Can you describe the need for drug treatment and harm reduction services in Ukraine?
Meteliuk: Ukraine’s high rate of HIV is mostly driven by injection drug use. We had a huge epidemic of opioid drug use in Ukraine after the Soviet Union collapsed in 1991. Ukraine was in the middle of drug trafficking routes from Afghanistan to European countries, but lots of drugs stayed in the country, leading to a dramatic increase in opioids and injection drug use.
Before the 2014 conflict, the Donbas area—which is the Donetsk and Luhansk regions—and Crimea were responsible for almost one-third of all patients taking opioid agonist therapies in Ukraine. Those are highly drug-using regions because they border Russia, and at that time, most of the drugs we had in the country were coming from Russia. So those areas were responsible for a large share of opioid treatment patients in general.
Ompad: There's a very strong harm reduction infrastructure throughout Ukraine. Organizations like Anna’s, the Alliance for Public Health, provide HIV testing and other harm reduction supplies, including needle exchange and condoms. And they’ve been working the whole time during the conflict. We cannot underestimate the dedication of public health workers and harm reduction specialists.
What has been most disruptive for opioid treatment in Ukraine? Supply issues? The destruction of treatment sites? Displacement of residents?
Meteliuk: It’s all of those things, but the major way opioid treatment is disrupted is because Russia is occupying areas. There is no methadone in Russia—opioid agonist therapies are prohibited. That’s why, once they take over a town that has a treatment site, it gets closed right away because it’s not allowed. If patients stay in that area, they may go back to street drugs or overdose and die. But if they leave for another part of Ukraine, they can be transferred to another treatment site.
Ompad: When Russia invaded Ukraine for the first time and occupied Crimea, the Russian drug czar came on TV and said that they’re going to get rid of opioid agonist therapies in Crimea. People were kicked off treatment almost immediately, and there were documented overdoses because they left people without the support they needed.
What are your study’s implications for the current conflict in Ukraine?
Meteliuk: This study teaches us a lesson of how to act in the current situation. When Russia invaded us again in February 2022, they occupied the whole Luhansk region, so the opioid treatment program in Luhansk completely closed. Most of the sites in Donetsk and areas in Zaporizhzhia closed as well. Russia also took Kherson, but we got it back and reopened the treatment program. So once our army frees any territory, sites are being reopened.
We’ve also had 17 sites ruined by shelling. But again, those of us at the front-lines, public health and the government and other non-government organizations, we are renovating and reopening sites. And if a site is destroyed, it doesn’t mean that patients don’t have anywhere to go; they are redirected to another site that is close to them.
