International - Russian Federation
(Prevalence of Injection Drug Use-Related HIV in Russia, 2012) "Russia has the largest population of injecting drug users (IDUs) in the world — an estimated 1·8 million people. More than a third have HIV; in some regions, the proportion is nearer to three-quarters. Astonishingly, an estimated 90% of Russian IDUs have hepatitis C, and most patients co-infected with HIV and tuberculosis in Russia are drug-dependent."
(Russian Demand Reduction and Treatment Services Deficient and Generally Ineffective) "The Russian government addresses demand reduction and drug abuse prevention in the State Counternarcotics Strategy. The Strategy outlines ongoing deficiencies in the demand reduction system, including insufficient medical treatment and social rehabilitation services, a shortage of specialized workers (doctors and social workers) and a shortage of centers serving drug abusers. At present, there exist only four state-run and 70 non-governmental organization (NGO) centers for rehabilitation of drug addicts. The few government-supported drug addiction treatment programs that do exist are generally ineffective, with high rates of recidivism. Most drug replacement therapies, such as methadone, are illegal in Russia, although treatment centers in St. Petersburg and Orenburg are implementing a few new models of cognitive therapy which expand the breadth of substance abuse programs and rehabilitation. A new medication-assisted therapy study on Naltrexone abuse, supported by the United States and Russian governments, is ready for publication. The Russian Orthodox Church continues to operate approximately 40 faith-based rehabilitation centers."Source:United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control (Washington, DC: March 2013), p. 278.
(Prevalence of Opioid Use and Related Mortality in Russia, 2010) "Revised data for the Russian Federation indicate annual prevalence of the use of opioids to be 2.3 per cent and the annual prevalence of heroin use: 1.4 per cent.61 Of the 9,263 drug-related deaths reported in 2010, 6,324 were attributed to opioid use."
(The Science and Practice of Drug Treatment in Russia: Narcology) "The science and practice of drug treatment in Russia – narcology – developed out of psychiatry in close collaboration with other state mechanisms of social control, including police agencies (Elovich and Drucker, 2008). Close links between narcology and police agencies remain (Bobrova et al., 2006). Access to drug treatment automatically requires official registration as an addict, which involves the removal of various citizenship rights, such as the rights to employment, as well as exposure to social stigma (Bobrova et al., 2006). The effectiveness of drug treatment approaches (which are modelled on alcohol detoxification methods) remain questionable, are linked to high rates of relapse, and are framed by a policy response at Federal level which prohibits the use of (internationally accepted) methadone and buprenorphine as substitution treatment (Elovich and Drucker, 2008; Mendelevich, 2004; Human Rights Watch, 2007). This policy rests on the rationale that treating addicts as patients would challenge policy discourse that labels drug users first and foremost as 'criminals' (Elovich and Drucker, 2008)."Source:Sarang, Anya, Rhodes, Tim, Sheon, Nicolas, and Page, Kimberly, "Policing Drug Users in Russia: Risk, Fear, and Structural Violence." Subst Use Misuse. 2010 May; 45(6): 813–864. doi: 10.3109/10826081003590938
(UNODC Considers Crime and Drug Use in Russia A Growing International Concern) "The growing number of young people abusing drugs is a serious concern. Worryingly, the overwhelming majority of drug addicts are between 18 – 30 years old. Many of them are unemployed, have a chronic history of offending and commit a large number of crimes to finance their addiction. As is the case in many other countries, the so-called ‘dark figure’ of crime – the mismatch between crime estimates produced by victimization surveys and those recorded by the police - is a well-known concept in Russia and most commentators agree that a relatively small number of opiate addicts are responsible for a staggering amount of acquisitive and violent crime. In this context it is worth noting that the Russian police registered around 12,000 crimes (of which 63 percent were rated as serious or extremely serious) which had been committed by offenders whilst they were suffering drug intoxication.
"The increase in drug abuse amongst otherwise law-abiding people, particularly adolescents, is causing a good deal of concern. Over the last few years, more and more young people have become ensnared in the cycle of drug abuse and crime. In 2006, more than 3,000 adolescents committed drug related crimes. Of these, some 845 cases involved the distribution of drugs. Young people’s increasing willingness to abuse drugs which too often leads to addiction, prostitution and homelessness, poses a real threat to community safety."Source:UNODC, "Illicit Drug Trends in the Russian Federation" (UNODC Regional Office for Russia and Belarus, April, 2008), pp. 10-11.
(Russian Policing Practices Violate Health and Individual Rights) "In the three Russian cities participating in this study, we found policing practices targeting injecting drug users (IDUs) to violate health, as well as individual rights. The brutality of police practices violate health directly, but also indirectly through the reproduction of day-to-day social suffering, which in turn can be internalized as self-blame, lack of self-worth, and fatalism regarding risk. These findings illustrate how law enforcement practices, particularly extrajudicial practices, generate an atmosphere of fear and terror, which shapes everyday practices of risk avoidance and survival among IDUs. Policing practices contribute to the reproduction and experience of stigma, and linked to this, a sense of fatalistic acceptance of risk, which may become crucial in shaping health behaviour, including HIV prevention. Yet we also identify nonconforming cases of resistance to such oppression, characterised by strategies to preserve dignity and hope. This leads us to consider how hope for change provides an important resource of risk reduction as well as escape, if only temporarily, from the pervasiveness of social suffering."Source:Sarang, Anya, Rhodes, Tim, Sheon, Nicolas, and Page, Kimberly, "Policing Drug Users in Russia: Risk, Fear, and Structural Violence." Subst Use Misuse. 2010 May; 45(6): 813–864. doi: 10.3109/10826081003590938
(Estimated Prevalence of Injection Drug Use in Russia, UNODC 2013) "Countries and areas with the highest rates of injecting drug use – more than 3.5 times the global average — are Azerbaijan (5.2 per cent), Seychelles (2.3 per cent), the Russian Federation (2.3 per cent), Estonia (1.5 per cent), Georgia (1.3 per cent), Canada (1.3 per cent), the Republic of Moldova (1.2 per cent), Puerto Rico (1.15 per cent), Latvia (1.15 per cent) and Belarus (1.11 per cent). China, the Russian Federation and the United States are the countries with the largest numbers of people who inject drugs. Combined, they account for an estimated 46 per cent, or nearly one in two, people who inject drugs globally."Source:UNODC, World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6), p. 5.
(Standard Opioid Substitution Treatment Unavailable in Russia) "In particular, Russian law forbids substitution therapy for opioid dependence with methadone or buprenorphine. Naltrexone is the only specific pharmacotherapy that is currently approved for use in the Russian Federation and is available as an oral tablet in extended-release formulations."Source:Krupitsky, Evgeny, Zvartau, Edwin, and Woody, George, "Use of Naltrexone to Treat Opioid Addiction in a Country in Which Methadone and Buprenorphine Are Not Available," Current Psychiatry Reports, 2010 October; 12(5): 448–453. doi:10.1007/s11920-010-0135-5.
(Number and Type of Drug Crimes Known to Authorities in Russia, 2006) "There were more than 240,000 drug crimes (acquisition, sale, manufacture etc.) registered by the Russian law enforcement agencies in 2006 - a 23 percent increase over 2005.
"Most of the crimes were committed in the large cities and industrial centres such as Moscow, St. Petersburg, Krasnodar, Kemerovo, Samara and Rostov. All these regions are located along the major drug trafficking routes.
"The number of crimes classified as “serious”and “extremely serious” has increased by 13 percent (from 134,988 cases in 2005 to 152,824 cases in 2006), although the overall number of drug crimes dropped by 5 percent (from 77 percent in 2005 to 72 percent in 2006). However, the definition of an “extremely serious crime” includes those cases where the offender has been arrested for possession of more than 2.5 grams of heroin.
"A similar trend is observed in drug trafficking cases where the number of these crimes increased by 12 percent in 2006 (100,000 cases in 2005 to 123,000 cases in 2006). However, in the context of all drug crimes, the proportion of drug trafficking cases actually declined by 5 percent (from 63 percent in 2005 to 58 percent in 2006)."Source:UNODC, "Illicit Drug Trends in the Russian Federation" (UNODC Regional Office for Russia and Belarus, April, 2008), p. 19.
(Homicide Rate in Russia, 2009) The Russian Federation's officially-reported homicide rate is 11.2 per 100,000 national population, with a reported 15,954 homicides in 2009.Source:UN Office on Drugs and Crime, "2011 Global Study on Homicide: Trends, Context, Data" (Vienna, Austria: UNODC, 2011), p. 95.
(Drug Crimes in Russia 2010, by Offense Type) "More than half of all cases are related to drug possession with no intent to supply, which refers primarily to people who use drugs rather than traffickers. This highlights the fact that Russia prioritizes punishment of people who use drugs in its war against illegal drugs, a situation further underscored by the following:
" In 2010 about 108,000 people were convicted for drug crimes (under Articles 228–233 of the Criminal Code)30; of them, nearly two-thirds (no fewer than 64.7%) were convicted for drug possession with no intent to supply31. More than 104,000 people were charged with fines and administrative arrest for mere drug use or possession of drugs in tiny amounts (e.g., 0.5 grams of heroin or less).32
" Russian laws define 'large' and 'extra large' amounts of drugs to be much lower than the average quantity necessary for daily use. That is because for some narcotic drugs, such as heroin, marijuana or methadone33, the 'large' and 'extra large' amounts are determined not by the weight of the pure substance but by the weight of the entire mixture seized34."Source:Merkinaite, S. A war against people who use drugs: the costs. Eurasian Harm Reduction Network (EHRN), Vilnius: 2012, p. 15.
(Relationship Between Street-Level Policing and High-Risk Drug Using Behavior in Russia) "Street-level policing practices in Russia have been found to fuel a pervasive sense of risk, and fear of arrest, fine or detainment, among IDUs, which in turn is linked to their reluctance to carry needles and syringes, thereby increasing the chances of high risk syringe sharing at the point of drug sale (Rhodes et al., 2003). Police agencies themselves emphasise a rationale of intense surveillance of drug users, enforced through a combination of extremely restrictive criminal articles on possession and the use of administrative codes unrelated to drug use (Rhodes et al., 2003, 2006). Moreover, civil society responses to HIV prevention, treatment and care for IDUs remain weak, as does public health policy and infrastructure, which depends heavily upon international donation (Sarang et al., 2007; Wolfe, 2007). Officials and health professionals give very weak endorsement to concepts such as ‘harm reduction’, which are still characterised by some as a corrupting influence of the West, and instead defer to normative social constructions of drugs users as unproductive, dangerous, and criminal (Tkathchenko-Schmidt et al., 2008; Elovich and Drucker, 2008; Wolfe, 2007)."Source:Sarang, Anya, Rhodes, Tim, Sheon, Nicolas, and Page, Kimberly, "Policing Drug Users in Russia: Risk, Fear, and Structural Violence." Subst Use Misuse. 2010 May; 45(6): 813–864. doi: 10.3109/10826081003590938
(Arrests for Drug-Related Crimes in Russia, 2006) "Eighty-seven thousand people were arrested for drug related crimes in 2006 – an increase of 24 percent over 2005.
"The increase in arrests and the fact that more traffickers are being prosecuted suggests that the Russian law enforcement agencies are becoming more effective. It is certainly the case that they are carrying out more covert operations directed against organized criminal groups and drug trafficking networks."Source:UNODC, "Illicit Drug Trends in the Russian Federation" (UNODC Regional Office for Russia and Belarus, April, 2008), p. 20.
(General Population, Prison Population, and Incarceration Rate in Russia, 2011) On May 1, 2011, the Russian Federation's officially reported incarceration rate was 568 inmates per 100,000 of national population, with a total prison population 806,100 out of an estimated national population of 141.93 million.
(Police Harassment and Injection Drug Use in Russia) "Researchers have found that police harassment is one of the most important factors that exacerbate risky behavior among drug users in Russia. In a 2002 study of drug use in five Russian cities, 44 percent of drug users said they had been stopped by the police in the month prior to being interviewed, and two third of these said that their injecting equipment had been confiscated by the police. Over 40 percent added that they rarely carried syringes for fear of encountering the police with them. In the Togliatti study, Rhodes and colleagues found that fear of being arrested or detained by the police was the most important factor behind the decision of drug users not to carry syringes, which in turn was an important determinant of sharing syringes during injection. This study concluded that drug users who had been arrested or detained by the police for drug-related offenses were over four times more likely than other users to have shared syringes in the previous four weeks. Drug users who feared the police in Togliatti tended to avoid not only syringe exchange services but also drug stores that sold syringes because police frequently targeted people buying syringes at such locations, a result also highlighted in a 2003 study of drug users in Moscow."Source:Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," April 2004, Vol. 16, No. 5, p. 18.
(HIV Prevalence in Prisons) "Being in prison or other state detention is an important risk factor for HIV in Russia. A very high percentage of drug users in the FSU [former Soviet Union] find themselves in state custody at some time in their lives. Injection drug use is reportedly widespread in Russian prisons, and HIV prevention services such as provision of sterile syringes, disinfectant materials for syringes and condoms are virtually absent. Official statistics indicate that from 1996 to 2003, HIV prevalence in Russian prisons rose more than thirty-fold from less than one per 1,000 inmates to 42.1 per 1,000 inmates. According to a 2002 report, about 34,000 HIV-positive personsover 15 percent of the persons officially counted as HIV-positive in the countrywere in state custody, of which the large majority found out about their HIV status in prison. The Kresty pretrial detention facility in Saint Petersburg was reported in 2002 to have about 1,000 HIV-positive persons among its 7,800 inmates. Some 300,000 prisoners are released each year from penal institutions in Russia, representing an important public health challenge."Source:Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 12.
(Heightened Arrest Risk for Casual Drug Use in Russia) "This was a couple of years after Russia had toughened its drug laws, lowering the minimum punishable dose to such a level that virtually any user could land behind bars. By 2004, the Justice Ministry estimated that 300,000 people were serving drug-related sentences in Russian prisons.
"That year the government -- responding in part to pressure from the Justice Ministry, which was fighting prison overpopulation -- raised the minimum punishable doses of illegal drugs, essentially ensuring that users who had no intent to sell would not be arrested. The police were incensed, arguing that some dealers took to carrying amounts just below the punishable level -- but still sufficient to satisfy between one and nine users. In other words, the police complained, they were being prevented from arresting users and small-time dealers and forced to focus on real drug dealers, whom they didn't want to touch with a 10-foot pole.
"The more-liberal policy lasted less than two years. The minimum punishable dose has been lowered again -- in most cases, by more than 50 percent. The dose is not quite as low as pre-2004 levels, but still low enough to put even casual users at risk."
(Transshipment of Afghan Heroin through Russian Federation) "In 2010 an estimated 25 per cent of the 380 tons of heroin manufactured in Afghanistan -some 90 tons- was trafficked northwards through Central Asia via the Northern route and onward to the Russian Federation. The 90-ton total includes heroin consumed within Central Asia and the Russian Federation, as well as heroin seized by law enforcement or trafficked onward. More than three quarters of this amount are destined for the Russian market, with a small portion (approximately 3-4 tons) continuing to eastern and northern Europe.1 Furthermore, in 2010 between 35 and 40 tons of raw opium were trafficked through northern Afghanistan towards Central Asian markets. The entire 2010 opiate demand of the Northern route is required to transit or be produced in northern Afghanistan."Source:United Nations Office on Drugs and Crime, "Opiate Flows Through Northern Afghanistan and Central Asia: A Threat Assessment" (UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs, May 2012), p. 9.
(Transshipping and Seizures in Central Asia) "In Central Asia, traffickers have access to a well-developed road and rail network. Around 70-75 per cent of opiates are transported by truck or another vehicle across Central Asia through Kazakhstan to major cities in south-western Russia and western Siberia.108 Trains and planes usually account for approximately 15-25 per cent of trafficking. Seizures on trains have been on the rise as of 2011, particularly in Uzbekistan. Based on available data for Central Asia and Russia, in 2011 the average size of heroin seizures on trains was 6 kg, out of a reported 55 seizures (at the time of this writing). Shipments can, however, be much larger, as shown by two heroin seizures of 191 kg and 118 kg made in 2010 in the Russian Federation and Tajikistan, respectively."Source:United Nations Office on Drugs and Crime, "Opiate Flows Through Northern Afghanistan and Central Asia: A Threat Assessment" (UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs, May 2012), p. 48.
(Drug Seizures in Russia, 2011) "Seizure statistics for 2012 were not available at the end of the reporting period. Total seizures of illegal narcotics over the first nine months of 2011 by type of substance were as follows: 1.64 MT of heroin; 19.66 MT of cannabis; 1.92 MT of hashish; 188.1 kg of cocaine; and 533.6 kg of synthetic substances."Source:United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control (Washington, DC: March 2013), p. 278.
(Illicit Cannabis Market in Russia, 2006) "The widespread trafficking of cannabis continues unabated. The trafficking is fuelled by the fact that cannabis grows wild in a number of regions in Russia and so is readily available. Indeed, the Russian Federation and neighbouring Kazakhstan contain the world’s largest areas of wild cannabis and the Russian authorities estimate that production of wild cannabis in Russia is around one million (1,000,000) hectares. Depending on the climate conditions, one hectare of cannabis may produce up to 1 million seeds with 5-8 years of reproduction cycle. The THC content of cannabis differs in different regions but tends not to exceed 5 percent. Since 1992, cannabis seizures steadily increased 8 times and reached 89.7 tons in 2004. However, seizures sharply decreased almost threefold in 2005 (30.6 tons) and continued to decrease in 2006 (23.7 tons)."Source:United Nations Office on Drugs and Crime, "Illicit Drug Trends in the Russian Federation" (UNODC Regional Office for Russia and Belarus, April, 2008), p. 13.
(Opiate Use in Russia, 2012) "In the Russian Federation, decreased availability of heroin has led to its partial replacement with local and readily available substances such as acetylated opium, as in Belarus, and with desomorphine, a homemade preparation made from over-the-counter preparations containing codeine.41"Source:UNODC, World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6), p. 17.
(Amphetamine-Type Stimulants (ATS) and Other Synthetic Drugs in Russia, 2006) "The illicit manufacturing of synthetic drugs remains one of the major concerns. A thriving chemical industry, often lacking sufficient regulatory control, means that precursor chemicals are easily obtained by Russian criminals and are used in the production of synthetic drugs for both the domestic and foreign markets. The current trend seems to be that precursors used in the production of ATS are trafficked to European countries whilst precursors used in the production of heroin, are trafficked to Asia.
"In terms of domestic production, so-called “kitchen labs”, still prevail. The majority of these laboratories produce relatively small amounts of pervitine (ATS) for local consumption. This drug is widely abused and in terms of injecting users, is second only to heroin and other opiates.
"In 2006, there were 1,486 registered cases of illicit production of drugs (+14 percent compared to 2005). The main types of drugs illicitly produced in clandestine labs are amphetamines, methamphetamines, 3-methylfentanyl, and phencyclidine. It is rather reassuring to report that there are very few cases when illicit synthetic drugs were produced in laboratories at industrial facilities and most of the clandestine laboratories are either the “kitchen labs”, described above, or otherwise small scale, rudimentary enterprises."Source:United Nations Office on Drugs and Crime, "Illicit Drug Trends in the Russian Federation" (UNODC Regional Office for Russia and Belarus, April, 2008), p. 14.
(HIV Transmission and IDUs in Russia, 2006) "The epidemic disproportionately affects IDUs who comprise 87% of the cumulative number of registered HIV cases, however, with the epidemic becoming more mature, the infection tendency away from IDUs to heterosexual is also increasing with 68% of newly registered cases by the end of 2004 corresponding to IDU and 30% to heterosexuals (In the previous year heterosexual transmission accounted for 23.4% of new infections). The interpretation of the tendency towards less new infections diagnosed is not an indication of a slowing of the epidemic but rather reflective of the changes in HIV testing policy, the smaller number of tests performed in population groups with high-risk behaviors and also a shortage of test kits."Source:United Nations Office for Drug Control and Crime, "Illicit Drug Trends in the Russian Federation, 2005" (Moscow, Russian Federation: UNODC Regional Office for Russia and Belarus, November 2006), p. 14.
(HIV Transmission and Injection Drug Use in Russia) "In 2002, an estimated 93 percent of persons registered by the government as HIV positive since the beginning of the epidemic were injection drug users. In contrast, in 2002 an estimated 12 percent of new HIV transmission was sexual -- that figure climbed to 17.5 percent in the first half of 2003 -- indicating the foothold that the epidemic is gaining in the general population. The European Centre for the Epidemiological Monitoring of AIDS (EuroHIV), a center affiliated with the World Health Organization, noted that HIV prevalence may have 'reached saturation levels in at least some of the currently affected drug user populations' in eastern Europe, including in Russia, but cautioned against complacency 'as new outbreaks could still emerge among injection drug users , particularly within the vast expanse of the Russian Federation.' Rhodes and colleagues in a February 2004 article echo this conclusion, noting evidence of recent examples of severe HIV outbreaks among drug users in Russia."Source:Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 10.
(Growth in Heroin Use from 1990-2004) "There is no doubt that drug use and heroin use particularly have risen meteorically in Russia since 1990. Mikhailov said the total number of drug users had risen 900 percent in the decade ending in early 2004. A Max Planck Institute study of the drug trade in Russia concluded that drug-related crimes increased twelve-fold from 1990 to 1999. Many analysts have traced the dramatic rise in use of injected heroin since the fall of the Soviet Union to economic collapse and attendant rises in unemployment, poverty and desperation and to increased availability of cheap heroin trafficked through central Asia and across the former Soviet states. Some observers have suggested that the aftermath of the events of September 11, 2001 in Afghanistan and central Asia has done nothing to stem the flow of heroin through the region and may even exacerbate it in the long run. Mikhailov of the SDCC has told the press on numerous occasions that the United States military intervention in Afghanistan has contributed to heroin consumption in Russia because the Taliban had been able to suppress opium production before they were overthrown. In 2003, Victor Cherkesov, head of the SDCC, said the drug trade in Russia was valued at about U.S. $8 billion a year."Source:Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 15.
(Prevalence of HIV in Russia Related to Injection Drug Use) "The Russian Federation borders on a generalised epidemic with a population prevalence of 1.0% (95% CI 0.9% to 1.2%).2 Official registration data from 2010 indicated over 38 000 prevalent cases in Moscow,3 the largest city of the Federation and the political and economic hub. The continued rise of HIV parallels the increase in sexually transmitted infections (STIs), most notably syphilis and Chlamydia, in the years following the fall of the Soviet Union,4 5 which subsequently stabilised to approximately 78.5 and 100.8 per 100 000, respectively, by 2004.6
"Russia’s epidemic is largely concentrated among vulnerable populations.2 7 Injection drug use (IDU), responsible for over half of all new infections, has been considered the primary driver.8 Sexual transmission is increasingly common and contributes approximately one-third of new HIV cases.8 9Source:Decker MR, Wirtz AL, Baral SD, et al., "Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers," Sexually Transmitted Infections (2012), doi:10.1136/sextrans-2011-050171
(Prevalence of Injection Drug Use and HIV/AIDS in Russia) "There is some controversy over the number of narcotic drug users in Russia. Dr. Vadim Pokrovsky of the Federal AIDS Center said that estimates of the number of active drug users in Russia in February 2004 ranged from 1 to 4 million, and he believed the high end of that range reflected the reality. On February 20, 2004, Alexander Mikhailov, the deputy director of the State Drug Control Committee (SDCC), a federal body, was cited in Pravda as saying that Russia had over 4 million drug users, and that the "gloomy prediction" of his office was that Russia could have over 35 million drug users by 2014. In early January 2004, the executive secretary of the Commonwealth of Independent States, which includes twelve former Soviet states, predicted that in 2010 the twelve countries would have 25 million drug users of whom 10 million would be living with HIV/AIDS, the vast majority in Russia."Source:Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," April 2004, Vol. 16, No. 5, pp. 14-15.
(HIV and IDUs in Russia and Central Asia) "In terms of absolute numbers, the Russian Federation is particularly affected with its 1.5 million addict population. The hugely damaging threat of HIV/AIDS is directly related to heroin injection. To date, there are over a quarter of a million registered HIV cases (although the number of unregistered cases is estimated to be much higher than this) in the Russian Federation. Of these, over 80% are intravenous drug users. In the CARs [Central Asian Republics], nearly 15 years of continuous heroin transit has created a local market of 282,000 heroin users, consuming approximately 11 mt of heroin annually. Local opium consumption is estimated at approximately 34 mt (although demand in Turkmenistan may be underestimated). This puts some Central Asian states on par with countries with the highest global opiate abuse prevalence."
(Availability of Naltrexone in Russian Federation) "In Russia, substitution therapy is forbidden by law, and naltrexone is the only available pharmacotherapy for heroin dependence. Due to the lack of alternatives to naltrexone and stronger family control of compliance (adherence), naltrexone is more effective for relapse prevention and abstinence stabilization in Russia than in Western countries. Long-acting, sustained-release formulations (injectable and implantable) seem particularly effective compared with oral formulations."Source:Krupitsky, Evgeny, Zvartau, Edwin, and Woody, George, "Use of Naltrexone to Treat Opioid Addiction in a Country in Which Methadone and Buprenorphine Are Not Available," Current Psychiatry Reports, 2010 October; 12(5): 448–453. doi:10.1007/s11920-010-0135-5.
(Abuse and Torture Masquerading as Drug Treatment Methods in Russia) "The inaccessibility and poor quality of services pertaining to the treatment of drug dependence in Russia have been extensively documented. Treatment methods reported include flogging, beatings, punishment by starvation, long-term handcuffing to bed frames, 'coding' (hypnotherapy aimed at persuading the patient that drug use leads to death), electric shock, burying patients in the ground and xenoimplantation of guinea pig brains62. The practice and acceptance of such methods clearly indicate that the government’s approach does not correspond to international drug treatment guidelines.
"Such methods are not only cruel but ineffective. As the Russian Federal Drug Control Service has acknowledged, over 90% of drug treatment patients return to using illegal drugs within one year63. As a result of the ineffective government approach to drug treatment and care, Russia has one of the largest numbers of people who use drugs—government estimate reaches 5 million64, while UNODC’s 2009 World Drug Report estimated that 1.6 million people use opiates65. Meanwhile, the number of people living with HIV in Russia continues to rise; in 2010 alone, a total of 58,633 new HIV cases were officially registered in the country66. Injecting drug use has long been the predominant risk factor, with around 80% of all HIV cases registered in the country from 1987 to 2008 associated with the use of injecting drugs67. The government’s refusal to respond adequately to the main transmission risk means that most of the funding goes to the management of the consequences rather than prevention of new infections. It is clear that 3% of the entire budget cannot possibly reach the most vulnerable population in an effective manner, and even the 3% spent on prevention is spent inefficiently."Source:Merkinaite, S. A war against people who use drugs: the costs. Eurasian Harm Reduction Network (EHRN), Vilnius: 2012, pp. 21-22.
(Potential Impact on HIV Transmission in Russia if Opioid Substitution Treatment Were Available) "A dynamic model of HIV transmission among people who inject drugs in Russia suggests that assuming a baseline HIV prevalence of 15%, increasing coverage of OST from 0% to 25% of all people who inject drugs could decrease HIV incidence by between 44% and 53%108."Source:Merkinaite, S. A war against people who use drugs: the costs. Eurasian Harm Reduction Network (EHRN), Vilnius: 2012, p. 32.
(Russian Economy, Corruption, and Money Laundering: US State Dept., 2013) "While there has been significant progress in improving the legal and enforcement framework, the prevalence of money laundering in Russia, high levels of organized crime, and corruption stand as major obstacles to this goal. A lack of transparency in the financial sector generally helps to enable corruption.
"Domestic sources of laundered funds include organized crime, evasion of tax and customs duties, fraud, public corruption, and smuggling operations. The country is considered a significant transit and destination country for international narcotics traffickers who also use the country to launder the proceeds of their crimes. "Criminal elements from Russia and neighboring countries continue to use Russia’s financial system and foreign legal entities to launder money. Criminals invest and launder their proceeds in securities instruments, both domestic and foreign real estate, and luxury consumer goods.
"Russia’s money laundering risk factors include an economic environment conducive to fraud; many large-scale financial transactions associated with its vast natural resources; the state’s major role in the economy; and chronic under-funding and lack of capacity of regulatory and law enforcement agencies. These factors help create an enabling environment for corruption and financial criminality. The country’s vast territory means that relations with both its regions and quasi-autonomous regions, especially in the Caucasus region, have relatively low oversight. Considerable vulnerabilities exist in relation to money laundering and the funding of terrorism in these areas."Source:United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume II: Drug and Chemical Control (Washington, DC: March 2013), pp. 180-181.
(Cost of Prosecuting Drug Offenders in Russia, 2010) "In 2010 alone, the prosecution of drug offenders (for use and supply) cost at least $100 million in Russia. In comparison, under the Budget Law for 2011, HIV prevention programming is to receive less than 3% of the total $640 million to be allocated in 2012 through the Federal Budget Law for HIV, hepatitis B and C, and the government continues to prohibit internationally accepted drug treatment interventions such as OST [Opioid Substitution Treatment]. The government therefore will spend millions more treating people infected with HIV than it would have in protecting their health and reducing transmission."Source:Merkinaite, S. A war against people who use drugs: the costs. Eurasian Harm Reduction Network (EHRN), Vilnius: 2012, p. 6.
(Value of Heroin Trade in Russia and Central Asia) "It is important to note that profits made from trafficking Afghan opiates into Central Asia (USD 344 million) in 2010 are dwarfed by the net profit pocketed by criminals trafficking onwards to the Russian Federation, which was around US$ 1.4 billion in 2010. This calculation does not include other drugs such as those of the cannabis group, which are also trafficked through the region.
"The mark-up on heroin brought into Central Asia and sold in the Russian Federation is as much as 600 per cent. As shown in the figure below, as prices increase purity decreases; this is explained by the growing distance from the source and by the practise of cutting the heroin with adulterants. This means that 1 kg of heroin at 70 per cent purity can become 2 kg at 35 per cent purity. This inversely proportional relationship between price increase and decrease in quality translates into greater profits for traffickers."Source:United Nations Office on Drugs and Crime, "Opiate Flows Through Northern Afghanistan and Central Asia: A Threat Assessment" (UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs, May 2012), p. 85.
(Use of Drug Enforcement to Silence Political Opponents) "It is important to note that Russian law enforcement agencies—including the Federal Drug Control Service (FDCS), which has an annual budget of $73 million35—often use drug charges as a way to silence political opponents, including human rights activists and journalists. A few examples:
" Since August 2011 Russian law enforcement agencies have been trying to suppress activities of the Andrey Rylkov Foundation (ARF), an organization that promotes and defends human rights of people who use drugs in Russia. First, ARF activist Irina Teplinskaya was planted with a tablet of methadone when she crossed the border from Ukraine to Russia in August 2011. Then in early 2012 the ARF website was shut down by the FDCS, which claimed that the information about OST posted on the ARF website should be categorized as drug propaganda, and thus prohibited under Russian drug laws36.
" Political activists Taisiya Osipova was prosecuted based on falsified drug charges by an anti-extremist police unit. In December 2011, despite obvious violations of procedural and substantial laws, Osipova was sentenced to 10 years in prison37.
" In April 2011 Evgeny Konyshev was planted with drugs by representatives of the 'City Without Drugs' Foundation after he openly testified on a federal TV channel about the Foundation’s ineffective and inhumane practices under the pretence of drug treatment. Despite multiple violations of procedural and substantial laws committed during the pre-trial investigation, by the end of February 2012 Konyshev remained in pre-trial detention facing a charge of possession of 'extra large' quantity of heroin (2.72 grams) with no intent to sell38.
" In 2010 anticorruption activist Denis Matveev was sentenced to six years imprisonment based on false accusation of drug trafficking after he reported corruption in his city involving police officers and members of the mayor’s office39."Source:Merkinaite, S. A war against people who use drugs: the costs. Eurasian Harm Reduction Network (EHRN), Vilnius: 2012, p. 16.
(The Emergence of 'Krokodil') "In the last three to five years an increasing number of reports suggest that people who inject drugs (PWID) in Russia, Ukraine and other countries are no longer using poppies or raw opium as their starting material, but turning to over-the-counter medications that contain codeine (e.g. Solpadeine, Codterpin or Codelac). Codeine is reportedly converted into desomorphine (UNODC, 2012; Gahr et al., 2012a, 2012b, 2012c; Skowronek, Celinski, & Chowaniec, 2012). The drug is called Russian Magic, referring to its potential for short lasting opioid intoxication or, more common, to its street name, krokodil. Krokodil refers both to chlorocodide, a codeine derivate, and to the excessive harms reported, such as the scale-like and discolored (green, black) skin of its users, resulting from large area skin infections and ulcers. At this point, Russia and Ukraine seem to be the countries most affected by the use of krokodil, but Georgia (Piralishvili, Gamkrelidze, Nikolaishvili, & Chavchanidze, 2013) and Kazakhstan (Ibragimov & Latypov, 2012; Yusopov et al., 2012) have reported krokodil use and related injuries as well."Source:Grund, J. -P. C., et al. "Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia." International Journal of Drug Policy (2013), http://dx.doi.org/10.1016/j.drugpo.2013.04.007
(Krokodil Production) "In considering the drug krokodil, two aspects are of importance, its pharmacology and its chemistry. The short half-life, limited high after the impact effect and, in particular the need for frequent administration may narrow the attention of users on the (circular) process of acquiring, preparing and administering the drug, leaving little time for matters other than avoiding withdrawal and chasing high, as reported in several popular magazines (e.g. Shuster, 2011; Walker, 2011). However, when the layers of bootleg chemistry and attribution are peeled off, what’s left is an opioid analogue (or several ones) that, besides the variations in half-life, behaves pharmacologically not very different than heroin or Hanka (Haemmig, 2011). There are various paths to synthesize desomorphine from codeine, but the chemical process most commonly reported to be used by PWID in Russia and Ukraine is very similar to that of home-produced methamphetamine or Vint (Grund, Zábransky, Irwin, & Heimer, 2009; Zábransky, 2007) – a rudimentary version of a simple chemical reduction. The illicit production of krokodil reportedly involves the processing of codeine into the opiate analogue desomorphine (UNODC, 2012; Gahr et al., 2012a, 2012b, 2012c; Skowronek et al., 2012). Desomorphine (Dihydrodesoxymorphine-D or PermonidTM ) is an opiate analogue first synthesized by Small in 1932 (Small, Yuen, & Eilers, 1933). The analgesic effect of desomorphine is about ten times greater than that of morphine (and thus stronger than heroin), whereas its toxicity exceeds that of morphine by about three times (Weill & Weiss, 1951). The drug’s onset is described as very rapid but its action is of short duration, which may lead to rapid physical dependence and frequent administration."Source:Grund, J. -P. C., et al. "Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia." International Journal of Drug Policy (2013), http://dx.doi.org/10.1016/j.drugpo.2013.04.007
(Harms Associated with Krokodil Use) "In recent years, harm reduction and drug treatment services from Russia, Ukraine, Georgia and Kazakhstan began reporting severe health consequences associated with krokodil injecting. Although serious localized and systemic harms have previously been associated with injecting homemade opiates and stimulants in the region (Grund, 2002; Volik, 2008), the harms associated with krokodil injecting are extreme and unprecedented. The most common complications of krokodil appear to be serious venous damage and skin and soft tissue infections, rapidly followed by necrosis and gangrene (Gahr et al., 2012a, 2012b, 2012c; Skowronek et al., 2012). Our research further identified an impressive, undoubtedly incomplete, list of injuries and symptoms (Table 1), reported in the media (e.g. Shuster, 2011; Walker, 2011) and identified in YouTube clips and photographs on the internet. Importantly, this list includes several parts of the body that are not typically used as sites for injecting drugs. This suggests that the ill effects of krokodil are not limited to localized injuries, but spread throughout the body (Shuster, 2011; UNODC, 2012), with neurological, endocrine and organ damage associated with chemicals and heavy metals common to krokodil production (Lisitsyn, 2010).
"It is important to note that the described harms seem to become manifest relatively shortly after krokodil injecting is initiated. Present accounts of krokodil related harms often concern young people presenting in emergency rooms and surgeries with extreme and advanced complications. According to NGOs that work with people who inject krokodil, these young people have relatively short histories of using the drug. Mortality rates among young krokodil users are reportedly high (Akhmedova, 2012; Shuster, 2011; Walker, 2011), with official reports associating krokodil use with half of all drug-related deaths in at least two Oblasts (Walker, 2011)."Source:Grund, J. -P. C., et al. "Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia." International Journal of Drug Policy (2013), http://dx.doi.org/10.1016/j.drugpo.2013.04.007
(Prevalence of Krokodile Use) "The estimated number of PWID in Russia was close to 2 million in 2008 (Mathers et al., 2008). 2.3% of the Russian population uses opioids annually and 1.4% heroin, compared to an annual prevalence of 0.4% opioid use in Western and Central Europe (UNODC, 2012). While actual epidemiological data is not available, a number of academic and media reports suggest that 5% or more of Russian drug users (approximately 100,000 PWID) may be injecting krokodil (Walker, 2011), while 'various official estimates' place the numbers of Russian PWID using krokodil as high as one million (Shuster, 2011). Epidemiological data is critical to evaluating claims that the use of krokodil is reaching epidemic proportions in Russia (Walker, 2011), and potentially, the Ukraine. There are an estimated 290,000 to 375,000 PWID in Ukraine (Mathers et al., 2008). A recent national survey found that 7% of PWID have used krokodil in 2011 (Balakireva, 2012), suggesting that around 20,000 PWID in Ukraine may have used krokodil that year. Balakireva and colleagues furthermore found statistically significant differences in krokodil use between the cities in the study, with most krokodil use reported in Uzhhorod (35.6%), Simferopol (26.9%), Kyiv (21.7%), Chernivtsi (15.5%) and Donetsk (12.6%). Estimates from other countries are not available. Outside of the former Soviet region, krokodil has been reported in Germany (Der Spiegel, 2011) and in Tromsø in northern Norway (Lindblad, 2012)."Source:Grund, J. -P. C., et al. "Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia." International Journal of Drug Policy (2013), http://dx.doi.org/10.1016/j.drugpo.2013.04.007
(Krokodil - Reasons and Risks) "In sum, these observations suggest that the relatively limited availability of black market opiates and stimulants and the relative ease of harvesting legal precursors to powerful analogues from the countryside and pharmacies inspired and sustained a Soviet-style homemade drug culture in the Eastern European region that remains radically different from those observed in countries where narco-traffickers dominate the production and distribution of drugs (Booth, Kennedy, Brewster, & Semerik, 2003; Grund et al., 2009; Grund, 2005; Subata & Tsukanov, 1999; Zábransky, 2007).
"The physical and logistical exigencies of home production; its locus in networks of drug injecting friends and the high degree of cooperative action involved (in foraging for, producing and using the drugs); the multiple roles and ambiguous status of injecting paraphernalia; the routine occurrence of well-known risk behaviours (e.g. syringe sharing, frontloading) and those currently less well understood, such as the slapdash nature of the bootleg drug synthesis and its unpredictable outcomes in terms of actual drug product, purity and pollution— indeed all of these factors contribute to and interact within the vastly complex high risk environment of home drug production in the region."Source:Grund, J. -P. C., et al. "Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia." International Journal of Drug Policy (2013), http://dx.doi.org/10.1016/j.drugpo.2013.04.007
(Stigmatization and Inhumane Treatment of Krokodil Users) "In Russia and many other post-Soviet countries, the old ideology lingers on in narcological institutes, out of sync with modern public and mental health concepts (Grund et al., 2009). Many narcologists continue to view addiction as criminal or moral deviance and not as a disease. Narcological dispensaries continue to share information with law enforcement (Mendelevich, 2011). The threat of removal of child custody rights may impede women’s access to health care in particular (Shields, 2009). Stigma and discrimination, hostile treatment and lack of confidentiality are persistent in the treatment of PWID and must be viewed as important barriers to timely seeking medical care (Beardsley & Latypov, 2012; Mendelevich, 2011; Wolfe et al., 2010). PWID have therefore strong incentives to avoid narcological facilities and, by association, other state health services. In their personal 'hierarchy of risk,' seeking help for significant health problems is subordinated by the need to stay under the radar of the authorities (Connors, 1992). Several of the YouTube clips on the internet furthermore document not only the gravity of harms among krokodil users, but also poor and inhumane treatment of those hospitalized with krokodil related injuries. In one video a man’s leg is sawn off under the knee with a lint saw in what seems not to be a surgical unit, but perhaps a common hospital ward. The man sits wide-awake in an ordinary wheelchair and holds his leg himself above a bucket, which was lined with a garbage bag just before. These videos and case reports (Asaeva et al., 2011; Daria Ocheret, personal communication, 2012; Sarah Evans, personal communication, 2012) suggest that the care provided to those with krokodil related injuries may be (grossly) substandard, sometimes exacerbated by improper diagnosis and faulty clinical decisions."Source:Grund, J. -P. C., et al. "Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia." International Journal of Drug Policy (2013), http://dx.doi.org/10.1016/j.drugpo.2013.04.007
Laws & Policies
(Russian Antidrug Strategy) "In June 2012, the government launched the 'State Counternarcotics Strategy until 2020' that calls all agencies and all levels of government to join in the fight against illicit drugs. The Strategy urges improvements in supply and demand reduction, and outlines new legislation aimed at deterring drug trafficking. An important development in implementing the Strategy in 2012 was the signing in March by then-President Medvedev of a law stipulating life sentences for trafficking large quantities of drugs. Previously, the maximum sentence was 20 years. The law also allows for the confiscation of property and money obtained by drug dealing."Source:United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control (Washington, DC: March 2013), p. 277.
(Russian Federal Drug Law Enforcement Agencies) "Four federal agencies in Russia conduct investigations of drug trafficking: FSKN, the Ministry of Internal Affairs (MVD), the Federal Security Service (FSB) and the Federal Customs Service (FTS). The FSKN is the primary drug enforcement agency and has an authorized staffing level of 40,000 employees, with branch offices in every region of Russia."Source:"International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control," Bureau for International Narcotics and Law Enforcement Affairs (Washington, DC: US Dept. of State, March 2012), p. 377.
(Criminal Penalties for Drug Possession in Russia) "Although in Russia drug use per se is not criminalized as in Georgia, possession without intent to supply in amounts exceeding 0.5 grams for heroin, opium or desomorphine is considered a crime and is punished by incarceration for up to three years27. At the same time it is important to emphasize that even where drug use is not a criminal offence, most countries apply administrative liability for it; in Russia, drug use can therefore result in 15 days arrest, which according to the European Court on Human Rights is equal to criminal liability."Source:Merkinaite, S. A war against people who use drugs: the costs. Eurasian Harm Reduction Network (EHRN), Vilnius: 2012, p. 15.
(Russian Juvenile Justice System) "The system of penalties for juveniles facing criminal charges in Russia is based on suspended sentences or detention in educational correctional facilities, which house young offenders aged up to 21 years. The average sentence is four years. Only one quarter of adult recidivists considered a high-risk to society are said to have been admitted to a VK [educational correctional facilities] as juveniles."Source:United Nations Office for Drug Control and Crime , "Illicit Drug Trends in the Russian Federation, 2005" (Moscow, Russian Federation: UNODC Regional Office for Russia and Belarus, November 2006), p. 15.
(Opioid Substitution Treatment Illegal in Russia) "Substitution (or replacement) therapy such as methadone maintenance therapy, which has been widely credited with controlling HIV transmission among injection drug users in many countries, is illegal in Russia, and the 2003 amendments to the drug law did not change this. Methadone is classified as "illicit" by the terms of the three United Nations conventions on drug control, though most countries that are signatories to the conventions have methadone programs that are successful in substituting injected heroin with noninjected methadone. In this case, neither the SDCC [State Drug Control Committee] nor the Ministry of Health seems necessarily disposed to review the status quo. Dr. Golyusov of the Ministry of Health said that he is concerned by first-hand accounts from drug users that methadone is more addictive or "harder to get off" than heroin and that other countries' experiences have been "contradictory.""Source:Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," April 2004, Vol. 16, No. 5, p. 23.
(Legal and Policy Barriers to Harm Reduction and Disease Prevention Services in Russia) "The main reasons cited for restricting the opportunity of drug users to obtain medical and social aid, including prevention services, are the legislative barriers and official policy course that emphasizes reducing supply through law enforcement and reducing demand by promotion of 'healthy lifestyle'. The Strategy of the Anti-Narcotic Policy of the Russian Federation until 202061 and the plan to implement the strategy reaffirmed that approach. The 10-year plan restricts all activities and advocacy associated with harm reduction and other evidence-based services for people who use drugs. OST [Opioid Substitution Treatment] and NSPs [Needle and Syringe Exchange Programs] are considered antithetical to the strategy because they are 'attempts to legalize substitution therapy with use of narcotic drugs and promotion of drug use under pretext of syringe replacement'. Non-governmental organizations (NGOs) are prohibited from providing information on OST and other treatment and prevention measures opposed by the government. Such restrictive policies clearly indicate that the punishment and social isolation of people who inject drugs is the basis of state’s strategic approach to drug demand reduction. These policies have high financial and social costs."Source:Merkinaite, S. A war against people who use drugs: the costs. Eurasian Harm Reduction Network (EHRN), Vilnius: 2012, p. 21.
(Russian Anti-Trafficking Legislation) "Russia has a legislative and financial monitoring structure that facilitates the tracking, seizure, and forfeiture of all criminal proceeds. Russian legislation provides for investigative techniques such as wiretapping, search, seizure and the compulsory production of documents. Legislation passed in 2004, entitled: "On Protection of Victims, Witnesses and Other Participants in Criminal Proceedings" extends legal protection to all parties involved in a criminal trial. Prosecutors or investigators may recommend that a judge implement witness protection measures if they learn of a threat to the life or property of a participant in a trial."Source:United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control (Washington, DC: March 2012), p. 378.
(Lack of Harm Reduction in Prisons in Russia) "Because of drug laws that have historically criminalized the possession of very small amounts of narcotics, drug users in Russia face a high probability of spending time in prison or pretrial detention at some time in their lives. Injection drug use is widespread in prisons. But basic HIV prevention measures, including condoms and materials for sterilization of syringes, are largely lacking in Russian correctional facilities, making prisons across the country high-risk environments for AIDS. The vast numbers of prisoners released every year thus represent a public health challenge for the general population. Both in and outside of prison, the virtual absence of humane services to treat drug addiction and the illegality in Russia of methadone and other drugs used elsewhere to treat heroin addiction further compromise HIV prevention among drug users."Source:Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 3.
(Russian Federation Policy Toward HIV and IDU) "The Russian Federation is facing a deadly epidemic of acquired immune deficiency syndrome (AIDS). It is driven in part by abuses of the human rights of those most at risk to get the disease and of the over 1 million Russians already living with the human immunodeficiency virus (HIV). The principal means of HIV transmission in Russia has been and remains injection drug use. But the Russian state has done little to support low-cost measures that would enable drug users to realize their right to be protected from this incurable disease. Instead, Russia has been a model of repression of drug users and stigmatization of HIV-positive people, putting the country squarely on the path of very high AIDS mortality and continued abuse of people affected by HIV/AIDS."Source:Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 1.
(Impact of Law Enforcement-Focused National Drug Policies in Russia) "The drug enforcement agencies are supported in their functions by strong drug control laws and high-level Governmental attention. While recent years have seen some increase in the resources devoted to the prevention of drug abuse and to the care for drug users, the major emphasis in the Government's policy is clearly targeted on addressing the problem of drug trafficking and production.
"Some outside observers believe that this heavy emphasis on law enforcement sometimes hampers efforts to address the problems of drug abuse, particularly among the youth. For one thing, there is some evidence that many drug users are sent to prison for drug trafficking, although they are arrested with small quantities of drugs in their possession. Since 1997, with the introduction of a new Criminal Code, the possession of a "small amount of narcotics" is not considered a criminal offence, but an administrative infraction. However, the definitions of what constitutes a "small amount" of the various drugs are established at extremely low levels. In the case of heroin, there is no quantity that can be considered a "small amount" and, thus, the possession of any quantity of that drug can be prosecuted as drug trafficking. This phenomenon, coupled with the fact that there are no juvenile courts in Russia, has resulted in the incarceration of many young drug users in adult prisons where there are few, if any, drug treatment programmes, and where they may be exposed to risks of violence, and of infection with tuberculosis and HIV/AIDS."Source:United Nations Office on Drugs and Crime, "County Profile: Russian Federation" (Moscow, Russia: UNODC Regional Office, Russian Federation, 2003) p. 33.
(Human Rights, Public Health, and Syringe Access in Russia) "State action that impedes people from protecting themselves from a deadly epidemic is blatant interference with the right of Russians to the highest obtainable standard of health. There is no dispute as to the effectiveness of sterile syringes for preventing HIV, hepatitis C and other blood-borne infections. Public health experts are virtually unanimous in the view that providing access to sterile syringes neither encourages drug use nor dissuades drug users from entering drug treatment programs. In reality, the near absence of humane treatment programs for drug addiction in Russia and the very nature of drug use guarantee that there will always be people who either cannot or will not stop using drugs. Impeding this population from obtaining or using sterile syringes amounts to prescribing death as a punishment for illicit drug use."Source:Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 3.
(Drug Treatment Largely Unavailable in Russia) "While provisions of the Federal Drug law guarantee state assistance to drug addicts, in fact, budgetary restraints have severely limited the capacity of state institutions to provide even a minimum level of support for drug users. Although the state drug-treatment centres are under the guidance of the Ministry of Health, they are, in fact, financed by the various administrative entities of the Federation. Since most of the oblasts and republics have severe financial restraints, in most cases, the drug-treatment centres have not been able to cope with the sudden expansion in the number of drug users requiring assistance. They lack the financial, material and staff resources to carry out the tasks, which are assigned to them by law. There are a few private treatment centres in some of the major cities, but only the wealthy can make use of their facilities. This general lack of treatment and rehabilitation facilities and activities for drug users are some of the reasons why the country has been facing extreme difficulties in attempting to address the very serious problem of HIV/AIDS infection among injecting drug users."Source:United Nations Office on Drugs and Crime, "County Profile: Russian Federation" (Moscow, Russia: UNODC Regional Office, Russian Federation, 2003) p. 34.