We write to express our deep concern about recent reports that the Cabinet of Ministers has proposed amending the list of scheduled drugs to reclassify methadone as a prohibited narcotic substance, thus barring its use for therapeutic purposes. This proposal contradicts recommendations from international health and drug enforcement bodies, which have advised the use of substitution therapy, including with methadone, as an integral part of HIV/AIDS prevention and treatment programs in Ukraine.
Opiate drug dependence plays an important role in fuelling the HIV/AIDS epidemic in Ukraine. Limiting access to substitution therapy will have a devastating impact on the human rights to health and life of all Ukrainians living with, or at risk of, HIV/AIDS, as well as those in need of treatment for opiate addiction. We urge you to oppose any changes in Ukrainian law or policy that would make it more difficult for injection drug users to obtain methadone and other drugs used in substitution therapy. We also urge you to ensure that methadone and other drugs used in substitution therapy are immediately available to those requiring treatment.
Ukraine is home to an estimated 360,000 people living with HIV/AIDS, the vast majority of them infected by injection drug use. An extensive body of research and evaluation has documented the effectiveness of substitution maintenance therapy, in particular with methadone, in reducing illegal drug use as well as criminal activity, overdose deaths, and behaviors such as syringe sharing that are associated with high risks of HIV prevention. In light of this evidence, the World Health Organization (WHO), the United Nations Office of Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued a joint statement in 2004 recommending that substitution maintenance therapy, including with methadone and buprenorphine, be integrated into national HIV/AIDS programs, both as an HIV prevention measure and to support adherence to antiretroviral treatment and medical follow-up for opiate dependent drug users. This recommendation applies particularly to countries such as Ukraine, where opiate dependence plays an important role in HIV transmission risk. The joint U.N. recommendations also emphasized the importance of ensuring access to a range of substitution therapy options, noting that no single treatment method is effective for all opiate-dependent individuals.
We recognize that Ukraine has taken important steps to introduce substitution therapy with buprenorphine in the six regions hardest hit by HIV/AIDS. However, as WHO, UNODC and UNAIDS emphasized in a June 2005 report on substitution therapy in Ukraine, these pilot programs are insufficient to address the treatment needs of opiate-dependent Ukrainians, and in turn to curb Ukraine’s burgeoning HIV/AIDS epidemic. These agencies noted in the report that methadone therapy is at least as effective as buprenorphine and significantly less expensive. They therefore recommended that the government “do everything in its power to simplify the introduction and scale up of methadone maintenance treatment.”
In the June 2005 report, the WHO, UNODC, and UNAIDS also reaffirmed that methadone and other forms of substitution therapy are consistent with the 1961, 1971, and 1988 United Nations conventions on narcotic drugs. The report concluded that interpreting Ukrainian legislation to allow the use of methadone for substitution therapy would be consistent with these conventions. Further, Ukraine is a state party to the International Covenant on Economic, Social and Cultural Rights, which recognizes the right of all individuals to the enjoyment of the highest attainable standard of health. Banning the therapeutic use of a substance that affords drug users the hope of effective of treatment for their opiate addiction and that significantly reduces their risk of infection with HIV/AIDS and other blood-borne diseases constitutes blatant interference with the right to health.
This is an important moment for Ukraine in its efforts to address its HIV/AIDS epidemic, with the launch of buprenorphine therapy and the scale-up of antiretroviral therapy programs. It is critical at this juncture that Ukraine use all the tools available to support these efforts. We strongly urge you to use your leadership to ensure that methadone is included as part of a rapid scale up of substitution therapy in Ukraine and thus contribute to an environment where all Ukrainians can enjoy their right to health and right to life.
Europe and Central Asia Division
HIV/AIDS and Human Rights Program
Cc: Mykola Tomenko, Deputy Prime Minister of Ukraine
Cc: Nina Karpacheva, Commissioner on Human Rights / Parliamentary Ombudsman
Cc: Olena Alexeyeva, Head of Committee, Special Committee on Drug Control Ministry of Health of Ukraine
Cc: Yuriy Lutsenko, Minister of Internal Affairs of Ukraine
Cc: Oleksandr Turchinov, Head of the National Security Service of Ukraine