In Control?: Ukrainian Opiate Substitution Treatment Patients Strive for a Voice in Their Treatment

Abstract

This article explores the burgeoning advocacy movement for methadone and buprenorphine treatment by patients, parents, and doctors in Ukraine, and their efforts to remake a system that infantilizes and controls patients into one where patients have a voice in their treatment. Through a review of gray literature and in-depth interviews with 28 patient-advocates and doctors in five Ukrainian cities between October 2009 and July 2010, this piece chronicles the emergence of opiate substitution treatment in Ukraine, describes successes toward patient-friendly treatment, and explores the institutionalized barriers that have pushed the patients to become advocates for their own treatment.

Keywords :

• opiate substitution treatment
• Ukraine
• patient advocacy
• police
• drug use

THE AUTHORS

Maria Golovanevskaya, BA, is a Program Officer with the International Harm Reduction Development (IHRD) Program of the Open Society Foundations, where she oversees community-based monitoring and advocacy efforts focused on improving access to and quality of treatment for people who use drugs and are living with HIV. Prior to joining IHRD in 2007, Maria consulted for the United Nations Office on Drugs and Crime in Tashkent, Uzbekistan. Maria holds a BA in Political Science from University of California at Berkeley.

Leonid Vlasenko, MD, graduated from the Dnepropetrovsk Medical University in 1981 with a degree in psychiatry. He spent 20 years working in the field of addiction treatment as a practicing clinician with the Dnepropetrovsk regional drug user treatment clinic. Since 2002, Dr. Vlasenko has been working in nonprofit organizations focusing on developing harm reduction and substitution treatment programs in Ukraine. He is a member of the All-Ukrainian Harm Reduction Association, International Harm Reduction Association, International AIDS Society, and EUROPAD.

Roxanne Saucier, MPH, is an independent consultant who works on harm reduction and HIV projects internationally. Until recently, she worked in the Open Society Foundations' International Harm Reduction Development Program, focusing on overdose prevention and ending detention as treatment for people who use drugs. She has an MPH in International Health from Tulane University.