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Stories from the field | The beginning of opioid treatment in the Ukraine

In this video Anton Basenko talks about the introduction of opioid substitution in the Ukraine
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Historically in the Ukraine, some plants which people used for drug production is part of our culture. Plants like poppies, and weed have been growing here for hundreds of years. We estimate that around 350,000 people in my country inject drugs.
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When we gained independence from the former Soviet Union in 1991, Ukraine inherited punitive drug laws. Drug users faced an HIV epidemic, a tuberculosis epidemic, homelessness problems with low income, as well as human rights violations and the risk of being marginalized or arrested. Over the 30 years since then, we have seen huge positive changes to the legal framework, although some laws are still in place for criminal possession and there is a list of types and amounts of drugs that are illegal. So, for example, Article 309 still says that you may be liable for arrest and imprisonment for up to 3 years for having just 0.005g of heroin or a acetylated opium, which is shirka in your pocket.
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That’s the equivalent of the last few drops in a syringe after the injection. So formally, even a dirty syringe in your pocket can be the reason for arrest.
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Opioid substitution therapy began in the Ukraine in 2004. It followed the World Health Organization’s defining OST
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Methadone and buprenorphine are considered as the gold standard of medications used in OST around the world. Its approach is to treat drug dependency as a chronic condition with a high rate of recidivism. A friend of mine and I were part of the first part of a group of 30 patients in Kiev to take part. Basically, we were provided with specific medication, similar by the action of the street drugs but in limited dosage, under strict medical control. We were given a dosage of methadone and buprenorphine every day. The effect of the replacement drugs lasted longer than the street drugs we had been injecting and took away our dependency on them.
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The drugs don’t give you a high, they just make you feel normal. After a certain number of months. Once the dosage had been stabilized, we moved to the take home stage. When we were able to take our medication at home. It meant they visited the clinic less and less, maybe only three times a month. It is important to understand
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I immediately felt the change it was making it was the same for all 30 of those patients who took part in the pilot project. It really changed our lives. Within six months, I reconnected with my family. I found work. I felt normal. I know I have a home and family of my own. I’m advocating OST and non-stigmatized Health care is now my profession. I’m still on the program. But now my dosage has dropped from 24 mg a day to the minimum of just 4 mg of buprenorphine. It opened doors for us to all other health treatments of HIV, Hep C and psychological services.
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Believe me OST improve patients’ quality of life, reduces their risk of illicit drug use and overdose and improves their health and that of the people around them.
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In 2005, a public hearing took place to decide whether this kind of medical assisted therapy should continue. I gave evidence about how OST had changed my life. The result was that the Ministry of Health gave the green light to substitution therapy and turned the pilot into an approved treatment program for drug dependency. At first, OST was part of the HIV AIDS prevention program. But now it is available as a kind of treatment for all people who inject opioid drugs, including its availability on the primary healthcare level. So currently there are more than 13,700 OST patients and 215 sites across 25 regions of Ukraine. Just over half of them are at the take home stage.
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But due to the covid quarantine measures and lockdown reality, up to 90 % of them were moved to take home approach. No, it’s the biggest harm reduction program in Eastern Europe and Central Asia.
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The provision of opioid substitution therapy is now guaranteed in law in the Ukraine. Since 2017, the state budget has covered the procurement cost for the medication paying for methadone and buprenorphine. But organizations like the Global Fund still pay for other wider and extremely important social psychological support. However, by 2023, these rehabilitation and resuscitation costs should be also transited to the state budget or local budget. And step by step, the goal is to increase coverage by up to 3.500 patients each year. By 2030, the goal is to ensure at least 40 % of people who inject opioid drugs in the Ukraine are supported by substitution therapy in line with WHO/UNAIDS/UNODC recommendations to reach the Global Sustainable Development Goals.

Each topic during this course will conclude with some examples from real-world experiences. In this video, Anthon Basenko will provide you with his personal experiences on how Opioid Treatment was introduced in the Ukraine.

Opioid Agonist Treatment is part of a Harm Reduction package, recommended by UN agencies in regards to an effective HIV response. You will learn more about this from Annette Verster from the WHO in the next topic ‘public health perspective of drug use and harm reduction’.

This step concludes the first topic of the course “What is harm reduction”. We hope you have gained a deeper understanding of what Harm Reduction stands for. As you have noticed, Harm Reduction has strong roots in individual wellbeing and public health. The second topic of this week will look specifically at the pubic health dimension of drug use and harm reduction.

Note; Opioid Substitution Therapy (OST), Opioid Agonist Treatment (OAT) and Opioid Treatment are terminology that are used interchangeably. OAT is recently getting the more preferred terminology. (see ‘words matter!’ document attached to step 1.4)

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This content is taken from London School of Hygiene & Tropical Medicine online course
Drug Use and Harm Reduction
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