Ukrainian narcologist detained for providing OST to HIV positive IDU’s

In 2005, Ilya Podolyan started an opioid substitution therapy unit in Odessa, Ukraine, specialised in providing help and services for injecting drug uses infected by HIV.  Dr Podolyan was one of the most dedicated service providers in Ukraine trying to establish the function of HIV prevention services and OST treatment to HIV positive drug users.  In March of 2010 Dr Podolyan, two nurses, the OST program coordinator and the regional coordinator of International HIV/AIDS Alliance were  detained and arrested by the police, under the accusation of alleged drug trafficking.  Podolyan was prosecuted under the accusation of the illegal possession of narcotic drugs which were discovered during a search of his residence. Following the intervention of many human rights lawyers, local and international advocacy organisations and lobbyists Podolyan was released on bail after some days, on the 15th of March.

However, the police investigation did not end there, as two months later Podolyan was again prosecuted and accused of drug trafficking (Article 307(2) of the Criminal Code), an offence which this time could condemn him to up to ten years in prison.  The indictment indicated that Podolyan “had sold OST medications (buprenorphine) to 42 patients of Odessa Regional Narcological Dispensary, illegally prescribing drugs to them” at a time when the drug treatment unit was not legally permitted to dispense narcotic substances to HIV positive patients.

The prosecutors did not take into consideration the fact that Dr Podolyan’s health was weak, as he was said to suffer from hypertension, diabetes and arrhythmia as well as the lack of the appropriate staff that could take care of his particular health condition.  On September, after almost four months in pre-trial detention, Podolyan was released on bail.

The detention of Dr Podolyan was irrational and unjustified, since as he has said, his clinic was totally legal and was operating under the knowledge of the police: “We have already been warned by the police and there have been such incidents in other cities in Ukraine where the program was closed… so we cooperate closely with the police, and representatives of the police and the department on illegal drug trafficking control come here and work with them and do their trainings’’, he said.  As the National Programme for HIV Prevention, Treatment, Care and Support for 2009-2013 indicate ‘licensed narcologists can legally dispense buprenorphine and methadone as opioid substitution therapy in Ukraine’. Given the legality of the dispension of the OST treatment, his arrest indicates that there is a deeply rooted punitive approach towards drugs and drug users and a tendency to forbid their treatment.

Podolyan was committed to improve the life and health of his patients. He was fighting for the expansion of his medical team, so that it would include more HIV and TB services. He was also trying to convince the government to drop the obligatory registration of patients, which was a legal obligation with a strong discriminatory character and was discouraging many HIV positive drug users from demanding  OST.

The requirement of the registration of drug users puts their jobs and everyday life in jeopardy. As one client said  “I have been in the programme since February, this year. And before, I liked everything about the programme and I only saw advantages of it. But now, when they told me I need to be registered, for me it is a huge problem. I think I will rather leave the program and go back to injecting illegal drugs because I don’t want to risk my job. That’s a really big ‘minus’. And that’s not only for me but I was told this by many other clients too’’.

“This really prevents many clients from being in this programme,” said Dr Podolyan. “In fact, some clients now think the whole programme has been some sort of trick — like at first they open these substitution programs, they enrol clients and then go ahead register them. Like the police did it on purpose — like a trap to find all of the drug users.”

Another client reported that when a patient is stopped and arrested by the police under the status of a registered drug user in a narcological dispensary, easily gets in trouble and faces harassment.

Therefore, the contribution of Dr Podolyan was crucial in  not only improving  the medical services and treatment of drug users but equally their position, dignity and acceptance in society, a contribution that was not quite appreciated by the Ukrainian authorities. Dr Podolyan stressed the importance of the adequate treatment .And the case of Podolyan is not the only one. Another doctor, named Yarsolav Olendr, who also dispenses substitution maintenance therapy  at a drug treatment centre was placed under house arrest at his residence in Ternopil, and was charged with going against the law on narcotic drugs.

“I can tell you that I can compare and can see the difference between people who have been on OST for four or five years and those who have just started. Those have already been on substitution therapy for a longer  time have changed mentally; they have changed their attitude toward life. They are different people now’’, Dr Podolyan said.

Let us hope that Ukrainian authorities will stick with the law, which has been allowing doctors to adopt drug substitution treatment programmes since 2004. Ukraine is a country that suffers enormously from drug consumption and has one of the largest HIV epidemics in Europe. Is it at all consolatory to think that at the moment there are just over 5,000 injecting drug users registered in drug substitution programmes, estimated to reach the number of 20,000 by 2014?

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