VZCZCXRO3680
RR RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHMO #5353/01 3140831
ZNR UUUUU ZZH
R 100831Z NOV 07
FM AMEMBASSY MOSCOW
TO RUEHC/SECSTATE WASHDC 5179
INFO RUEHYG/AMCONSUL YEKATERINBURG 2844
RUEHVK/AMCONSUL VLADIVOSTOK 2525
RUEHZN/EST COLLECTIVE
RUEAUSA/DEPT OF HHS WASHDC
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 02 MOSCOW 005353 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR EUR/RUS 
USAID FOR GH, E&E 
HHS FOR OGHA 
 
E.O. 12958: N/A 
TAGS: TBIO PHUM SOCI RS
SUBJECT: RUSSIA REJECTS HUMAN RIGHTS WATCH PROPOSAL ON METHADONE 
 
MOSCOW 00005353  001.2 OF 002 
 
 
THIS CABLE IS SENSITIVE BUT UNCLASSIFIED.  PLEASE PROTECT 
ACCORDINGLY. 
 
¶1. (SBU) SUMMARY:  In a 110-page study released November 8, Human 
Rights Watch International concluded that substance abuse treatment 
in Russia is of such poor quality that it amounts to a violation of 
the right to health.  The report recommended that Russia immediately 
permit the use of drug-substitution therapy (e.g., methadone) for 
heroin addicts.  Russian public health and drug control officials 
reacted quickly to the report and reaffirmed that methadone therapy 
would continue to remain illegal under Russian law.  Senior Russian 
health officials and policy makers continue to believe that the 
substitution of one addictive drug for another does not constitute 
medical treatment, and would be politically unpopular.  END 
SUMMARY. 
 
--------------------------------------- 
WHY WON'T RUSSIA START USING METHADONE? 
--------------------------------------- 
 
¶2. (SBU) The November 8 "Rehabilitation Required" report released by 
Human Rights Watch International (HRW) argued that substance abuse 
treatment in Russia is of such poor quality that it constitutes a 
violation of the right to health.  Russia is one of the few 
remaining countries that does not permit the use of 
drug-substitution therapy (e.g., methadone or buprenorphine) in the 
treatment of heroin addicts.  The prescribing of methadone is 
illegal under Russian law, and buprenorphine can only be prescribed 
as a pain medication, but not to treat drug addicts.  Russia only 
uses detoxification treatment for drug addicts in substance abuse 
and rehabilitation clinics.  There are not enough clinics to provide 
longer-term rehabilitation for drug addiction at government expense. 
 As Russia's HIV/AIDS epidemic continues to spread among drug users, 
the lack of drug substitution therapy in Russia as an available 
means of treatment has complicated the effort to treat HIV/AIDS 
patients.  Russian clinicians will not place an HIV positive drug 
addict on anti-retroviral (ARV) therapy (ART) until after he has 
demonstrated that he has discontinued using drugs, because of 
concerns he will not adhere to the full course of ART. 
 
¶3. (SBU) The HRW report immediately provoked a strong negative 
reaction from Russian health and drug control officials.  Chief 
Medical Officer Gennadiy Onishchenko, the head of the Federal 
Surveillance Service for Consumer Rights Protection and Human 
Well-Being, stated November 9 that it was completely inappropriate 
for HRW to suggest that Russia legalize an addictive drug.  A 
spokesman for the Federal Drug Control Service (GosNarkoKontrol) 
told the press that methadone would continue to be illegal under 
Russian law.  He also contended that methadone therapy was 
expensive.  Other Russian observers with similar views saw the HRW 
report, and similar recommendations by the WHO and the UN Office on 
Drugs and Crime, as an attempt by western drug companies to make 
further inroads on the Russian pharmaceuticals market. 
 
¶4. (SBU) As Dr. Alexander Golyusev, Rospotrebnadzor's senior 
HIV/AIDS official, has explained to us, the substitution of one 
addictive drug for another does not constitute "medical treatment," 
and would in any event, be politically unpopular in Russia.  Dr. 
Nikolay Gerasimenko, the Deputy Chair of the Duma Health Committee, 
has also told us that methadone therapy is completely inappropriate 
for Russia, despite the worldwide medical consensus to the contrary. 
 Likewise, Dr. Nikolay Ivanets, Director of the Russian Institute of 
Substance Abuse and the Chief Substance Abuse Specialist at the 
Health and Social Development Ministry, has been adamantly opposed 
for many years to methadone treatment.  Even more progressive public 
health voices, such as Dr. Valeriy Krasnov, President of the Russian 
Psychiatric Society and Director of the Moscow Institute of 
Psychiatry, have been skeptical that drug substitution therapy would 
be successful and have worried that a black market in methadone 
would immediately arise among drug addicts. 
 
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COMMENT 
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¶5. (SBU) In recent years, international health donors, including the 
United States, have sponsored small-scale research projects and 
study tours to persuade Russian health policy makers and 
practitioners of the utility of drug substitution therapy.  Some 
observers also had hoped that Russia might consider legalizing 
methadone treatment after China presented recent successes with drug 
substitution therapy at the International AIDS Society Meeting in 
Toronto in August 2006.  A small study tour by senior Russian health 
officials and Duma members visited China earlier this year, but 
 
MOSCOW 00005353  002.2 OF 002 
 
 
again, given the official position of the Russian government, no 
change in Russian policy was anticipated.  On a positive note, a 
growing number of private, faith-based organizations are providing 
rehabilitation services in Russia.  The Russian Orthodox Church has 
advised us that representatives from three of the Church's drug 
rehabilitation centers will visit the United States on a study tour 
of faith-based substance abuse programs later this year.  However, 
as the latest flap over the HRW report makes clear, Russia is still 
a long way from legalizing methadone treatment. 
 
BURNS