Cablegate: Russia Rejects Human Rights Watch Proposal On Methadone

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ZNR UUUUU ZZH
R 100831Z NOV 07
FM AMEMBASSY MOSCOW
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INFO RUEHYG/AMCONSUL YEKATERINBURG 2844
RUEHVK/AMCONSUL VLADIVOSTOK 2525
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UNCLAS SECTION 01 OF 02 MOSCOW 005353

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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

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THIS CABLE IS SENSITIVE BUT UNCLASSIFIED. PLEASE PROTECT
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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.

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WHY WON'T RUSSIA START USING METHADONE?
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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.

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COMMENT
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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

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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

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