Pavel Kutsev, leader of the Drop-In Center project, has recently posted an update of what's going on in the community of Ukrainian substitution therapy program patients. Many of the issues he raises have been discussed in previous Rising Voices posts.

Pavel Kutsev and his wife

A few months ago, Rising Voices wrote about the attempts of some Ukrainian cities to ban substitution therapy programs in municipal medical establishments. Their reasoning was that an addiction to one drug cannot be treated with another drug. However, many experts concluded that this decision was aimed mostly at earning the support of voters, rather than solving medical problems.

After the city Sevastopol put the ban in place, a few other cities in Ukraine introduced the ban in municipal hospitals. Pavel Kutsev commented on this. He says:

With the upcoming elections, the situation with substitution therapy is getting worse and worse. All methadone programs are under threat. It started in Crimea, and now we have cases in Donetsk and Dnepropetrovsk…How would you like this newspaper headline: “Methadone Monsters Ruled by the Hand of Evil?” This is from one of the newspapers from the Sumy region…So we are quite concerned about all this…

In his overview Pavel named another opponent of substitution therapy in Ukraine. These opponents are various religious groups working in the field of drugs and HIV/AIDS prevention. These types of organizations receive a great deal of financial support from local governments. Here is what Pavel had to say about this situation:

By the way, most government funding for the social support of drug addicts goes to various religious organizations. These guys’ motto is “Say No to Methadone Hell”…Oh yeah, of course, they are the saviors…Well, if you think about it all, you start to doubt whether substitution therapy programs will survive in Ukraine at all.

Pavel also refers to a problem that seems to be of greatest importance to him: whether the drug used for substitution therapy in Ukraine is the right one. He points out that the drug that the Ukrainian government has purchased for substitution therapy is not the best available drug, as it has a fairly short time of excretion from the body.

According to Ukrainian law, participants of substitution therapy programs can receive these medications only once a day and only in certain medical establishments. A drug with a period of excretion of less than 24 hours essentially means that those taking these drugs experience abstinence syndrome (or withdrawal) for a few hours a day. Pavel says:

To tell the truth, I had started feeling better for a while. My daily dose was 180 mg. In a week my old problems returned… tolerance, shortness of breath, insomnia…

It's been almost a year now since my wife and I started “adjusting” to methadone. To tell the truth, we still need to take antidepressants as the medication just does not suit patients like us well. We are not talking now about the side effects. We just feel that there is no reason for us to increase the daily dose more and more…It does not matter how large your dose is if the active substance will be excreted from the body in 12-16 hours. The only alternative that would work in this case is to consume the medication at least twice a day, in the morning and at night.

According to our estimation, almost all 400 people from our methadone site consume other drugs along with the provided medications. Every third person still shoots up. Others take various pills. This is because in the morning you have such a severe feeling of cold turkey that you just need another drug. You cannot call this a treatment! Please understand! If you are a drug addict and every morning you have abstinence syndrome you just do not feel the effect of the therapy.

The idea of substitution therapy is that while taking medications the person is getting used to sober life and forgets about the nightmare of cold turkey syndrome.

I just need to take replacement therapy medications, like vitamins, to get out of the euphoria habit, which is called “psychological dependency.” I just need to take medications that would support my body and let me function without cold turkey syndrome…for at least 30 hours. Only in this case will the therapy be successful…

What happens if in 15 hours you start feeling pain again and start thinking about a new dose? You cannot even complain to medical personnel as they do not take you seriously. They call the medication they give you “a drug.” Naturally if we consume this medication we are under the influence, we are not adequate…so why to listen to us…

Finally, Pavel sums up his thoughts:

The only option for drug addicts to defend their interests is self organization. Only staying united we can be healthy.