ÿþ1

00:00:03,103 --> 00:00:07,273

Russia and Methadone: Breaking the Ice



2

00:00:07,307 --> 00:00:12,245

The Russian Federation is experiencing one of the most rapid growth of HIV/AIDS infections in the world, 



3

00:00:12,345 --> 00:00:17,083

and most infections are due to the sharing of needles and syringes among injecting drug users. 



4

00:00:17,450 --> 00:00:22,055

These infections are easily prevented in other countries using cheap and effective programs 



5

00:00:22,055 --> 00:00:27,927

such as the provision of sterile needles and the substitution of street heroin with medications like methadone. 



6

00:00:27,927 --> 00:00:33,800

However, Russia ignores the scientific evidence and still refuses to adopt these harm reduction programs. 



7

00:00:35,402 --> 00:00:39,839

At the 53rd session of the Commission on Narcotic Drugs of the United Nations 



8

00:00:40,206 --> 00:00:46,112

HCLU's video advocacy team attended the press conference of the Russian delegation to ask why.



9

00:00:46,846 --> 00:00:51,518

In the European Union, they have methadone prescription programs.



10

00:00:53,286 --> 00:00:57,123

Does the Russian government think that maybe introducing these kinds of programs 



11

00:00:57,123 --> 00:00:59,893

could decrease the demand for drugs in Russia?



12

00:01:00,093 --> 00:01:06,699

As for the second question on substitution therapy, which in most part concerns methadone treatment,



13

00:01:07,300 --> 00:01:13,373

- I can say that in Russia a consolidated opinion of our scientific experts, 



14

00:01:13,573 --> 00:01:19,212

including narcologists and health authorities, is constantly kept against it.



15

00:01:19,312 --> 00:01:23,783

Moreover, the world science does not yet dispose of scientifically proven clinical trials



16

00:01:23,850 --> 00:01:28,154

that confirm the effectiveness of this method.



17

00:01:28,321 --> 00:01:36,129

In this issue we share the position with our colleagues in the United States.



18

00:01:36,129 --> 00:01:44,237

However, we do not prohibit certain experiments with the methadone therapy in our regions. We do not ban it.  



19

00:01:44,270 --> 00:01:48,641

But altogether we do not provide the federal support to the methadone treatment.



20

00:01:54,180 --> 00:01:57,884

Yesterday, Mr Ivanov from the Federal Drug Control Agency



21

00:01:57,884 --> 00:02:02,355

said that there is no evidence that methadone substitution treatment works.



22

00:02:02,922 --> 00:02:09,696

I ask again, is there any way that the UNODC can engage in a dialogue



23

00:02:09,696 --> 00:02:13,366

with the Russian government to change their position 



24

00:02:14,134 --> 00:02:17,937

Regarding Russia, yes, I did attend myself the session



25

00:02:18,071 --> 00:02:23,276

the meeting with the press   by the Russian drug czar, Mr Ivanov.



26

00:02:23,309 --> 00:02:30,783

Yes, he made a statement about substitution therapy and methadone as not being successful.



27

00:02:30,817 --> 00:02:35,622

We are all entitled to our views, that's what he said. I would have not said that,



28

00:02:35,622 --> 00:02:38,491

but I also recall, and I pay tribute to him



29

00:02:38,525 --> 00:02:45,598

he said that there is no federal legislation in Russia supporting methadone facilities



30

00:02:45,632 --> 00:02:47,901

but we allow experimentation to go on; 



31

00:02:47,967 --> 00:02:56,042

we allow regional entities including municipal administrations to engage in substitution therapy. 



32

00:02:56,109 --> 00:02:58,978

I believe that this is something quite positive.



33

00:02:59,012 --> 00:03:04,984

What we are left with is to help Russia understand the question. Thank you very much.



34

00:03:14,827 --> 00:03:17,997

Yesterday there was a press conference of the Russian delegation



35

00:03:18,031 --> 00:03:22,435

and Mr. Ivanov of the Federal Drug Control Agency said that



36

00:03:22,502 --> 00:03:27,440

there is absolutely no evidence that methadone works



37

00:03:27,540 --> 00:03:31,611

What is the position of the European Commission on opiate substitution treatment?



38

00:03:32,545 --> 00:03:37,617

The exact opposite of what Mr Ivanov says on all accounts.



39

00:03:37,617 --> 00:03:42,021

We believe that it is peer-reviewed scientific evidence and we are using it. 



40

00:03:42,021 --> 00:03:45,291

We are using methadone treatment all throughout the EU



41

00:03:45,325 --> 00:03:46,826

and we are not going to change that. 



42

00:03:47,126 --> 00:03:52,098

Do you think that the EU can have a role in convincing the Russians?



43

00:03:52,665 --> 00:03:55,468

We re trying.  We re trying and we keep talking to them.



44

00:03:55,468 --> 00:04:01,574

And we also know that we have the support of the partners, like the US.



45

00:04:01,574 --> 00:04:05,144

I would hope that anybody who is dealing with the Russian government



46

00:04:05,144 --> 00:04:08,348

is giving them much better advice than they get now from their specialists.  



47

00:04:08,381 --> 00:04:11,384

Anybody who speaks, Mr Ivanov, or anybody else who says that



48

00:04:11,417 --> 00:04:16,522

this is not an evidence-based intervention, is directly, scientifically wrong.



49

00:04:16,689 --> 00:04:23,896

Furthermore, during the use of methadone treatment in Ukraine, Belarus and the Baltic states 



50

00:04:24,297 --> 00:04:28,835

we see only the worsening of the drug situation.



51

00:04:29,068 --> 00:04:32,805

In other words, there is no effect or vice versa a negative effect.



52

00:04:32,872 --> 00:04:35,441

What are your experiences with methadone programs in Lithuania?



53

00:04:35,441 --> 00:04:38,745

How many programs do you have and how successful are they?



54

00:04:38,745 --> 00:04:43,516

 Substitution treatment was implemented in Lithuania in 1995.



55

00:04:43,583 --> 00:04:47,820

I expect that this is quite a long time for results.



56

00:04:47,820 --> 00:04:54,694

The main point is that substitution treatment and related services



57

00:04:54,694 --> 00:05:07,407

led us to decrease new HIV cases from 70% five years ago, to 30%.



58

00:05:07,407 --> 00:05:09,809

It is a quite positive result   I think.



59

00:05:09,942 --> 00:05:12,545

I ve been working with the Clinton Foundation in the Ukraine



60

00:05:12,578 --> 00:05:15,615

since the advent of methadone in the country,



61

00:05:15,615 --> 00:05:17,817

particularly in the Oblast of Dnipropetrovs k 



62

00:05:18,084 --> 00:05:20,019

It has worked out very well. 



63

00:05:20,053 --> 00:05:23,623

There are now over 500 patients in the Oblast on methadone   



64

00:05:23,623 --> 00:05:28,261

they need many more in order to impact the huge drug problem that they are having there now.



65

00:05:28,261 --> 00:05:31,097

But the patients are extremely happy with it. 



66

00:05:31,130 --> 00:05:33,599

It is just phenomenal to see the changes in their lives.



67

00:05:33,599 --> 00:05:43,343

But on the other hand, we have medical data confirming that while the heroin intoxication is withdrawn within two weeks, 



68

00:05:43,776 --> 00:05:49,716

the withdrawal of methadone intoxication takes forty days.



69

00:05:49,749 --> 00:05:54,554

Well, many countries start with narcotic clinics detoxifying patients



70

00:05:54,587 --> 00:05:58,257

and hoping to support them after they have stopped taking heroin.



71

00:05:58,291 --> 00:06:02,195

In fact, we have seen from so many studies that this not only does not work, 



72

00:06:02,261 --> 00:06:06,699

but those that relapse   and there will be many, everyone, as a basic human right,



73

00:06:06,699 --> 00:06:13,106

needs access to the medication that will save their lives, prevent infection,  and prevent overdose.



74

00:06:23,483 --> 00:06:29,689

I have a question for Mr. Sidibé, if you can clarify for us whether we can consider 



75

00:06:29,722 --> 00:06:32,925

the restriction of access to sterile needles,



76

00:06:32,992 --> 00:06:37,797

and the denial of methadone treatment to drug users, a human rights violation.



77

00:06:38,030 --> 00:06:38,998

If you could talk about this.



78

00:06:39,031 --> 00:06:46,506

For me, not giving the right to people to have access to services,



79

00:06:46,506 --> 00:06:51,477

when those services can save lives, it is a violation of human rights.



80

00:06:51,811 --> 00:06:53,613

And I am just saying that like that.



81

00:06:57,183 --> 00:07:00,686

Allan Clear from the Harm Reduction Communication in New York.



82

00:07:00,686 --> 00:07:06,459

When a country like Burma violates human rights, they are internationally isolated.



83

00:07:06,859 --> 00:07:11,731

When Russia comes to meetings like this and denies the science behind methadone,



84

00:07:11,831 --> 00:07:15,501

and needle exchange, and publicly refutes the science that we all believe in,



85

00:07:15,535 --> 00:07:21,207

not a word is said.  And yet, they are denying access to all these medications,



86

00:07:21,207 --> 00:07:25,945

to methadone, to sterile syringes, and there is no response.



87

00:07:25,978 --> 00:07:31,417

What can we do, as an international community, to actually put pressure on the Russians?



88

00:07:31,884 --> 00:07:39,525

The IAS does not really have the opportunity to put any formal pressure,



89

00:07:39,525 --> 00:07:47,333

other than bringing the evidence, making the evidence known and highlight the gaps present.



90

00:07:47,533 --> 00:07:49,869

 Russia has the largest epidemic in the region,



91

00:07:49,869 --> 00:07:52,171

with a million people infected with HIV



92

00:07:52,171 --> 00:07:57,977

and we are deeply concerned by the non-availability of opiate substitution therapy



93

00:07:58,010 --> 00:08:01,280

and the fact that the vast majority of needle and syringe programs



94

00:08:01,347 --> 00:08:03,583

are being supported by external donations.



95

00:08:03,616 --> 00:08:07,487

 We personally believe that when scientific evidence is there,



96

00:08:07,487 --> 00:08:13,059

it needs to be used and used to reduce certainly the suffering.



97

00:08:13,259 --> 00:08:17,497

We count of all of you, the press, to make this a priority and



98

00:08:17,497 --> 00:08:22,168

to highlight the nature of the deficiency we are here outlining for you.



99

00:08:32,845 --> 00:08:40,253

Subtitling: Arielle Reid, István Gábor Takács