Britain should welcome Ukrainians with drug problems – they desperately need our help

If Russia takes control of Ukraine, harm reduction and treatment will be terminated – a move that is sure to cultivate blood-borne viruses such as HIV and hepatitis

For those with drug problems who are unable to leave Ukraine, the future looks increasingly bleak (Getty Images)

The war in Ukraine is filling the headlines – but behind the scenes is another battle that has been raging since 2011: Vladimir Putin’s war on drugs.

The Russian president recently accused the Ukrainian leadership of being “a gang of drug addicts”, making clear his view of Ukrainian politicians – as well as people who are dependent on drugs.

His strident views on addiction are well-documented: in 2011, he declared “total war” on those that use drugs; yet, paradoxically, the number of Russians using drugs rose from an estimated 6 million in 2011, to the most recent estimate of 8 million people in 2018. In my view, this only serves to demonstrate how this punitive policy facilitates expansion – rather than contraction – of drug use.

Russia is the only country among 47 member states of the Council of Europe to prohibit opioid substitution therapy (OST). This evidenced-based treatment provides an alternative to using heroin and other opiates, so that people have a route to recovery and abstinence.

By contrast, Ukraine has adopted a harm-reduction approach to those that use drugs – which includes OST. According to the statistics, Kyiv alone has 1,328 people registered with treatment services, out of 317,000 total users across Ukraine. Of these, nation-wide, 14,868 are in treatment.

For those providing drug treatment in Ukraine, war has severely impacted their ability to continue operating. The situation fluctuates on a daily – if not hourly – basis.

Judy Chang, executive director of the International Network of People Who use Drugs (INPUD), said that despite a shipment of methadone arriving in Kyiv from a factory in Odessa, transporting the medication to other parts of Ukraine is difficult – and leaves some patients without a supply of medication, which – in addition to all the other risks and stresses they face – adds the prospect of abrupt opiate withdrawal.

Chang says there are an estimated 7000 patients accessing private prescriptions for drugs like methadone. Few people knew about the size of this patient group until the invasion. Yet, as the state prioritised supply of medicines to their clinics, it swiftly became apparent how many Ukrainians had been accessing private treatment.

Until recently, patients in cities like Luhansk were advised to go west to avoid running out of medication. Unfortunately, treatment programmes and supplies of medication are now compromised there too – as Russia extends bombing to cities that were thought to be safe.

Moving west is only an option for those with money, as transport costs are escalating – some are paying $700 to move from one part of the country to another – an option only a few can afford.

Logistics are not the only issue: doctors are leaving to join the army or to support their family. Consequently, the Ukrainian Ministry of Health is now permitting up to 30 days of methadone to be handed out rather than the usual daily dose. This sounds positive – but these prescriptions are often cut by 50 per cent, so patients only receive 15 days’ worth of medication, which is expected to last 30 days.

Extending prescriptions reduces daily treatment journeys, which are increasingly dangerous as Russian forces target more Ukrainian cities. Yet navigating this danger are the legion of workers who continue providing treatment, despite the personal risks. You won’t see their efforts or hear their stories, but their compassion and courage exemplify a selfless and steely humanity, ensuring Ukrainians who have problems with drugs are not abandoned during this war.

Naomi Burke-Shyne, from Harm Reduction International, warns that Putin’s invasion “has destroyed the best practice health interventions in Ukraine which support people who are most vulnerable – including people who use drugs, people living with HIV and people in need of pain relief – and will have life changing repercussions for years to come”. This is a truly bleak assessment of the current situation, and its potential legacy.

With more than 2 million Ukrainians seeking refuge, the Ministry of Health is negotiating with its counterparts in Poland, Romania, Moldova and Slovakia to secure access to medications – including OST. Missed doses can trigger severe withdrawal symptoms, which potentially pushes people back to street heroin.

There are significant differences in the way countries provide opiate treatment, and many are not as progressive as Ukraine. Recent ceasefires opened humanitarian corridors to Belarus and Russia, both of which are opposed to treatment. The Ministry of Health’s efforts are supported by the International Narcotics Control Board, which has encouraged these countries to provide access to substitute opiates for refugees.

For those with drug problems who are unable to leave Ukraine, the future looks increasingly bleak – not only do they risk abrupt opiate withdrawal due to running out of medication; but if Russia takes control of Ukraine, harm reduction and treatment will be terminated – a move that is sure to cultivate blood-borne viruses such as HIV and hepatitis, as people will be unable to access clean needles and syringes.

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This is exactly what has already happened in Russia, where 40 per cent of new HIV infections are linked to those injecting drugs. Without access to needle and syringe exchange programmes, these viruses are free to spread. Contrast this with Ukraine – which has adopted the World Health Organisation recommendation to provide harm reduction interventions, as these positively impact both rates and treatment of HIV.

One uplifting aspect of this war is the hospitality offered by people in Poland and other neighbouring countries welcoming refugees from Ukraine into their homes. That same generosity is emerging in the UK, although this has been stifled by the incompetence of the home secretary.

Kindness cannot be conditional; it must be extended to all refugees including those who have problems with drugs. Otherwise, we risk mirroring Putin’s intolerance and mistreatment of this group as we judge who is worthy of our empathy. Sadly, I fear many UK homes will not open their doors to these refugees, although I desperately want to be proved wrong. They need our help as much as anyone.

The Independent has a proud history of campaigning for the rights of the most vulnerable, and we first ran our Refugees Welcome campaign during the war in Syria in 2015. Now, as we renew our campaign and launch this petition in the wake of the unfolding Ukrainian crisis, we are calling on the government to go further and faster to ensure help is delivered. To find out more about our Refugees Welcome campaign, click here. To sign the petition click here. If you would like to donate then please click here for our GoFundMe page.