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Immediately lift the ban on the medical use of methadone and buprenorphine in the treatment of drug dependence, and introduce maintenance therapy programs.
Remove the ban on detoxification in private clinics.
Consider adding capacity to detoxification facilities where waiting lists exist, including by introducing outpatient detoxification services.
Adopt and fund a federal plan aimed at increasing the availability of rehabilitation treatment by opening new rehabilitation programs and centers in regions that do not currently have any. This plan should have a clear timeline and benchmarks for implementation, and should prioritize regions and towns on the basis of need. These steps should coincide with measures to address the low uptake of rehabilitation treatment, including the introduction of psychosocial counseling during detoxification and steps to end the overmedication of patients in detoxification (see also below).
Take steps to ensure drug users can enter treatment without delay. Tests for various health conditions should be conducted at the narcological clinic or through cooperation with other relevant healthcare structures. Steps must be taken to end waiting lists.
Create conditions at narcological clinics that are conducive to recovery of patients. Proper hygiene should be observed. Medical personnel should be compassionate toward patients. The practice of mixing drug users and alcoholics should be ended.
Local and federal authorities should, consistent with the requirement of the Russian constitution, provide adequate funding to narcological clinics. Out-of-pocket charges for medications should be ended. Narcological clinics should clearly display information on the cost of various paid services.
Narcological clinics should take steps to counter distrust among drug users. These steps should include tough action on corrupt practices and proactive outreach to the drug user community. Clinics should seek active cooperation with harm reduction programs and self-help groups.
Integrate evidence-based drug treatment policies into the drug treatment system.
Introduce differentiated treatment goals and indicators that take into consideration the chronic nature of drug dependence disease, and the particulars of individual patients.
End overmedication of patients in detoxification. Review existing treatment protocols and amend them in accordance with research findings on effective detoxification procedures.
Introduce psychosocial interventions as an integral part of the detoxification procedure. Treatment protocols for detoxification should contain clear guidance on the kinds and frequency of interventions that should take place during detoxification.
Take steps to ensure all patients in detoxification receive proper counseling on HIV and other diseases that are prevalent among drug users, as well as about overdose prevention. HIV counseling should include information about transmission prevention, including needle exchange, as well as about treatment of HIV. Narcological clinics should work together on this with AIDS centers and HIV/AIDS groups.
Reform the drug user registry. Blanket restrictions on rights of people on the registry should be removed. They could be replaced with a system that assesses the need in individual cases.
Take steps to ensure confidentiality of medical information. All narcologists should be reminded of confidentiality rules. The procuracy should review all regulations on cooperation between narcological services and law enforcement to ensure that they do not require the improper sharing of confidential information.
The fee-for-anonymity system should be abolished. People should not have to pay for confidentiality of their medical information.
Create a single document that outlines the rights of patients of narcological clinics.
Immediately adopt instructions on harm reduction programs that are in line with evidence of best practices.
Permit and encourage scientific discussion about maintenance therapy.
The international community, including UNAIDS, WHO, and UNODC, should actively encourage Russia to adopt evidence-based drug dependence treatment practices and implement the recommendations of this report.
The World Health Organization should develop and widely distribute best practice guidelines on drug dependence treatment.
The international community should provide funding to NGOs and other structures that provide drug dependence treatment and harm reduction services.
November 2007
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