On drug treatment and social control: Russian narcology's great leap backwards

Columbia University, Mailman School of Public Health, NYC, USA. .
Harm Reduction Journal (Impact Factor: 1.26). 02/2008; 5(1):23. DOI: 10.1186/1477-7517-5-23
Source: PubMed


The medical discipline of narcology in Russia is a subspecialty of psychiatry from the Soviet era and it is given warrant to define the scope of health activities with regard to alcohol and other drug use, drug users, and related problems. Narcological practice is in turn constrained by the State. The emergence of widespread injection opiate use and associated HIV morbidities and mortalities during the first decade following the collapse of the Soviet Union has brought the contradictions in Russian narcological discourse into high relief. Narcology officials in the Russian Federation have consistently opposed substitution treatment for opiate dependence – the replacement of a short-acting illegal substance with a longer acting prescribed drug with similar pharmacological action but lower degree of risk. Thus, despite the addition of methadone and buprenorphine to WHO's list of essential medicines in 2005 and multiple position papers by international experts calling for substitution treatment as a critical element in the response to HIV (IOM, 2006; UNODC, UNAIDS, and WHO, 2005), methadone or buprenorphine remain prohibited by law in Russia.
The authors detail Russian opposition to the prescription of methadone and buprenorphine, describing four phenomena: (1) the dominance of law enforcement and drug control policy over public health and medical ethics ; (2) the conflation of Soviet era alcoholism treatment with treatment for opiate dependence; (3) the near universal representation of detoxification from drugs as treatment for dependence; and (4) a framework for judging treatment efficacy that is restricted to "cure" versus "failure to cure," and does not admit its poor outcomes or recognize alternative frameworks for gauging treatment of opiate dependence. In keeping with this position, Russian narcology officials have taken an implacable ideological stance toward illicit drug use, the people who use drugs, and their treatment. By adopting policies and practices totally unsupported by scientific evidence and inquiry, officials in Russia have rendered narcology ( and medical practice) insensitive to the alarming rates and continued spread of HIV, with its dire morbidity and mortality rates in the Russian Federation, turning their backs on all the other health problems posed by opiate use and dependence itself.

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Available from: Richard Elovich, Feb 17, 2014
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    • "To date, HIV/AIDS has infected approximately 1% of the Russian population with the highest infection concentrations among intravenous drug users (Denisov & Sakevich, 2005; Central Intelligence Agency, 2014). Additionally, imprisonment rates are among the world's highest (Dolan, Bijl, & White, 2004; Elovich & Drucker, 2008) with 1 in 4 Russian men having served a prison term (Gilinskiy, 2006). HIV-positive inmates comprise 16% of the prison population in Russia (Lukina, 2005) and the majority of those are intravenous drug users (Denisov & Sakevich, 2005). "

    03/2014; 6(2):143-154. DOI:10.1080/19409419.2014.900723
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    • "There was a focus on heavy medicalization and an emphasis on administrative duties, rather than caregiving, with few incentives to seek any major changes in the field. These historical characteristics of Soviet narcology can be found in contemporary narcology in Georgia and in other post-Soviet countries (Elovich & Drucker, 2008; Latypov, 2011). Respondents in the service-providers' group were able to identify a range of factors hindering access to treatment for substanceusing women, but appeared unable to propose any meaningful solutions. "
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    ABSTRACT: Background: In the Republic of Georgia, women comprise under 2% of patients in substance use treatment and to date there has been no empirical research to investigate what factors may facilitate or hinder their help-seeking behaviour or access to treatment services. Methods: This study included secondary analysis of in-depth interviews with 55 substance-using women and 34 providers of health-related services. Results: The roles and norms of women in Georgian society were identified as major factors influencing their help-seeking behaviour. Factors that had a negative impact on use of drug treatment services included an absence of gender-specific services, judgmental attitudes of service providers, the cost of treatment and a punitive legal position in regard to substance use. Having a substance-using partner served as an additional factor inhibiting a woman's willingness to seek assistance. Conclusion: Within the context of orthodox Georgian society, low self-esteem, combined with severe family and social stigma play a critical role in creating barriers to the use of both general health and substance-use-treatment services for women. Education of the public, including policy makers and health care providers is urgently needed to focus on addiction as a treatable medical illness. The need for more women centred services is also critical to the provision of effective treatment for substance-using women.
    The International journal on drug policy 06/2013; DOI:10.1016/j.drugpo.2013.05.004 · 2.54 Impact Factor
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    • "In countries where public campaigns or media position drug use as social evil and where health providers are viewed as closely aligned with law enforcement or other systems of social control (e.g. child protection agencies), PWID are likely to postpone seeking treatment for medical problems that need urgent professional care (Elovich & Drucker, 2008; Orekhovsky et al., 2002; Wolfe, Carrieri, & Shepard, 2010). Elsewhere we have argued that the current response to drug use, HIV and infectious diseases in Russia and many former Soviet countries is strongly rooted in the Soviet Union's approach to deviance (Grund et al., 2009; Grund, 2002; Latypov, 2011). "
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    ABSTRACT: Background: Krokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated with its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon, krokodil use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively estimated to have injected the drug in 2011. In this paper we review the existing information on the production and use of krokodil, within the context of the region's recent social history. Methods: We searched PubMed, Google Advanced Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or media reports, grey literature and video reports. Survey data from HIV prevention and treatment NGOs was consulted, as well as regional experts and NGO representatives. Findings: Krokodil production emerged in an atypical homemade drug production and injecting risk environment that predates the fall of communism. Made from codeine, the active ingredient is reportedly desomorphine, but - given the rudimentary 'laboratory' conditions - the solution injected may include various opioid alkaloids as well as high concentrations of processing chemicals, responsible for the localized and systemic injuries reported here. Links between health care and law enforcement, stigma and maltreatment by medical providers are likely to thwart users seeking timely medical help. Conclusion: A comprehensive response to the emergence of krokodil and associated harms should focus both on the substance itself and its rudimentary production methods, as well as on its micro and macro risk environments - that of the on-going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend more on political will than on the practical implementation of interventions. The legal status of opioid substitution treatment in Russia is a point in case.
    The International journal on drug policy 05/2013; 24(4). DOI:10.1016/j.drugpo.2013.04.007 · 2.54 Impact Factor
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