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Ukraine’s opiate users: Russian invasion has severely disrupted access to drug-treatment services

About 317,000 Ukrainians inject drugs like heroin regularly. As of January, 14,868 of them were receiving substitute opiates such as methadone and buprenorphine. 

Ukraine has been funding these treatment services since 2017. In that year, it also rapidly expanded its services for people in need of sterile syringes, condoms and peer support or counselling – the World Health Organization-recommended minimum for harm reduction among drug users and those at risk of HIV. 

The Russian invasion has severely disrupted access to these specialist drug-treatment services. Before the war, some people would collect their methadone daily, but the Ministry of Health has advised that a 15-30 days’ supply should be given. This helps to reduce the number of trips to services, which in some parts of the country are risky. Yet even at this early stage in the war, ensuring people can secure medication is proving difficult. (Conversation, UK, 09.03.2022)

https://theconversation.com/ukraines-opiate-users-russian-invasion-has-severely-disrupted-access-to-drug-treatment-services-178624

ALLIANCE FOR PUBLIC HEALTH UKRAINE (ukrain./engl.)

https://aph.org.ua

ALLIANCE FOR PUBLIC HEALTH: response to challenges caused by the Russian aggression against
Ukraine (situational report as of 08.03.2022)

https://aph.org.ua/wp-content/uploads/2022/03/SiTRep-war-2022_1_eng.pdf

UNAIDS. Keeping harm reduction available in Ukraine (Interview)

Ten days after the start of the Russian invasion of Ukraine, UNAIDS spoke to Oleksii Kvytkovskyi, the head of the Volna Donbas Resource Center of the All-Ukrainian Association of People with Drug Addiction, a nongovernmental organization working with people who inject drugs in Ukraine. (UNAIDS, Genf, 09.03.2022)

https://www.unaids.org/en/resources/presscentre/featurestories/2022/march/20220309_oleksii-kvytkovskyi

Has resourcing of non-governmental harm-reduction organizations in Ukraine improved HIV prevention and treatment outcomes for people who inject drugs? Findings from multiple bio-behavioural surveys. 

Trickey A, Semchuk N, Saliuk T, Sazonova Y, Varetska O, Walker JG, Lim AG, Stone J, Vickerman P. 

J Int AIDS Soc. 2020 Aug;23(8):e25608. doi: 10.1002/jia2.25608. PMID: 32851812; PMCID: PMC7450208.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450208/

Engaging people who inject drugs and their peers in HIV testing and harm reduction in Ukraine: do they make a difference? 

Kravchenko N, Denisiuk O, Kuznetsova J, Jayaraj J, Zachariah R, Smyrnov P. 

J Infect Dev Ctries. 2019 Jul 31;13(7.1):118S-125S. doi: 10.3855/jidc.11293. PMID: 32065814.

https://jidc.org/index.php/journal/article/view/32065814/2094

Methadone maintenance for HIV positive and HIV negative patients in Kyiv: acceptability and treatment response. 

Dvoriak S, Karachevsky A, Chhatre S, Booth R, Metzger D, Schumacher J, Chychula N, Pecoraro A, Woody G. 

Drug Alcohol Depend. 2014 Apr 1;137:62-7. doi: 10.1016/j.drugalcdep.2014.01.008. Epub 2014 Jan 30. PMID: 24548802; PMCID: PMC3985084.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985084/

Opioid Agonist Treatment and Improved Outcomes at Each Stage of the HIV Treatment Cascade in People Who Inject Drugs in Ukraine. 

Mazhnaya A, Marcus R, Bojko MJ, Zelenev A, Makarenko I, Pykalo I, Filippovych S, Dvoriak S, Altice FL. 

J Acquir Immune Defic Syndr. 2018 Nov 1;79(3):288-295. doi: 10.1097/QAI.0000000000001827. PMID: 30312275; PMCID: PMC8215524.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215524/

МІНІСТЕРСТВО ОХОРОНИ ЗДОРОВ’Я УКРАЇНИ

Міністерство охорони здоров’я України у зв’язку з введенням з 24 лютого 2022 року воєнного стану в Україні відповідно до Указу Президента України від
24.02.2022 No 64/2022, з метою забезпечення безперервності надання медичної допомоги особам із психічними та поведінковими розладами внаслідок вживання опіоїдної залежності в умовах військової агресії Російської Федерації, повідомляє. (МІНІСТЕРСТВО ОХОРОНИ ЗДОРОВ’Я УКРАЇНИ. 25.02.2022)

Ukraine_OST_in_emergency_situations-ukrain

Ukraine. Opioidsubstitution in Notsituationen

Gesundheitsministerium der Ukraine zur Sicherstellung der Kontinuität der medizinischen Hilfe für Personen mit psychischen und Verhaltensstörungen infolge der Opioidabhängigkeit, 25.02.2022 (Deutsche Übersetzung: DeepL-Übersetzer)

Ukraine_OST in emergency situations-de

The Global State of Harm Reduction 2020

Ukraine und Opioidabhängigkeit: Tabelle auf Seite 82 und Kapitel zur TBC-Prävalenz, Seite 56-57

HRI – Harm Reduction International, 2021

https://www.hri.global/files/2021/03/04/Global_State_HRI_2020_BOOK_FA_Web.pdf

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review. 

Melo JS, Mittal ML, Horyniak D, Strathdee SA, Werb D. 

Subst Use Misuse. 2018;53(9):1558-1570. doi:10.1080/10826084.2017.1416404

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033671/

Russia's ban on methadone for drug users in Crimea will worsen the HIV/AIDS epidemic and risk public health. 

Kazatchkine M. 

BMJ. 2014 May 8;348:g3118. doi: 10.1136/bmj.g3118. PMID: 24812004.

No abstract available

https://pubmed.ncbi.nlm.nih.gov/24812004/

Association of patterns of methadone use with antiretroviral therapy discontinuation: a prospective cohort study. 

Bach P, Wood E, Dong H, et al.

BMC Infect Dis. 2015;15:537. Published 2015 Nov 19. doi:10.1186/s12879-015-1255-7

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653887/

Sovereign Rules and Rearrangements: Banning Methadone in Occupied Crimea. 

Carroll JJ. 

Med Anthropol. 2019;38(6):508-522. doi:10.1080/01459740.2018.1532422

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536354/

Ukraine. Mass Deaths in Crimea as Russia Bans Methadone

Soon one year will have passed since Russia’s annexation of Crimea. I remember it well: March 16, 2014. What happened next caused a lot of distress for everyone in Crimea. Life was upended, from the invalidation of our passports to the loss of land rights to the introduction of a new currency. But for people who use drugs, the annexation and its aftermath unfolded like a nightmare. Under Russian rule, the life-saving treatments of methadone and buprenorphine were abruptly taken away. (OSF, 17.02.2015)

https://www.opensocietyfoundations.org/voices/mass-deaths-crimea-russia-bans-methadone

Ukraine. Krim-Krise bedroht auch Substitutionsbehandlung für mehr als 800 Patienten

Bei einem Anschluss der Halbinsel Krim an Russland wären Präventions- und Behandlungsprogramme für Drogengebraucher in Gefahr. (DAH, 17.03.2014 (!))

https://www.aidshilfe.de/meldung/krim-krise-bedroht-substitutionsbehandlung-fur-mehr-800-patienten

Patterns of harm reduction service utilization and HIV incidence among people who inject drugs in Ukraine: A two-part latent profile analysis. 

Ompad DC, Wang J, Dumchev K, et al. 

Int J Drug Policy. 2017;43:7-15. doi:10.1016/j.drugpo.2016.12.008

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714049/

"Bureaucracy & Beliefs": Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine. 

Bojko MJ, Mazhnaya A, Makarenko I, et al. 

Drugs (Abingdon Engl). 2015;22(3):255-262. doi:10.3109/09687637.2015.1016397

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831711/

Treating opioid dependence with extended-release naltrexone (XR-NTX) in Ukraine: Feasibility and three-month outcomes. 

Makarenko I, Pykalo I, Springer SA, Mazhnaya A, Marcus R, Filippovich S, Dvoriak S, Altice FL.

J Subst Abuse Treat. 2019 Sep;104:34-41. doi: 10.1016/j.jsat.2019.05.008. Epub 2019 May 10.

PMID: 31370983 Free PMC article.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215516/

Effect of expanding opioid agonist therapies on the HIV epidemic and mortality in Ukraine: a modelling study. 

Tan J, Altice FL, Madden LM, Zelenev A.

Lancet HIV. 2020 Feb;7(2):e121-e128. doi: 10.1016/S2352-3018(19)30373-X. Epub 2019 Dec 23.

PMID: 31879250 Free PMC article.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289179/

The real-world impact of dosing of methadone and buprenorphine in retention on opioid agonist therapies in Ukraine. 

Farnum SO, Makarenko I, Madden L, Mazhnaya A, Marcus R, Prokhorova T, Bojko MJ, Rozanova J, Dvoriak S, Islam Z, Altice FL.

Addiction. 2021 Jan;116(1):83-93. doi: 10.1111/add.15115. Epub 2020 Aug 9.

PMID: 32428276 Free PMC article.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674222/

Perspectives of clients and providers on factors influencing opioid agonist treatment uptake among HIV-positive people who use drugs in Indonesia, Ukraine, and Vietnam: HPTN 074 study. 

Kiriazova T, Go VF, Hershow RB, Hamilton EL, Sarasvita R, Bui Q, Lancaster KE, Dumchev K, Hoffman IF, Miller WC, Latkin CA.

Harm Reduct J. 2020 Oct 1;17(1):69. doi: 10.1186/s12954-020-00415-x.

PMID: 32998731 Free PMC article.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528574/