after accusing the City Without Drugs rehab of practising torture under the guise of drug treatment.
But as Mikhail Golichenko points out, Russian user-activists cannot be effective for two reasons.
“Firstly, they are too busy looking for illicit drugs while there is lack of access to life-saving substitute treatment. Secondly, they are too often in prison – because every drug-dependent person is doomed to spend his life in jail for nothing but an illness – addiction.”
Other citations against the authorities on ARF’s caseload include inhumane treatment through denial of TB treatment, inhumane treatment of a pregnant woman with drug dependency through coercion to have an abortion and inhumane and degrading treatment of a drug-dependent woman through denial of cancer treatment in prison.
“We are worried and afraid for every one of our activists, especially since Putin’s inauguration and the scale of political repression we have witnessed,” says Sarang.
“Now the repression of political and human rights activists by the current dictatorship has become mundane. More and more political activists are thrown in prison.”
Sarang has expressed solidarity with Pussy Riot and all the other victims, including Russia’s poor, of what she calls the “shameless Russian justice”.
“For heroin users, the state and the medical system are their enemies,” she says. “They are treated like scum, and people are in a vicious circle where they cannot get any treatment for their addiction and end up slowly dying.”
Now that much of the funding for harm-reduction programmes in Russia has dried up, partly due to the fact that Russia became a donor rather than a recipient of the Global Fund to Fight Aids, Russia’s drug-fuelled public health disaster is set to become catastrophic. Apart from organisations such as the ARF, which are thin on the ground in Russia, what assistance can the country’s problem drug users, HIV, TB and hepatitis C sufferers hope to get from the international community?
Sarang says, since the appointment of her compatriot Yuri Fedotov as Executive Director of the UNODC in 2010, Russia has merely become more efficient at snuffing out all semblances of UN influence on its domestic policy. The UN human rights system has simply failed to respond.
“The UN has offices here, but it should withdraw them because they are powerless. It is a waste of time and money, and they should spend it somewhere else. Here, the UN has become a puppet. Like our citizens, the UN has become a hostage of Russia’s drug policy.”
Drug harm experts say funding for a nasal spray that reverses opioid overdoses is critical in the face of an increasingly toxic drug supply and the emergence of powerful synthetic opioids.
Survey participants also reported that barriers to accessing services, resources and information were high.
A group of powerful synthetic opioids that were first detected in the country just a year ago may have already been linked to several deaths.