RUSSIA REJECTS HUMAN RIGHTS WATCH PROPOSAL ON METHADONE

UNCLAS SECTION 01 OF 02 MOSCOW 005353 SIPDIS SENSITIVE SIPDIS DEPARTMENT FOR EUR/RUS USAID FOR GH, E&E HHS FOR OGHA E.O. 12958: N/A TAGS: TBIO PHUM SOCI RS SUBJECT: RUSSIA REJECTS HUMAN RIGHTS WATCH PROPOSAL ON METHADONE MOSCOW 00005353 001.2 OF 002 THIS CABLE IS SENSITIVE BUT UNCLASSIFIED. PLEASE PROTECT ACCORDINGLY. ¶1. (SBU) SUMMARY: In a 110-page study released November 8, Human Rights Watch International concluded that substance abuse treatment in Russia is of such poor quality that it amounts to a violation of the right to health. The report recommended that Russia immediately permit the use of drug-substitution therapy (e.g., methadone) for heroin addicts. Russian public health and drug control officials reacted quickly to the report and reaffirmed that methadone therapy would continue to remain illegal under Russian law. Senior Russian health officials and policy makers continue to believe that the substitution of one addictive drug for another does not constitute medical treatment, and would be politically unpopular. END SUMMARY. -------------- WHY WON'T RUSSIA START USING METHADONE? -------------- ¶2. (SBU) The November 8 "Rehabilitation Required" report released by Human Rights Watch International (HRW) argued that substance abuse treatment in Russia is of such poor quality that it constitutes a violation of the right to health. Russia is one of the few remaining countries that does not permit the use of drug-substitution therapy (e.g., methadone or buprenorphine) in the treatment of heroin addicts. The prescribing of methadone is illegal under Russian law, and buprenorphine can only be prescribed as a pain medication, but not to treat drug addicts. Russia only uses detoxification treatment for drug addicts in substance abuse and rehabilitation clinics. There are not enough clinics to provide longer-term rehabilitation for drug addiction at government expense. As Russia's HIV/AIDS epidemic continues to spread among drug users, the lack of drug substitution therapy in Russia as an available means of treatment has complicated the effort to treat HIV/AIDS patients. Russian clinicians will not place an HIV positive drug addict on anti-retroviral (ARV) therapy (ART) until after he has demonstrated that he has discontinued using drugs, because of concerns he will not adhere to the full course of ART. ¶3. (SBU) The HRW report immediately provoked a strong negative reaction from Russian health and drug control officials. Chief Medical Officer Gennadiy Onishchenko, the head of the Federal Surveillance Service for Consumer Rights Protection and Human Well-Being, stated November 9 that it was completely inappropriate for HRW to suggest that Russia legalize an addictive drug. A spokesman for the Federal Drug Control Service (GosNarkoKontrol) told the press that methadone would continue to be illegal under Russian law. He also contended that methadone therapy was expensive. Other Russian observers with similar views saw the HRW report, and similar recommendations by the WHO and the UN Office on Drugs and Crime, as an attempt by western drug companies to make further inroads on the Russian pharmaceuticals market. ¶4. (SBU) As Dr. Alexander Golyusev, Rospotrebnadzor's senior HIV/AIDS official, has explained to us, the substitution of one addictive drug for another does not constitute "medical treatment," and would in any event, be politically unpopular in Russia. Dr. Nikolay Gerasimenko, the Deputy Chair of the Duma Health Committee, has also told us that methadone therapy is completely inappropriate for Russia, despite the worldwide medical consensus to the contrary. Likewise, Dr. Nikolay Ivanets, Director of the Russian Institute of Substance Abuse and the Chief Substance Abuse Specialist at the Health and Social Development Ministry, has been adamantly opposed for many years to methadone treatment. Even more progressive public health voices, such as Dr. Valeriy Krasnov, President of the Russian Psychiatric Society and Director of the Moscow Institute of Psychiatry, have been skeptical that drug substitution therapy would be successful and have worried that a black market in methadone would immediately arise among drug addicts. -------------- COMMENT -------------- ¶5. (SBU) In recent years, international health donors, including the United States, have sponsored small-scale research projects and study tours to persuade Russian health policy makers and practitioners of the utility of drug substitution therapy. Some observers also had hoped that Russia might consider legalizing methadone treatment after China presented recent successes with drug substitution therapy at the International AIDS Society Meeting in Toronto in August 2006. A small study tour by senior Russian health officials and Duma members visited China earlier this year, but MOSCOW 00005353 002.2 OF 002 again, given the official position of the Russian government, no change in Russian policy was anticipated. On a positive note, a growing number of private, faith-based organizations are providing rehabilitation services in Russia. The Russian Orthodox Church has advised us that representatives from three of the Church's drug rehabilitation centers will visit the United States on a study tour of faith-based substance abuse programs later this year. However, as the latest flap over the HRW report makes clear, Russia is still a long way from legalizing methadone treatment. BURNS