"As noted above, human rights organizations and UN bodies have documented human rights violations against PWUD in Russia, including the absence of drug dependence treatment for people living with HIV and tuberculosis [56], the use of unscientific methods and the drug user registry in drug dependence treatment [57], and the prohibition on OST [57, 58].

"Analysis of court statistics demonstrates that the 2013–2014 amendments have not led to the expected outcome of “motivating” PWUD to undergo drug treatment or rehabilitation. Only about 2% of people convicted for drug administrative offenses chose to undergo treatment rather than punishment (about 1500 out of more than 70,000) [32] and only about 1% of 48,557 people who were involuntarily ordered to undergo drug dependence treatment remained drug-free within a year or more after treatment.

"Recently, this opposition to science and human rights reached a new frontier. In 2010, Russia’s Chief Narcologist announced his endeavor to create a four-level system of “social pressure” in order to respond to the country’s “drug problem” [26]. The first level of this system involves “early detection” of drug use by way of school and workplace testing; the second level is voluntary drug treatment; the third level is compulsory treatment by referral from the criminal justice system; and the fourth level is compulsory treatment within the criminal justice system.

"The latest information, obtained directly by us from the Ministry, covers the year ending 2017, and reports the number of newly registered PLHIV [People Living with HIV] has increased by 105,844. Clearly, this is not an exact measure of incidence, but it gives an indication that numbers continue to rise unabated.

"According to multiple sources, drug users in Russia have numbered between 7.3 to 8.5 million for the past several years. At an October 2017 Saint Petersburg conference, experts reported that in 2016, there were 637,482 people incarcerated in Russia, for which 63 percent were for drug offenses, and 10 percent of whom are HIV positive.

"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 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.

"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 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.

"By far the highest prevalence of HIV among PWID [People Who Inject Drugs] is in South-West Asia and in Eastern and South-Eastern Europe, with rates that are, respectively, 2.4 and 1.9 times the global average. Together, those two subregions account for 49 per cent of the total number of PWID worldwide living with HIV. Although the prevalence of HIV among PWID in East and South-East Asia is below the global average, 24 per cent of the global total of PWID living with HIV reside in that subregion.