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Ukraine: A Sad Story from The Life of the Substitution Therapy Patient

Maryna Reshetnyak — Mon, 06 Feb 2012 22:26:35 +0000

Recently two Ukrainian bloggers focused on harm reduction issues. Livejournal users depo3p and zpt_users reposted a story of a patient of the opiate replacement therapy (ORT) from the town of Shostka. The patient appeared to be in a serious trouble, and despite that fact the main reason of the problem was his behavior, the other patients did everything they could to help him.

The story was first published by the blogger vovan9619. He posted:

День добрый Всем !!! Хотелось бы поделиться некоторыми новостями,касаемо Сайта ЗПТ и его Участников.. Есть у нас (в Шостке) такой вот Лёша..На программе он вместе с Женой. Имеют маленькую …. Около года принимал препарат Он , чуть меньше-его жена.. Около двух недель назад,пропустив один день выдачи(по своим причинам..) он пришёл на сайт,через час после его закрытия. Будучи пьяным,он не понимал-почему ему не выдают препарат. Старшая медсестра-отказала в выдаче,.. Тогда он не отдавая себе отчёт в поступке-схватил её за горло и стал душить.., На следующий день,его исключили из программы, мало того-ст.медсестра,написала заявление на него,обвинив в побоях(..??)

Good day to everyone. I just wanted to share the news concerning our ORT site and the patients. There is a guy Lesha in our town, He attends the program together with his wife. They have a little daughter …He is on medications for about a year, and his wife just a little bit less. A couple of week ago he missed the business hours of the site (for his own reasons) and came to the site one hour after it was closed. He was drunk and could not understand why he can not receive the medicine. The senior nurse refused to give it to him. Then he started to strangle her not understanding what he was doing … next day he was expelled from the program and the nurse filed a report accusing him beating her.

In a few days the other patients of the ORT site started to worry about Lesha and his wife and decided to visit him. They found Lesha in a very bad condition, drunk and with severe abstinent syndrome. They decided to help him. Vovan9619 wrote:

В-общем провели с ним беседу,где он клятвенно пообещал-прекратить Пить и извиниться перед медсестрой. После чего было написано ходатайство глав.врачу, с просьбой восстановить его на Программе ЗПТ.. Глав.врач-подписал ходатайство,и спустя несколько дней,-Лёшу восстановили. …. В кругу Тех Людей,кто за него поручился-Лёша клятвенно пообещал не приходить на сайт-в нетрезвом состоянии,зная о том,-что может за ЭТО,получить “по ушам”-от Своих же,которых он может подвести… А мораль сей Истории такова;- ЗПТ и Алкоголь(даже - пиво !!!..)- НЕСОВМЕСТИМО !!!!

So we talked to him and he swore that he would stop drinking and apologies to the nurse. Than we submitted the appeal to the head doctor asking to renew him into the ORT program – and the doctor agreed to do this and in few days Lesha was renewed into the program. ….Lesha promised that he will never come to site drunk again to people who were like him. And he knew that he could be punished by these people and he could not let this people down. And the moral of this story is – ORT and alcohol (even a beer) are not compatible!!!!

After a few days the bloggers posted the second part of this story and it was not a story with a happy and. Vovan9619 posted:

Участник ЗПТ “ЛЁША ВАЩЕНКОВ”, благодаря тому что его все участники ЗПТ взяли на поруки и человеческому отношению главврача Орищак Н.С. Был возвращён на программу ЗПТ. Но … его здоровье было на столько подорвано, что он первый день еле пришел, второй день его привела мать. Лёша реально бредил , по всему видно, что очень БОЛЬШИЕ проблемы со здоровьем. Это не могли не заметить “наши” врачи из сайта и поэтому в срочном порядке он был направлен ….на второй этаж (стационар наркологии). Его осмотрел врач-нарколог … и .. определил, что ему нужно срочное обследование ХИРУРГА! Через 10 мин он уже был у хирурга, (рядом 50 метров поликлиника №1) Хирург в СРОЧНОМ порядке направил Ващенкова Лёшу в приёмное отделение ЦРБ г. Шостка.
НО, КАК ТОЛЬКО УЗНАЛИ ,ЧТО ОН НАРКОМАН, ЕМУ ОТКАЗАЛИСЬ ДЕЛАТЬ ОПЕРАЦИЮ, О НЕОБХОДИМОСТИ КОТОРОЙ, САМИ ЖЕ И ГОВОРИЛИ!
Лёше становилось все хуже , да и мать начала плакать и умолять врачей о помощи… НО, на , что они решились под этим натиском-направить его почемуто в ТЕРАПЕВТИЧЕСКОЕ отделение. Где он в … УМЕР В ТЕЧЕНИИ ДВУХЧАСОВ!

Because of the efforts of the other patients and human attitude of the chief doctor N.S. Orishchak, the ORT patient ‘Lesha Vashchenkov’ was renewed into the ORT program. But his health was so weak that during the first day he could hardly walk and on the second day his mother brought him to the site. He had delusions and it was obvious that he had very serious health problems. The doctors from our site noticed this and sent him … to the second floor (narcology hospital). The narcology doctor examined him and … said that he needed urgent assistance of a surgeon! In 10 minutes he was in a surgeon’s office (the policlinic #1) is within 50 meters from the office. The surgeon urgently sent Vashchenkov Lesha to the Central Regional Hospital of Shostka.

But when doctors of the hospital learned that he is a drug addict they refused to do the surgery which they insisted on before!

Lesha was feeling worse and his mother started crying and begging the doctors to help, but they decided to send him for some reasons to the therapy department where he died within 2 hours.

The patients were sure that the main reasons of the death of his counterparts was stigma towards people living with the drug addiction from he medical personnel. They established the initiative group to attract the attention of the society to their problems and, as they wrote, “to stop the conveyor of deaths”.

Ukraine: Harm Reduction Activists Report Small Accomplishments

Maryna Reshetnyak — Sat, 26 Nov 2011 21:24:26 +0000

The work of the activists of the Association of Substitution Therapy Treatment of Ukraine is focused on making the lives of the patients of opiate replacement therapy more comfortable, helping them to better integrate back into society. The major problem the substitution therapy patients face today in Ukraine is the fact that the only place where they can receive a medication are special sites where patients have to come every day personally.

Because of the efforts of the Association and other harm reduction NGOs with the support of international organizations, the situation in this area started changing for better gradually. Blogger Viktoria Lintsova reported positive changes in her city of Kirovograd where patients started receiving Methadone in regular hospital. At the middle of October Viktoria posted that the regional health care authorities adopted a new regulations allowing patients to receive opiate replacement medications in other medical establishments. Victoria was very grateful to the Association for the support it provided in this regards. She wrote:

.. сие событие стало возможным благодаря тому, что в Кировоградский облздрав было подано обращение от Ассоциации в начале июня этого года. Затем был визит технической поддержки нашего специалиста по развитию регионов Алексея Загребельного, во время которого была проведена рабочая встреча с нашим областным наркологом по вопросу беспрерывности и разработки областного приказа.

…this became possible because at the beginning of June the Association submitted a special appeal to the regional health care authorities. Then, the regional development specialist Aleksey Zagrebelnyy visited us and provided technical support, he met with the Oblast chief doctor in narcology and discussed the issues of continuity of treatment and new regulations in this regard.

On 11/11/11/ Viktoria reported that this new regulations now work in reality. The first substitution therapy patients started receiving Methadone while staying in a Tuberculoses clinic. She posted:

Одним из наиболее проблемных моментов было лечение ТБ, особенно в случаях с открытой легочной формой - тогда пацинт вообще попадал в замкнутый круг - при открытой форме ТБ больным не разрещается покидать территорию больницы, поэтому необходимость ежедневного посещения сайта ЗПТ ставила человека под угрозу выписки из-за нарушения больничного режима. Кроме того, все усложнялось тем, что противотуберкулезный стационар находится за городом (около 20 км), добираться долго и сложно, и с учетом того, что туберкулезный больной с открытой легочной формой является источником инфекции для других …

[…]

важность беспрерывности при госпитализации несомненна - …, теперь не надо выбирать между лечением и участием в ЗПТ.

One of the biggest problems in TB treatment, especially in its open form, is that the patient appears in a circle. With the open TB form the patients are not allowed to leave the territory of the hospital and the necessity to go every day to the replacement therapy site put them at risk to be kicked out of the hospital for not following the hospital’s regime. Moreover, the TB clinic is located outside of the town (20 kilometers) so it was really hard and time consuming to get there and you need to take into account that a patient with the open form of lungs’ TB is a source of infection for others …

[…]

the importance of continuity of the therapy in the hospital is obvious - …now you do not need to make a choice between a treatment or replacement therapy.

Blogger buprik from Dnipropetrovsk, who is a patient of Buprenorphine substitution therapy, reported that regional health care authorities allowed him and his wife to receive the medications via prescription. Blogger buprik and his wife had more than 20 years of drug addiction experience and a few imprisonments and became the patients of the replacement therapy in 2008. At first they were very happy about the program but later on they were disappointed with certain aspects of it. The way the substitution therapy was provided did not allow them to live a full life, to find a job or to travel. Necessary to go to the therapy site every day for many years had become a real burden for them.

In 2009 the regional health care authorities started a pilot project of provision of Buprenorphine though the prescriptions. At first, only four people were qualified to take part in this experiment but the situation has been gradually changing for better and now 30 our of 50 Buprenorphine patients receive their medications via prescription and the blogger buprik and his wife are among them.

Buprik posted:

Что для нас рецептурная форма выдачи??? ВСЕ!!! Это как глоток свободы за столько лет!!!

Могла ли мечтать моя жена … что пройдет такое время??? Пройдут годы горя и страданий, годы заключения, годы жизни в подполье и постоянном страхе, появяться болезни и вот уже ей не молодой ГОСУДАРСТВО ВЫДАСТ НА РУКИ ТО РАДИ ЧЕГО ОНА СТРАДАЛА И ТЕРПЕЛА ВСЮ ЖИЗНЬ!!!!!!!!!!!!!!!!!! И теперь она хотя бы под конец жизни сможет просто поболеть дома-лежа в постели,съездить туда там где никогда не была, работать там где ей нравиться, и в конце концов стать полноценным человеком общества со свободным перемещением!!! При этом у нее в кармане будет ЖЕЛЕЗНЫЙ ДОКУМЕНТ подтверждающий хранение жизненноважного лекарства с хорошо видной печатью(для слепых мусоров)-РЕЦЕПТ!!! И походка на этот раз у нее будет уверенная …Хотя бы маленькая группа многострадального общества наркопотребителей теперь стала В ЗАКОНЕ!!!

What is it for us the provision of medication through a prescription? Everything!!! This is a first gulp of freedom for so many years!!!

Could my wife even dream …that there will be such time??? That after many years of sorrow and suffering, many years of imprisonment, many years of leaving in fear the government will give her, not young and healthy lady the thing for which she has been suffering her entire life!!!!! And now at the end of her life she could just spend a few days home in a bad when she is sick and visit places she had never been before, to work where she likes and became a full member of the society with freedom of movement!!! While she has a DOCOMENT in her pocket proving the presence of the necessary medication with big visible stamp (for blind cops)- A PRESCRIPTION!!! And now even her walk will be confident…At least a small group of long-suffering community of drug users has become LEGAL!!!!

Ukraine: Finding Comfort and Advice in a Forum

Maryna Reshetnyak — Mon, 14 Nov 2011 03:06:59 +0000

Upon first glance, the discussion board of the web-site Motilek.com.ua run by Ukrainian non-profit organization and Rising Voices grantee the Drop-in Center looks exactly like any other discussion boards: a typical interface with a list of topics to discuss. The main purpose of the board is that it unites people living with drug addiction, which makes it another alternative for citizens to have conversations about the topic.

Drop-in Center Activists

Forum members of the on-line community discuss the sometimes controversial issues affecting their lives, such as how to quit drugs without starting to use them again, and why it is so hard to accomplish that, which rehabilitation program to choose, health and employment problems typical for people living with drug addiction. Forum member Omela-X asked for advice in how to find a job for her husband who is a Methadone substitution therapy patient with HIV, Hepatitis C, and three imprisonment records.

Forum member Mazay believed that the best area of employment for such person is to work in a non-profit organization to help people in similar situations. Mazay wrote:

Однозначно - только в общественной организации. Для начала надо найти силы и какое-то время зарекомендовать свою “нужность” - быть волонтёром. Только так начинается трудовой путь у большинства наркозависимых, кого жизнь потрепала не балуй как…

Я (к слову, имея почти весь набор перечисленных вами “регалий”=)))) , в 44 года пошел “стажером аутрич работника по обмену шприцев”. Через 2 месяца мне стали доверять самостояльно работать - менять шприцы на маршруте. 2 час дорога на работу и обратно, 2 часа работы и 2 часа на “собрания” - 16 грн./день . Этого хватало на проезд, хлеб, сигареты и банку килек. И я был счастлив. Потому что всегда есть,с чем сравнивать….

[…]

Банальщина, но свидетельствую - отдавая другим, ты обретаешь вдвойне…
Прости долги, верни долги и начинай с читого листа.

For sure he should go to a non-profit organization. At the beginning, he will need to make an effort and prove his usefulness – to become a volunteer. This is a typical beginning of a new career for the majority of drug addicts who have seen much troubles in their previous lives. ..

I, myself (by the way, I also have almost the entire set of ‘regalia’ you mentioned) at 44 started as an outreach intern in needle exchange. In two month, I was trusted to be responsible for exchanging needles on a certain route. I spent 2 hours to get to the place and 2 hours to get back, 2 hours of work and 2 hours for ‘packing’ – 16 hryvnias for everything [$2]. It was enough to pay for the bus, for bread, cigarettes and a can of fish…But I was happy, because I had something to compare with….

[…]

It might sound banal but I can swear – when you give something to others, you gain twice as much. So forgive your debts, pay your credit, and start from scratch…

In the harm reduction section, the forum members discuss issues from how to live after completing rehabilitation to how to reduce harm to health if a person continues injecting drugs.

Here on the discussion board, friends and relatives of drug addicts can obtain firsthand consultations on how they can help their loved ones to get out of the addiction. Forum member Nasty posted a story that a few months ago her boyfriend became addicted to opium. Although the boyfriend claims that he quit drugs, Nasty has some concerns in this regards; she is afraid of HIV and her boyfriend recently became very rude, but she believes that if she leaves him, he will for sure return to the drugs. She asked the on-line community for an advice and here is what the community suggested.

Forum member SD posted:

Привет, соскочить реально, но в последующем удержаться сложно..((
Отчаиваться не стоит, если остались отношения, борись.. “нет” - меняй пока не поздно свою жизнь..
У самого были такие качели, во время самой спрыжки и движения, отношения идут на второй план..((
Помни, самопожертвование должно быть оправдано..

Hello, it is realistic to quit, but it is very hard not to start again. Do not be desperate, if you still have relationships, than fight, if not – then change your life until is not too late…

I also went through such swings, when you are on drugs or trying to quit, relationships are not a first priority…

Remember, self-sacrifice should be justified.

Forum member Gipertonik has another opinion. He wrote:

Если он говорит правду про срок употребления, то ещё не всё потеряно!!! Есть масса примеров кто проторчав меньше года, бросают это навсегда!!! А если он стремиться покончить с наркотиками, ты ему обязательно помогай и ни в чём не упрекай, а то что он срываеться на тебя это нормально, после этой дряни психика подорвана ( это со временем пройдёт) ИМХО если увидишь в далнейшем рецидив, бросай!!!

If he tells the truth about the addition then everything is still possible!!! There are many cases when those with a drug experience of less than a year quit drugs forever!!! And if he really is serious about giving up the drugs, than you need to support him and not to blame him, the fact that he is rude is also normal, this trash ruins the psyche (it will disappear with time) IMHO, if he will return to drugs in future – just leave him!!!

The discussion board also contains a memory book where the community’s members post stories in memory of their friends who have passed away because of drugs. Often the memory records mention young people who had just recently posted something on the discussion board. This is how the community reacted on death of the member Fibi. After Fibi’s mother, who was also a member of the discussion board, posted that the daughter had passed away forum member Sweet Dream wrote:

Очень жалко фиби, она была первой с кем я здесь начал общаться, всё хотела к нам с Игорьком приехать да не судьба

I feel really sorry for Fibi, she was the first one who I met here, she always wanted to visit me and Igor, but, perhaps, it was not in her fate

Forum member Zhdanov posted:

ЭТО ВСЕМ НАМ ТОРМОЗ .ВКЛЮЧАЕМ А ТО СКОРО УВИДИМ ФИБИ .ЗЕМЛЯ ЕЙ ПУХОМ

This is a sign to all of us to step on the brakes; otherwise we will meet Fibi very soon. Let the earth be gentle to her

Ukraine: A Healthy Debate in the Comments Section

Maryna Reshetnyak — Wed, 26 Oct 2011 19:00:41 +0000

Recently, a popular Ukrainian internet website Ukrayinska Pravda [ru] published a lengthy article criticising opioid replacement therapy (ORT) programs. The article led to a huge discussion among readers on whether or not Ukraine needs harm reduction programs.

The author of the article, journalist Yuriy Potashniy argued that the promotion of the opiate replacement therapy is actually an attempt by pharmaceutical corporations to take up the drug market. He considered substitution therapy to be a form of drug legalization, when criminal drugs are replaced with medical ones. Another issue that the journalist raised was the funding problem. As for now, harm reduction programs are implemented with the financial support of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, but in the future they would become a burden for the Ukrainian state budget. According to Mr. Potashniy, in most of the countries the Methadone programs have been cut back because Methadone has been proven to be even more harmful and caused more deaths than heroin.

Photo by Deepfruit and used under a CC BY-NC 2.0 license.

Among the 146 comments posted by the readers, there were voices who shared the opinion of the author, as well as those who strongly disagreed with him.

The reader “duty” pointed out that despite of some negative consequences, substitution therapy programs have many positive features which were totally ignored in the article. The reader wrote:

Я повністю підтримую ЗПТ, й якраз з позиції зменшення шкоди… для здорової частини суспільства:
1. ЗПТ дозволяє (певною) декриміналізувати наркоманію, надавши легальне джерело безкоштовного наркотику; таким чином виводячи наркозалежного з кримінальної сфери;
2. ЗПТ дозволяє не роботи ін”єкцій, отже зменшується ризик поширення специфічних інфекцій зараженим наркозалежним або його інфікування;
3. ЗПТ дозволяє певною мірою контролювати та обмежувати повсякденну поведінку наркозалежного (це називається ре-соціалізація).
[…]

…(ЗПТ) не призначають здоровим людям. Пацієнти ЗПТ ВЖЕ приймають наркотики

I fully support the ORT programs, as they allow for reducing harm …for the healthy part of the society:

ORT helps to decriminalize drug addiction by providing the opportunity to legally receive drugs free-of-charge, thus, taking a drug user away from a criminal sphere;
ORT allows (to some extent) to stop the injection of drugs, thus, reducing the risk of spreading out of infections which are typical for drug users;
ORT allows (to some extent) to control and to limit the behavior of a drug user (it is called re-socialization)

[…]

…ORT is not – prescribed to healthy people. ORT patients are ALREADY drug users…

The reader “viliam3″ supported the position of the author of the article. The reader's idea was that because it was a personal choice of people to start using drugs, then they have to bare full responsibility for the consequences. He posted:

Товарищи наркоманы, бывшие, настоящие, “лечащиеся” на ЗПТ! Вы когда начинали нюхать-колоться и далее воровать, вести асоциальный образ жизни - так Вы ни минуты не думали, что это может привести Вашу жизнь в пропасть?!? Тогда Вам было нормально, все шло путем, а сейчас с пеной у рта доказывают какие они болящие, им бедолагам нужен метадончик, не закрывайте наши ЗПТ…тьфу! ВЫ САМИ СЕБЕ СОЗДАЛИ ТАКУЮ ЖИЗНЬ!

My dear friends, drug users, former, present, and those who are ORT patients. When you have started to ‘sniff’ or ‘inject’ and then to steal, and to have an anti-social lifestyle – why did not you think back that this might ruin your life? Everything was good for you back then, but now you are screaming that you are sick, you poor little things need Methadone, do not close our ORT…pah!. YOU CREATED THIS LIFE YOURSELF!

In contrast, a reader “Victoria21″, opposes substitution therapy programs for their lack of a humanistic approach. She is concerned that Methadone treatment does not lead to full rehabilitation from drug addiction. She wrote:

И самое опасное во всем этом , что больному человеку не оставляется шанса на выздоровление, так как срок лечения метадоном – пожизненно, при этом длительность жизни резко укорачивается.

[…]
P.S Дорогие врачи! Помните что вы давали клятву помогать людям, а не губить их, раздавая наркотики под видом лекарства!

The most dangerous part is that the sick person does not have any chance for recovery, as the treatment by Methadone lasts for one's entire life, meanwhile the life of the patient is reducing significantly.

[…]

P.S. Dear doctors! Remember that you took the Hippocratic Oath to help people, but not to harm them by giving out the drugs in the guise of treatment.

The reader Yevgeniy Selin was among ORT supporters. He questioned Mr. Potashniy's statement concerning the reduction of the substitution therapy programs in the world and commented on the financial implications of harm reduction programs. He wrote:

Люди противники ЗПТ , как вы не можите понять то ,что программы Заместительной терапии входят в принятые по всему миру программы Снижение вреда от наркотиков рекомендованные Всемирной организацией здравоохранения и ООН работают они почти по всему миру включая такие страны где до недавнего времени были наказания за употребление в виде тюрьмы но эти страны как Иран и Китай поняли что так бороться с наркотиками нельзя, … наркозависимый обходится всего в 7 $ в месяц государству при программах ЗТ , а если человек употребляет наркотики то вреда от него в десятки раз больше : их нужно содержать в тюрьмах, лечить от кучи болезней которые они переносят еще и обычным гражданам (туберкулез, ВИЧ , гепатиты ), содержать целую армию милиции которой нужно платить зарплату …

To those people who argue against ORT, why can't you understand that substitution therapy programs are accepted all over the world as a part of harm reduction programs recommended by the World Health Organization and UN and they work well all over the world, including countries where until recently, drug addiction was punished with imprisonment. Even countries like China and Iran realized that you cannot fight drugs in this manner …. Under the ORT program, a drug addict's cost to the government is only $7 a month, but if people take street drugs the cost of harm is ten times higher - you need to keep them in the prisons, provide treatment from various diseases which can be transferred to ordinary citizens as well (TB, HIV, Hepatitis), you need to keep an huge number of police and pay them a salary..

The leader of the Rising Voices grantee project the Drop-in-Center, Pavel Kutsev commented on this article in his blog [ru]. He noted that the huge online discussion in the comments section of the article is a good indicator of a positive impact of ORT, since now people living with drug addiction are involved in civil society and advocating for their rights. He wrote:

Я бы ограничился отметкой факта повышения, очевидного повышения интерактивности защитников ЗПТ, как правило, состоящих из прогрессивных специалистов и людей, живущих с наркозависимостью, что само по себе является наилучшей иллюстрацией несомненной пользы заметстительной терапии - именно благодаря ЗПТ .. в стране наблюдается … активизация представителей гражданских сообществ (ещё недавно маргинальных)…

I just want to highlight how active the ORT supporters are, and most of them, in fact, are progressive people and people living with a drug addiction, this is a best illustration of the obvious usefulness of the substitution therapy. Thanks to ORT we can observe a rise of activity in civil communities (which were marginalized before)…

Ukraine: ASTAU Adds Blogging Workshop for Members

Maryna Reshetnyak — Mon, 17 Oct 2011 00:07:41 +0000

The Association of the Substitution Treatment Advocates of Ukraine (ASTAU) was created in 2009 and currently unites harm reduction activists from almost all the regions of Ukraine. The Rising Voices grantee project the Drop-In Center is part of this association. Most of the members are people who live with drug addiction and who are patients of opiate replacement therapy. The goals of the Association are to fight against stigma and discrimination of people living with drug addiction, to promote the idea of substitution therapy in Ukrainian society thus, reducing the spread of HIV/AIDS, TB and Hepatitis C epidemics. The Association advocates for the interests of the patients of opiate replacement therapy in government and health care authorities and provides various kinds of support to its members. In 2011, members of the ASTAU have taken part in a number of citizen media workshops as a way to share their personal stories. The activists of the association consider blogging to be a very effective tool to achieve some of these goals.

2nd ASTAU ConferencePoster, photo from ASTAU web-site

In our e-mail interview with the head of the Association, Olga Beliayeva talks about why the Association was established and how it helps its members. She also discusses how citizen media has helped in promoting the idea of substitution therapy in Ukraine and how blogging could help the replacement therapy patients to better express themselves.

Answering a question on the history of the Association, Olga said:

Идея родилась на одном из тренингов в Днепропетровске, когда утром пациенты ЗПТ из других городов получали лекарство на нашем сайте. Сразу же завязались жаркие разговоры о самых волнующих темах в жизни каждого, чье спокойствие зависит от приема лекарств. Люди не могли поверить в то, что в нашем городе работают и рецепты и беспрерывность. Изначально мы создавали Ассоциацию, чтобы закрепить достижения Днепропетровска по всей Украине. Вот так мы увидели, сколько людей готовы учиться и работать, чтобы изменить свою жизнь.

The idea of the Association was generated during one of the training sessions in Dnepropetrovsk when one morning, the patients from other cities came to our site to receive a medication. We started a hot debate on topics of concerns for people whose well-being depends on daily intake of a medication. The people could not believe that in our city, both the provision of medication through a pharmacy and continuity of [Methadone] treatment while staying in a hospital exist. So, originally we created our association to spread good practices throughout Dnepropetrovsk and in other regions of Ukraine. Then, we realized how many people are ready to work to change their lives for the better.

Olga also talked about the association's accomplishments:

Когда есть где собирать и обобщать опыт, единичные случаи выстраиваются в стройную систему. Люди видят свои победы и что их усилия не напрасны. А кто еще разделит радость, как не такой же как ты сам. Только за сентябрь в двух регионах участники ЗТ добились обеспечения беспрерывности лечения и это вдохновляет других не жаловаться, что все плохо, а действовать самому, делая свою жизнь комфортнее и спокойнее.

When there is a platform where you can collect and summarize the experiences, the single fact transforms into a logical system. The people see their victories and understand that their efforts bring results. And the best way to share your happiness is to share it with like-minded people.

Sharing these experiences with like-minded, as well as those that may not agree with their mission are some of the reasons why the ASTAU added citizen media to the programs offered to its members. The ASTAU website has a section where each member can start his or her own blog. Those activists who were interested in becoming a citizen journalists could participate in a special training in on-line story telling. Talking about why blogging is important for the patients, Olga said:

Блоги могут быть исключительно полезны для формирования внешнего имиджа пациентов ЗПТ. Например, пишет журналист материал, гуглит и выходит на блог и видит не отписки чиновников, не умные слова медиков, а реальных людей, которые пишут о своих проблемах и их решениях, о радостях и печалях. А если блог тематический, как в нашем случае, комментарии могут оказаться весьма полезными. И для самого блогера дневник – это возможность посмотреть на себя со стороны. Что задумывал, чего добился, своеобразная социальная интерент-терапия.

Blogs can be very useful for forming a positive image of patients of substitution therapy. For example, a journalist working on an article uses Google finds a blog where he can read not just official documents or ‘smart’ words of doctors, but words of real people who post about their problems, ways to solve them, their joys and sorrows. If a blog follows a particular topic, then even comments to a blog posts could be very useful. Having a blog gives the patients an opportunity to look at themselves from a different angle, to post on a diary what was planned, what was achieved, so it is a sort of social Internet therapy.

Ukraine: Bloggers React to the Detention of Activist

Maryna Reshetnyak — Thu, 15 Sep 2011 14:31:21 +0000

It the middle of August, the Ukrainian harm reduction community was very disturbed with the detention of Russian activist Irina Teplinskaya. Russian web-media reported [ru] that Irina was detained by police at the airport of her home city of Kaliningrad accused of drug smuggling. Law enforcement claimed that one pill of Methadone was found in her luggage. Irina stated that these drugs were planted on her. Irina was flying from Kiev, Ukraine where she went through a course of rehabilitation.

Irina Teplinskaya, photo is taken from Andrey Rylkov Foundation web-site and used under Attribution 3.0 Unported (CC BY 3.0)

Irina is a well-known human rights leader who fights for rights of Russian people living with drug addiction to have access to Methadone substitution therapy. Irina is one of the leaders of the Andrey Rylkov Foundation for Health and Social Justice and is a member of the Steering Committee of the Eurasian Harm Reduction Network.

Irina openly admits that she has been living with drug addiction for more than 30 years. Her life story was shared in her speech , which can be found on the Rylkov Foundation blog, during the International Harm Reduction Conference in Beirut in April 2011. Growing up in a well-off Soviet family, Irina started using drugs when she was 14. Many times she tried to quit but without much success. For drug-related crimes, she spent approximately 16 years in prison. Though the use of unsterile syringes, she became infected with HIV, TB and Hepatitis C. After receiving treatment in a TB hospital, she started aid work helping other TB and HIV infected people living with a drug addiction.

Irina sees her main goal in forcing Russian government to permit the opiate replacement therapy which is recommended by UN and which is effectively used in all developed countries all over the world. Advocating introduction of substitution therapy in Russian, Irina repeatedly appealed to various courts of Russian Federation as well as the European Court for Human Rights. In 2010, Irina submitted a claim to the UN Special Rapporteur for the right of everyone to enjoy the highest attainable standard of physical and mental health. Irina was among those NGO leaders who met with the High Commissioner for Human Rights Navanethem Pillay during her visit to Russia in February 2011.

Irina with UN High Commissioner for Human Rights, photo from Andrey Rylkov Foundation web-site and used under Attribution 3.0 Unported (CC BY 3.0)

Ukrainian blogger from the Rising Voices grantee project the Drop-In Center Pavel Kutsev commented on Irina’s detention and analyzed what implications it might have on the substitution therapy programs in Ukraine. Pavel was particularly concerned that the detection of an entire pill of Methadone might make medical personnel return to the practice of grinding the pills into a powered before giving to the patients. This practice was abandoned a couple years ago after protests of harm reduction activists. Pavel wrote:

Очень трудно быть объективным, когда происходит нечто международно-скандальное, изначально мутное… Известную активистку Иру Теплинскую, которая ещё недавно проходила в Киеве курс лечения задержали на томожне с РФ прямо в Калининградском а/п и теперь выдвигают обвинение… в контрабанде наркотиков.

Внимательно отслеживая все обсуждения этого инцендента, пока могу поделиться только одним неутешительным выводом … для оппонентов ЗПТ появлись достаточно весомый аргумент.
Если из Украины можно вывезти наркотический препарат применяемый исключительно в программах заместительной терапии …, то его происхождение можно (и, увы, не без оснований) истолковать только одним - утечка в нелегальный оборот наркотиков используемых в исключительно медицинских программах ЗПТ - не такой уж и “единичный случай”…
[…]
Остается надеяться, чтобы не началось закручивание гаек со стороны МВД в самой Украине. Дескать, вообще уже охренели - сайты дырявые, а этот грёбанный метадон даже закордон “гуляет”. И примут “меры”.
И мы помним эти меры - дробление в порошок, кипяточек… Неужели то, чего мы с таким трудом добивались - своё право на получение препарата без нарушения его целостности, теперь может снова кем-то оччень умным поставиться “под сомнение”… Тревожно, однако.

It is hard to be objective when you face something so international, so scandalous, and obviously not transparent…Well-known activist Irina Teplinskay which just went through treatment in Kiev was detained at one of the Customs Control of the Russian Federation at Kaliningrad airport and accused of … drug smuggling.

Carefully following all developments of the incident I can come only to one conclusion – opponents of substitution therapy have now got quite a strong argument.

If you can take medication out of Ukraine … which is used in the replacement therapy only, than it is obvious where it comes from (and this unfortunately makes sense) – so leaking the drugs used in medical substitution therapy into a black market is a fairly common thing.

[…]

We just need to hope that after this the Ministry of Internal Affairs of Ukraine will not start cracking down on us. They might say that you guys went nuts, that the sites definitely have ‘holes’ … Methadone is detained even abroad. And then they might start ‘to take measures’.

And all of us remember these ‘measures’ – grinding the pills into power and mixing with a hot water. Is that what we worked so hard to achieve? Our right to receive the pills as an entire pill, can now be questioned again? I really worry about this….

On September 5^th the web- site of the Andrey Rylkov Foundation published good news that Irina was released from the prison and her criminal case was closed. This became possible not only because of the good work of her lawyers, but also because of widespread public support.

Photo taken from Andrey Rylkov Foundation web-site and used under Attribution 3.0 Unported (CC BY 3.0)

Blogger Slava from the Association of the Substitution Treatment Advocates of Ukraine (ASTAU)commented on this:

Рад за Ирину Теплинскую

Мня сегодня очень обрадовала ссылка,что дело в отношении Ирины прекращено.И по этому поводу решил черкануть в блоге.Так на душе приятно что полицаи Калининградские сломали свои зубы-клычища которыми хотели укусить Ирку.

Ведь понятно что кто-кто а Ира человек который всегда на чеку,и с такой ерундой не в жизнь бы не решилась пересекать границу.Слава Богу что все обошлось!!!

I am very happy for Irina Teplinskaya. I was very glad when I have read the news that the criminal case against Irina has been closed. So I decided to write about this on my blog. My heart feels warm when I realize that Kaliningrad police ‘cracked their teeth’ on Irina’s case.

It was obvious that such an experienced and careful person such as Irina would never decide to cross the border with the pill. Thank God that everything is fine now.

Ukraine: The Pluses and Minuses of Harm Reduction

Maryna Reshetnyak — Mon, 22 Aug 2011 04:50:39 +0000

How does substitution therapy change the life of people living with drug addiction? Bloggers from the Association of Substitution Treatment Advocates of Ukraine (ASTAU) [ru] use their blogs to share their personal and firsthand life's stories.

Blogger Viktoria Lintsova has been a patient of the opiate replacement therapy for three years. As an activist of the ASTAU, she often represents the Association at various conferences, roundtable discussions, and on television shows where she promotes the ideas of harm reduction programs using her life story as an example of the positive effects that such program has on those on living with drug addictions. In her native city of Kirovohrad, Viktoria established a self-support group which helps replacement therapy patients to overcome common problems together.

In her recent post she analyzes the pluses and minuses of her life as a patient of substitution therapy, and concludes that despite some challenges, her life has significantly changed for better. She wrote [ru]:

Когда необходимость ежедневного посещения сайта ЗПТ вызывает во мне бунт и раздражение, когда я завидую людям, у которых нет медикаментозной зависимости, я вспоминаю ту свою прошлую наркоманскую жизнь, когда заместительной терапии не было, а зависимость была, когда каждое утро надо было в первую очередь обеспечить себе возможность нормального самочувствия, т.е. - очередную дозу….

When I feel angry and annoyed because I have to visit the substitution therapy site everyday, and when I envy people who live without a dependency on medication, I recall my life as a drug addict, when I did not have the substitution therapy, but instead had a drug addiction. Every morning I had to secure a ‘good feeling’ for myself, meaning to find a dose of drugs.

Viktoria shared a story of how she became a drug addict and described her numerous attempts to overcome the dependency. She blogged:

Заложницей “кайфа” я стала в 1994 году, тогда я попробовала наркотик впервые, и он сразу на долгие годы стал моим навязчивым спутником. Уже через несколько месяцев я была “в системе”, т.е. опиаты ввошли в метаболизм моего организма ( это на физическом уровне), а что происходит в душе употребляющего наркомана, я думаю, полностью способны понять только наркопотребители - эти тяжелые чувства, которые сопровождали мое употребление… . Вина, страх, смятение, отчаяние, и самое тяжеловыносимое - ненависть к себе,ведь необходимость поддерживать употребление вынуждала совершать такие поступки, за которые стыдно, порой, даже через много лет. Сейчас даже и сосчитать трудно, сколько раз я пыталась себя преодолеть, перекумаривалась “на сухую”, лечилась в психиатрии и наркологии, уезжала в другой регион и даже в другую страну - и в итоге - проблема зависимости от наркотиков сопровождала меня всегда, как темная, страшная часть меня, которую я не люблю, но преодолеть не в силах. Каждая попытка лечения, очередной курс реабилитации, заканчивались всегда одинаково - срыв, возврат к активному употреблению, отчаянье, самобичевание, страдания близких мне людей, горькое одиночество человека, захлопнувшегося в капкане …

В периоды ремиссий мечтала всегда об одном - чтоб так было всегда, чтоб можно было жить и не колоться, смотреть на мир - и радоваться, исправить ошибки прошлого, восстановить все то, что разрушил наркотик. …

I became a ‘hostage of kef (high)’ in 1994, when I tried drugs for the first time and they immediately became my ‘close friends’ for many long years. Just in a few months I had become an addict, meaning that the opiates had become a part of the metabolism of my body (on a physical level), and only drug users could understand these terrible things that were going on in my mind… A sense of guilt, anxiety, despair, and what was the hardest was that I hated myself because of the necessity to find drugs which made me commit such acts which I am ashamed of even after many years. It is hard to count how many times I tried to overcome the addiction by trying not to use drugs, I went though treatment with narcology doctors and psychiatrists, I moved to a different region, and even to a different country, but my problem of drug addiction was with me all the time as a dark and scary part of me, which I hated but was not able to change. Every new attempt of treatment and rehabilitation ended in the same way – with failure and a return to active drug usage together with despair, self-flagellation, suffering of my loved ones, and sad loneliness of a person who finds one's self in a closed trap.

During the periods of remission, I had dreamed about only one thing – to live like this all the time, without drug injections, to look at this world and be happy, to correct the errors of my past, to renew everything that drugs destroyed. …

Now Viktoria has a new life and she uses every opportunity to defend the substitution therapy concept and to advocate the needs and rights of the patients. She posted:

Третий год участвую в программе ЗПТ,порою чувствую, что очень устала от ежедневных поездок на сайт, от ограничения свободы передвижения ( уехать можно только в тот город, где есть возможность получать “Эднок”),и еще много минусов можно найти, если постараться, но плюс очевиден - и он все перевешивает - можно жить и не колоться! Можно планировать завтрашний день, просыпаться без страха, что нечем раскумариться, ходить по улицам, не боясь милиции, можно наконец не врать, не прятаться и не бояться!

[…]

И все негативные установки относительно программы ЗПТ, которые распространяются в СМИ, и неграмотные мнения агрессивно настроеных обывателей, и прочие преграды - все это часть нашей борьбы за право жить. За право получать лечение в том виде, который удобен и эффективен для нас. За право выбора…

This is my third year as a substitution therapy patient and sometimes I get really tired from daily trips to the site and limited freedom of movement (I can travel only to the cities where I have an opportunity to receive Ednok [analog of Buprenorphine], actually I can find many more ‘minuses’ but the ‘plus’ is obvious and it outweighs everything – I can live without injections of drugs! I can plan my day for tomorrow, I wake up without fear that I do not have a dose, I can walk along the streets and not be afraid of police, I can live without a lie, I do not need to hide and be afraid of everything!

And all negative statements about the substitution therapy which the media spreads, as well as unprofessional opinions of ignorant and aggressive people and other challenges should be considered as a part of our fight for the right to live. For the right of receiving the treatment in the format which would be convenient and effective for us. For the right of choice…

Ukraine: Substitution Therapy Programs at Home and Abroad

Maryna Reshetnyak — Sun, 07 Aug 2011 02:44:07 +0000

Activist Pavel Kutsev from the Rising Voices grantee project the Drop-In Center has been active in raising awareness about substitution therapy programs in his country of Ukraine. In addition, he has become very interested in how these programs are implemented in other countries around the world. In his blog depo3p [ru], Pavel highlights some of these cases, including a recent conversation with the fellow substitution therapy patient from Israel [ru], who told him:

«У нас в Израиле метадоновые программы стараются избегать. Самая большая вероятность в них угодить, это если попасть в тюрьму. Действительность выглядит примерно так. … помещают в одиночный бокс. При этом стараются создать такие жесткие условия чтобы исключить малейшую возможность передачи наркотиков. А именно – трое суток никаких передач, свиданий, круглосуточное видеонаблюдение. И на протяжении всех этих дней вас проведывает врач и всё время предлагает… метадон. Многие не выдерживают и уже на третьи сутки сдаются. А что остается делать если жуткий абстинентный синдром?

Here in Israel many people try to avoid Methadone programs. The best chance to become a part of the program is when you gets into a prison. …first they put you in a solitary cell. Meanwhile they make sure that you will not get any drugs, and for the first three days you receive no visitors, no packages, 24/7 video control. The only person who visits you every day is a doctor who always offers…Methadone. Many people cannot stand this and give up on the third day. But what else can you do if you suffer from the abstinence syndrome?

Pavel also blogged about the similar situation with substitution therapy in China. Before Methadone therapy was introduced in China, he states that there were informational campaigns conducted to state that opiate replacement therapy was just a substitution of one drug for another. He wrote [ru]:

Общество (в том числе и наркозависимые) со свойственным китайцам прагматизмом усвоили – лучше (дешевле) держать на поводке (контролировать) чью-то вышедшую из-под контроля зависимость, чем терпеть и страдать, подсчитывая потери. Метадоновые программы в Китае (как и в других странах) считаются эффективной альтернативой наказанию. Здесь очень серьёзно эксплуатируют главное свойство метадона (которому у нас почему-то не придают должного значения) – блокирование опиатных рецепторов. Что исключает саму возможность дальнейшего употребления всех других наркотиков опиатного ряда, кроме метадона. То есть – мало того, что сам метадон не обладает эйфоричным потенциалом … , так он ещё и сводит к минимуму ЛЮБЫЕ попытки употребления нелегального героина, опия и проч.пд. Наркозависимый практически лишен выбора. Или отказ от наркотиков вообще (что немыслимо для большинства наркоманов в наши времена) или…только метадон. Со всеми свойственными метадону последствиями. Однако, метадоновые программы прежде всего направлены на Снижение вреда, и являются ключевым звеном профилактической модели, направленной на снижение темпов эпидемии ВИЧ , чему способствует отказ от инъекционного употребления… В этом контексте программы оправданы. …

The pragmatic Chinese society in general, including the drug users in particular, accepted the idea that it is better (and cheaper) to control somebody’s addiction than to endure, suffer, and take losses. Methadone programs in China are considered to be an effective alternative to punishments. Here they emphasize the main quality of Methadone (which, for some reason, is not considered much in our country) to block opiate receptors. This illuminates even a possibility to use any other opiate drug besides methadone. So, it is not only that methadone itself does not have any euphoria potential … it also blocks any attempts to illegally use heroin, opium, etc. So a drug user almost does not have any choice. Either he should stop using drugs at all (which in reality is not possible for most addicted people) or to use Methadone only, with all the negative effects which Methadone brings. However Methadone programs are aimed first of all on harm reduction and are a key element of the prevention model focused on the reduction of the HIV/AIDS epidemic through decreasing the injection use of drugs. In this context, such programs are well justified.

Pavel then compares these two experiences with the situation in his home country of Ukraine, where patients can only receive Methadone by personally commuting every day to the clinic, even when the patient is sick. He noted that patients that start therapy become dependent on medical personnel at the site, and will also be under the watch of the police, which does not always have favorable attitudes towards drug users.

There are a pair of cartoons drawn by by Ksenia Z. and Vladimir Lomeyko and published on the Drop-In Center newsletter. The cartoons depict how patients see substitution therapy in Ukraine. The first cartoon presents the replacement therapy as an inflatable life preserver which helps the patient not to drown, but it is not a reliable means for swimming in the sea of life. Pavel commented on the cartoon:

Substitution therapy in Ukraine, cartoon drawn by Ksenia Z. and Vladimir Lomeyko

Действительно принимая легальный заместительный препарат, человеку предоставляется шанс не утонуть в океане проблем. Но и доплыть до конкретного берега – будь то работа, учеба, семья – также остается несбыточной мечтой для большинства пациентов. … Отсутствие рецептурной или какой иной формы выдачи ЗПТ для СТАБИЛЬНЫХ пациентов (отказавшихся от употребления нелегальных наркотиков), делает программу не только бесперспективной в плане социального благополучия…

A person that takes a legal medication is given a chance not to drown in the ocean of problems. But to swim to shore, whether it be a job, study, family - also remains unrealistic for most patients. The lack of prescription from a doctor for STABLE patents (to refuse the use of illegal drugs), makes the program useless with regards to social welfare.

The second cartoon shows how the absence of the provision of Methadone by pharmacies makes the patient totally dependent on the doctors. Pavel noted that those patients that have demonstrated a serious attempt to give up illegal drugs, by testing negative on drug tests for half a year, should have a chance to manage the therapy one's self under the supervision of a doctor. In his opinion, this would provide a stronger incentive for changing one's behavior.

Substitution therapy in Ukraine, cartoon drawn by Ksenia Z. and Vladimir Lomeyko

Ukraine: Advice for Friends and Families of Addicts

Maryna Reshetnyak — Fri, 22 Jul 2011 01:32:21 +0000

Ukrainian organizations working in the field of harm reduction often use their web resources to provide ongoing assistance to their clients and their families. The psychologists and social workers, who also are experts in the field of rehabilitation give useful tips to people living with drug addition on how to make the rehab process easier and advise the families on the correct steps to take to help their loved ones to overcome the addiction. The Rising Voices grantee Drop-In Center has continued providing an online newsletter called “Motilek” for its clients for additional support. They have embedded a copy of the newsletter on their project blog.

Title page of the 31st issue of 'Motilek' newsletter

The Director of the rehabilitation center, Iryna Romashkina, provides advice on what to do if a relative or loved one becomes a drug addict. She called the situation a “co-addiction” and urged the family member not to blame themselves. She wrote [ru]:

If you feel guilty on what has happened and you always ask yourself “What did I do wrong?” “Where were my mistakes?” you should know that even if you find a correct answer you would not help a drug addict or an alcoholic, but instead would end up harming yourself. The addict actually wants you to blame yourself constantly, so that they can easily manipulate you by saying “This is entirely your fault…”

According to Iryna, the biggest mistake the family member of a drug user can make is to start using drug as well. She noted (pdf format):

If you decide to go the same way and to try the drugs to make your situation easier or to better understand what a drug addict feels, you have to remember that this is a very dangerous trap. To get off drugs for both of you would be thousand times harder and, as our experience shows, it will be almost impossible.

Iryna speaks honestly about the issues and gives many other useful tips to relatives of drug users on how to behave to help their loved ones to overcome the abuse. She also emphasizes that alcoholism or drug addiction treatment is a life-long process. She wrote (pdf format) [ru]:

If you think that alcoholism or drug addiction is not curable, then you are not correct. It is possible to treat and to stop a chemical dependency, but yet one can not be cured totally. Those who went through treatment and returned to a normal lifestyle are called “recovering” not “recovered”. Recovering is a very long process requiring everyday commitment. Both alcoholics and drug addicts have to say ‘no’ for their entire lives.

In the recent post published on the blog of the Association of Substitution Treatment Advocates in Ukraine an activist from the Cherkassy Charitable Foundation ‘Inside,’ Oksana Likarkina advises how people living with drug addiction can find a new motivation which would help them to stop use the drugs. First of all Oksana analyzed the reasons why many people living with drug addiction did not try to change their lives for better. She wrote [ru]:

Может ли изменить свое отношение к жизни человек, который много лет проупотреблял наркотики? Мы встречаем работающих в организациях ребят-«выздоравливающих»наркоманов и социальных работников реабилитационных центров. И задаем себе вопрос: «Почему другие зависимые, уставшие от вечной погони за наркотиком, зачастую не делают серьезных попыток прекратить употребление?»

Итак, попытаемся разобраться почему же подобные «живые» примеры не вдохновляют многих потребителей наркотиков на реабилитацию или прекращение приема наркопрепаратов. Возможно вся проблема в неверии в свои силы или в нежелании что-либо менять? Вот какие причины зачастую называют потребители: «привык к такой жизни», «нет причин менять что-то», «жизнь почти закончена, у меня ВИЧ/СПИД», «жизнь плохая, работы нет, нет семьи», «пробовал, ничего не получилось», …, «нет денег на реабилитацию» и т.д. Психологи определяют это как защитные отговорки для себя и легко развенчивают причины: «попробуй другую жизнь, тебе же должно быть интересно пожить в трезвости», «многие только и начинают пересматривать свою жизнь после того как узнают о статусе»

Is it possible that people who have used drugs for many years to change their attitude to life? Working in an NGO and rehabilitation center we often meet ‘recovering’ drug addicts and ask ourselves why other drug addicts who are tired of the permanent search of drugs never make any steps to stop the drug abuse.

Let's try to find out why good examples of their counterparts do not encourage other drug users to go through a rehab to quit drugs. Maybe the issue is a lack of confidence and an absence of a desire to change anything? These are the most common reasons which drug users present: “we just get used to this lifestyle”, “I do not see any reasons for change”, “I am HIV positive and my life is almost over”, “my life is bad, I do not have a job or a family”, “I have tried but failed”… “I do not have money for rehab center”. Psychologists qualify this as just self excuses and easily debunk this reasons saying “try a new lifestyle, you might find a sober life interesting”, “many people reconsider their lives after they learn about their HIV positive status”….

Oksana noticed the sad fact that most of the drug users just do not believe that they could change their lives for the better, to reestablish relationships with the family members and to find a job. Many of them come to a decision to give up drugs after some shocking thing had happened in their lives such as a death of a fellow drug user, news about their positive HIV status, TB, or cancer. Some people living with drug addiction make a decision to quit drugs for the sake of a wife, children, mothers, but this could often lead to failures and frustrations as the enthusiasm to change yourself for the sake of somebody else often does not last long. But Oksana believes that for people living with a drug addiction it is still possible to change life for better. She wrote [ru]:

Стремление и желание жить иначе, занятие деятельностью, поддержка со стороны близких или знакомых, общение с Анонимными наркоманами или группой верующих, которые знают о проблемах с наркотиком, напротив дают хорошие результаты.

Самое главное – убрать ежедневную привычку искать наркотик и научиться занимать дни чем-то продуктивным,поверить в то,что сможешь жить без наркотика. Не стоит бояться срывов, поскольку вначале они есть почти у всех, главное - настроиться на успех и не бояться просить поддержку у кого-то из тех,кто раньше был потребителем или сможет помочь удержаться.

The aspiration and desire to have a different life, activities, support from relatives and friends, attendance of Drug Addicts Anonymous group or a Christian group where people are aware about drug addiction problems often brings good results.

The most important is to get rid of an everyday habit to search for drugs and to start doing something productive and start to believe that you can live without drugs. Do not be afraid of failures as at the beginning, almost everybody has them, but just be positive about success and do not hesitate to ask a support from those who used to be a drug user and could help to keep away you from drugs.

Ukraine: Tackling the Issue of Hepatitis C

Maryna Reshetnyak — Wed, 06 Jul 2011 11:28:01 +0000

Igor Kuzmenko, an activist of the Association of the Substitution Therapy Advocates in Ukraine [ru]from Simferopol, Crimea attended a workshop held in Tallinn, Estonia about organizing advocacy campaigns that aim to increase access to Hepatitis C treatment. Igor became more interested about the Hepatitis C epidemic through the presentations by the workshop instructors Konstantin from Eurasian Harm Reduction Network and Raminta Stuikyte from European AIDS Treatment Group. He blogged about the situation with Hepatitis C in Ukraine and suggests the steps the people living with drug addiction could undertake to fight the virus.

The workshop instructor Raminta Stujkite, photo taken from ASTU web-site The workshop instructor Konstantin Lezhentsev, photo taken from ASTU web-site

Hepatitis C is one of the major problems for substitution therapy patients. According to media reports about 77 % of injection drug users in Ukraine are infected with Hepatitis C. Most of the time the virus is transferred through unsterile syringes, but sometime the drug itself can be infected. This is how the Hepatitis C epidemic was described in the blog post:

Процент забракованной по тем или иным причинам донорской крови в Украине составляет примерно 10 процентов. По данным на 2007 года, 21,2% из этих 10 приходилось на него – гепатит С. Мало это? Нет, конечно, это очень много. Учтите, что речь идёт о донорах, людях, которые заботятся о своём здоровье и постоянно обследуются. И среди этой вот, отнюдь не маргинальной группы, в 2007 году, целых 2% узнали вдруг, что у них гепатит С! Что же говорить о простых смертных, тем паче о нашем брате – ПИНе, ….

The percentage of donor blood that is rejected because of various infections in Ukraine is about 10%. In 2007, 21.2% out of this 10% rejected blood was because of Hepatitis C. Is it a lot? Yes, these numbers are huge! Take into consideration that we are talking about blood donors, about people who care about their health and go through medical examinations. And just imagine, in 2007 only 2% of the people out of this non-marginal group learned that they are infected with Hepatitis C! And just imagine how this situation would look like among us, injection drug users…

Hepatitis C is not a solely a Ukrainian problem. The epidemic affects developed countries as well. Currently. the death statistics from Hepatitis looks much worse than from other infective diseases such as HIV and TB. Igor wrote:

В сытой Европе тоже не всё слава Богу. Страшная триада «ВИЧ, ТБ, Гепатит С» немного видоизменилась там за последнее время. Причина в том, что смертности от ВИЧ, как таковой нет. Надёжно работают схемы антиретровирусной терапии. И с туберкулёзом вопрос стоит там не столь остро, как у нас. Смертность же от гепатита С высока и в ЕС. В сверхблагополучных Соединённых Штатах, от «нежного убийцы» ежегодно умирает 12 000 человек. Точнее, умирают, как правило, от цирроза печени, который развивается вследствие инфицированности гепатитом С. По оценкам, во всём мире, этим вирусом поражены 170 млн. человек.

In more wealthy Europe, the situation is not good as well. The scary triangle ‘HIV, TB, Hepatitis C’ has slightly changed recently. The main reason is that HIV causes almost no deaths. The schemes of antiretroviral therapy works really well. The situation with TB over there is also much better than in our country. But number of cases of death caused by Hepatitis C is high even there. Even in a very wealthy USA, more than 12,000 people die each year because of the ‘gentle killer’. Namely they die because of liver cirrhosis caused by the Hepatitis C virus. According to estimations, more than 170 million people all over the world are affected by the virus.

The workshop instructor Konstantin Lezhentsev, photo taken from ASTU web-site

According to media reports in Ukraine Hepatitis C treatment is very expensive for most of the people (about $20,000 per year) and is not funded by Ukrainian government. Although the blogger suggests that there are certain steps which would make the treatment more accessible. He posted:

Что до лечения, то уже достаточно давно, оно возможно. Правда, это не просто, мягко говоря. Москвич Арсений Павловский, написал даже некий «мануал» - пособие в помощь тем, кто нашёл средства и силы начать лечиться от гепатита. Я рекомендую всем этот, не побоюсь сказать, труд – выстраданный, точный, помогающий.

Брэндовые препараты пока ещё далеко не всем по карману, вряд ли они когда-нибудь станут доступней. Но есть генерики. Не стоит бояться этого слова, … Это просто воспроизведение брэндовых, патентованных препаратов. Как правило, производством генериков занимаются «третьи страны». Безусловно, ведущая роль в этом принадлежит Индии. Иные генерики ничем не хуже оригиналов.

Talking about the treatment I need to say that it has existed for fairly long time. But to say that it is not so easy to access is an understatement. A Moscow author Arseniy Pavlovskiy even wrote a manual for those to find funds for Hepatitis C treatment. I would recommend to everybody this precise and helpful manual.

Most of us cannot afford brand name drugs. But there are generic drugs. We should not be afraid of these words… This just means that this is a replication of brand name patented medications. As a rule, the generic drugs are produced in ‘third-world countries’. The leading country, of course, is India. Many generic medications are no worse than originals.

Igor is optimistic about the future and encourages his counterparts to take care of their health. He wrote:

Фармакология не стоит на месте. Самое главное, что новые препараты значительно сокращают время лечения, что очень важно, учитывая тяжёлое состояние в момент приёма терапии. […]

Нам нужно лишь бережнее относиться к самому ценному, что есть на свете – к самим себе, к здоровью и жизни. Будем здоровы!

The pharmaceutical industry develops very fast. What is most important is that the new medications significantly reduce treatment time because one must take into account how hard the therapy is to go through. […]

We need to care about the most valuable things we have – ourselves, our health, and our life. Let's be healthy!