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Story Publication logo December 16, 2014

Crimea: With or Without Drugs


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Russia's military annexation of the Crimean Peninsula from Ukraine has already upended many lives...

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Recovering drug addict Georgii Gaidamaka. Image by Dimiter Kenarov. Ukraine, 2014.

When he picks up his brownish-yellow acoustic guitar, something changes in Georgii Gaidamaka. His diffidence disappears; the nervousness melts away. His usually quiet, slightly anxious voice suddenly becomes confident and his depressions blossom into something like euphoria.

"Poppy fields grow on the ground, / poppy fields gleam in my dreams," he sings in Russian, the voice rising and echoing in his tiny dorm room in Kiev, his blue eyes shut tightly. The right hand is furiously striking the strings, while the left one moves deftly along the frets of the neck. "Heal me bird, heal me girl, kill my fear. For people don't remember, people don't know how difficult it is to make the first step again."

Georgii is a drug addict from Simferopol, the capital of Crimea, and a patient on opioid substitution therapy (OST). It replaces dangerous street narcotics for less potent but longer lasting medication like methadone and buprenorphine. The goal is to reduce the risks of overdose and HIV infection, while helping drug users to lead more stable and productive social and personal lives. With OST Georgii has achieved just that: stability and a normal life.

It has not been an easy road. He began using drugs in his teenage years in Crimea, after a traffic accident left him with serious injuries and doctors prescribed morphine for reducing the pain. By the age of 18, he was already addicted: painkillers, opium, amphetamines, methamphetamines, marijuana, alcohol. He would pop prescription tablets, shoot intravenously, smoke or steep poppy seeds—anything to get a high.

But his life started to fall apart. As a younger man he had been involved in boxing and wrestling, but he gradually lost interest in sports. He was a lead singer in a rock band, which was on its way to local fame, with one of their songs voted best song in Crimea in 2004, but as his drug habit became worse, he couldn't keep awake during rehearsals and was eventually asked to leave the band. The prospects were not good.

"You see yourself turn into another creature," Georgii tells me. "You look at yourself in the mirror and you see another person, who doesn't look like you at all."

He tried to discontinue the use of one drug by starting another, only to sink deeper. Eventually, he was forced to seek his parents' help. His father, a policeman in Simferopol, was not very supportive, so Georgii had to rely mostly on his mom. He checked in and out of hospitals, and even agreed to a forced detention for three weeks at a medical facility, but nothing helped—every time he relapsed back into heavy drug use. He was taking 50, sometimes 60 pills a day, feeling terrible when not on drugs, feeling terrible on them. "One part of me was feeling guilty and tried to fight, but my psyche was in tatters and my body needed the fix," he remembers.

When Georgii first tried opioid substitution therapy in Simferopol, a decade ago, the program was still in its pilot stage. Ukraine had been struggling with rising numbers of drug addiction and, related to it, HIV epidemic, and some kind of solution was desperately needed. With the support of The International HIV/AIDS Alliance, an NGO network, OST quickly achieved popularity in the country. By early 2014 there were 170 facilities in different population centers, treating up to 8,700 Ukrainian patients. It significantly reduced HIV infection rates in Ukraine and helped the social integration of drug users, many of whom managed to resume normal personal lives. Georgii was one of them.

"With OST I don't feel like a drug addict," he says. "I feel well, I run, I function OK. I can't live without the therapy at this point and I don't want to go back to street drugs."

The therapy introduced a certain regiment in his life, a certain order. He found a job as a music editor at the local Chernomorskaya radio station and later on at Crimea's State Teleradio Company. He was once again becoming a functioning human being, despite continuing to take medically prescribed opiates. Things were looking up. But then suddenly, at the end of February 2014, Russia invaded Crimea, quickly organized a referendum, and annexed the peninsula in less than a month.

Unlike Ukraine and the countries of the European Union, the Russian Federation does not allow for opioid substitution therapy, which it considers ineffective and highly contentious. In 2011 the head of Russia's Federal Anti-Narcotics Agency, Viktor Ivanov, argued that there are "no clinical trials to prove the effectiveness of the method," despite the fact that the World Health Organization considers OST "one of the most effective treatment options for opioid dependence."

To avoid legal chaos, Russia had promised to uphold Ukrainian laws in parallel with Russian ones until the end of the year, but nothing went as planned. The acrimony between the government in Kiev and the new authorities in Crimea, which Ukraine did not recognize, led in the final run to the premature closure of the OST program on the peninsula at the end of May. More than 800 patients were all of a sudden left without medical support, 200 of whom were HIV positive. For many of them, the choice was to go back to street drugs, as they were not even given time to try to decrease the dosage. As a result, over 20 people have died so far.

There was another problem too. Under Russian law drug users are not seen as people in need to help, but as criminals and are prosecuted accordingly. In Georgii's view, his choice in the new Crimea was between prison and relapse—which for him meant certain death. Luckily, with the help of The International HIV/AIDS Alliance he managed to leave Crimea to continue treatment in Kiev. It was a matter of simple survival for him.

Today, Georgii lives in a small dorm-room in Kiev, paid for by Alliance. He has also found a job as supermarket cashier. The refugee life is not easy, but he doesn't complain. Most importantly, he still has his guitar. "Music brings me back the joy of life," he says and begins to play another song. It is Depeche Mode's "Personal Jesus."



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