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Russia: Drug Users Face Lonely, Uncertain Road To Recovery

Trying to kick the habit at a rehab facility in Yekaterinburg (AFP) Eduard is a survivor.

At 32, this young man from Russia's Tatarstan Republic has almost a decade of heroin abuse behind him. After years of dependence and a series of failed attempts to quit drugs, Eduard signed up for detoxification at a state-run clinic in 1998.

He relapsed just months later.

"The treatment there wasn't good," he says. "They locked me within four walls, with the sole task of quitting drugs. No one talked to me about how to lead a drug-free life afterward. The attitude to me was like in a shop: I pay, they deliver."

Despite the setback, Eduard was still determined to give up heroin. He eventually turned to Roza Vetrov (Wind Rose), a nongovernmental organization founded in 2002 in the republican capital, Kazan, that offers free psychological and social rehabilitation to drug abusers.

"The most extraordinary thing in my life then happened," he says. "I saw that it was possible to put the information I had been given at the Roza Vetrov rehabilitation center into practice, that this would help me stay away from drugs. I saw the light."

Eduard has been off heroin for nearly a year. He now works at Roza Vetrov, helping others to combat their own drug addictions.

Success stories like Eduard's are few and far between in Russia, where the wave of heroin that swept the country following the Soviet collapse has claimed hundreds of thousands of lives and destroyed countless others.

Lack Of Official Resolve

Russia today ranks as a leading consumer of heroin, which is easily smuggled from Afghanistan through the porous borders of Central Asia. According to official figures, some 10,000 Russians die every year from drug overdoses and another 70,000 from drug-related health conditions.

Despite such catastrophic figures in a country struggling with a demographic crisis, Russia's drug victims have largely been overlooked by a presidential administration keen on touting its social achievements.

The state remains the chief provider of dependence treatment in Russia, although private clinics and support groups like Roza Vetrov have mushroomed in recent years. As few as 10 percent of drug abusers, however, make it to so-called "narcology dispensaries" -- state inpatient facilities for alcohol and drug detoxification -- and fewer still succeed in staying off narcotics.

The reason for this, according to Human Rights Watch, is the poor treatment offered at these clinics -- so poor, in fact, that the international watchdog says it constitutes a violation of the right to health.

"Because of the lack of effective drug-dependence treatment, there are a lot of drug users in Russia who are at risk of becoming HIV-infected, at risk of getting hepatitis C, at risk of overdose," says Diederik Lohman, who co-authored a recent Human Rights Watch (HRW) report on drug dependence in Russia. "If Russia were to improve its drug-treatment system, many of these people would be able to lead productive lives."

One of the first steps would be to expand the network of state rehabilitation centers, which are available only in one-third of Russia's regions. Detoxification treatment at such facilities consists of removing drugs from the bloodstream, but offers no advice on how to rebuild a drug-free life after leaving the clinic.

Beating The Odds

HRW says more than 90 percent of addicts, like Eduard, relapse within a year of undergoing detoxification.

"In many regions in Russia there is no state rehabilitation," says Lohman. "People either have to pay for rehabilitation services in private facilities, which is often too expensive, or turn to rehabilitation centers that are run in many regions by religious organizations. So a very large percentage of those who go through detoxification never actually get into a rehabilitation program. Many of those people then very quickly go back to using drugs."

Another key obstacle to combating drug dependence in Russia is the practice of listing patients undergoing detoxification at state facilities on a national registry that restricts some of their rights, such as obtaining a driver's license or holding certain jobs. Human Rights Watch says clinics also regularly leak their lists of drug patients to law-enforcement agencies.

Former drug addicts can be removed from the registry after a five-year period of abstinence -- a single relapse resets the complete procedure.

The registry not only acts as a strong deterrent to those seeking to give up drugs, it also encourages discrimination and bribe taking. In most regions, drug users can avoid the registry by footing hospital bills themselves, and some clinics have been reported to use the registry to pressure drug users into coughing up the money.

Eduard, like many others, opted for the self-pay treatment. "I paid 18,000 rubles [$730] in order not to figure on the registry," he confesses. "What most scared me was the prospect of being on the registry, of not being able to find a job. People don't trust former drug addicts, even those who haven't been taking drugs for a long time. That was the most frightening thing for me."

Old Habits

For those ending up on the registry, who number around 340,000, the incentive to clear one's name rarely translates into successful rehabilitation. Nikolai Ivanets, Russia's chief narcologist, admits that most people are taken off the registry not because they recover but because they die.

The registry is a holdover from the Soviet Union, whose health system was more concerned with placing drug addicts under surveillance than helping them kick their habit.

On the whole, Moscow's hard line against those who fall victim to hard drugs has not changed much over the past two decades, and they continue to be treated as criminals rather than victims.

"Today's drug-related health care is a product of the Soviet era. It hasn't changed much, it remains repressive," says Oleg Zykov, the director of Russia's No To Alcoholism And Drug Abuse foundation. "In Soviet times, drug-treatment care was part of the repressive system and focused chiefly on limiting people's rights. The federal drug-dependence services, represented by the National Narcology Research Center, is a completely obsolete structure that has failed to find its place in today's Russia."

With adequate support, however, breaking the vicious circle of drugs is not beyond reach for Russia's estimated 4 million to 6 million drug addicts. The lack of a national strategy to combat drug dependence makes local initiatives such as Kazan's Roza Vetrov all the more vital -- not only to save lives, but also to show that addicts, even hardened ones like Eduard, are not a lost cause.

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