Use of Methadone To Curb Rising Injection Drug Use, Spread of HIV in Russia Examined at Conference

Faced with a "steady increase" in injection drug use that is cited as the leading cause of the spread of HIV/AIDS in Russia, a meeting of physicians and specialists was held in the country in February to discuss the use of methadone in treating injection drug users, which number between three million and six million in Russia, the New York Times reports. Although injection drug use is "widely linked" to the country's HIV/AIDS epidemic, "the issue of methadone treatment is all but taboo" in Russia, according to the Times.

Injection drug use in Russia accounted for about 66% of new HIV/AIDS cases in 2006, and the numbers continue to grow, though not as quickly as in the past, according to UNAIDS. The Russian government estimated that as of 2007, more than 400,000 people in the country were HIV-positive, out of a population of about 142 million. The United Nations' estimated in 2005 that 940,000 were living with HIV in the country. The Times reports that although methadone is central to a therapy endorsed by the United Nations and 55 other countries to treat IDUs, there is considerable opposition to the treatment in Russia. Some opponents argue that methadone keeps patients in lifelong addiction, while others say that Western countries push the treatment on Russia for commercial profit. There also are fears that methadone could enter the black market, because there is a considerable amount of corruption at many clinics throughout the country, according to the Times.

At the conference, Gennady Onishchenko, Russia's chief sanitary physician, said health officials "are not convinced" that methadone "is effective," adding, "There is little optimism for legalizing methadone therapy in the near future." Nikolai Ivanets -- the country's top narcotics specialist, who criticized the professional credentials of some conference participants -- said, "Everyone has become so annoyed with methadone, with the exception of a few groups of people who call themselves specialists." Ivanets added, "This is a group of dissenters." Vladimir Mendelevich -- director of the Institute for Research Into Psychological Health and organizer of the conference who supports methadone use -- said, "There is no possibility to have a normal discussion about this issue."

According to the Times, some Russian specialists, along with current and former IDUs, "have begun to challenge the official line." Evgeny Krupitsky, head of a laboratory that conducts research on drug addiction at St. Petersburg State Pavlov Medical University, said, "Scientific arguments, evidence-based data, are not convincing" opponents of methadone. Russian methodology regarding opiate addiction "is not evidence-based," but relies on "subjective opinions of major leaders in the field," Krupitsky added. Although not all IDUs would benefit from methadone treatment, more than 60% in Russia would, Krupitsky said. The Times reports that many researchers on both sides of the methadone debate agree that only a small fraction of heroin users in Russia seek treatment at detoxification centers and that most who do -- some say more than 90% -- relapse into drug use shortly after leaving.

At the clinics, physicians encourage immediate abstinence from drug use rather than the gradual process that methadone substitution therapy entails. Patients also receive sedatives and painkillers to cope with withdrawal symptoms. Many are allowed to leave after one or two months with the expectation that they will remain drug-free; however, few do so, the Times reports.

Consequently, methadone supporters or other opiate substitution therapies say that if properly administered by medical professionals, the treatment can end IDUs' dependence on drugs, acting as a surrogate to ease withdrawal symptoms while decreasing the risk of overdose (Schwirtz, New York Times, 7/22).