The following is a transcript of an interview with Anya Sarang, President of the Andrei Rylkov Foundation in Moscow. Sarang, who has worked on developing and supporting the emerging harm reduction movement in Russia, discusses contemporary drug policy in the country and its effects. The interview was conducted by Alexander Marshall as part of his recent GDPO policy brief, ‘From drug war to culture war: Russia’s growing role in the global drug debate’.
Q: I’ve read a lot about how things are going in Russia but there is a lot of course that I still don’t understand, and I recognize this fact, therefore to begin with I still have a lot of what might seem general questions regarding the local context, particularly as there is a comparative aspect with other countries in our project. Your opinion is very important and I’m very glad you agreed to meet me. My first question is how you see the current situation in Russia currently developing generally? What is your opinion?
A: It seems to me that compared with the 1990s open drug scene, access for heroin has reduced-in the 1990s access was as free as you please, ‘you want heroin, you want khanka [Russian slang: a home-made opium derivative, normally injected] go ahead‘-compared to this the situation has quite changed, it’s become more closed and less accessible, and also that people have started using synthetic drugs and pharmaceutical substitutes, for example last year we had a string of cases of people using prescription drugs without prescription, and we had a three year epidemic of ‘krokodil’. We street methadone in the market, but since last year this has also become less accessible. To me it seems that if one compares today with the 1990s and start of the 2000s access to substances has become more limited in general, even with pharmaceutical drugs, however new synthetic drugs are becoming more available.
Q: Many thanks. Could you say a few words about your organization, what you do here in Moscow and how the authorities relate to you?
A: Our foundation was created to honour the name of Andrey Rylkov, we wanted to create a mobile group of activists and we were the whole time occupied with the problem of HIV/AIDS, but it became clear that it was impossible to engage this question without also engaging with the issue of drug policy, so, we are advocates of drug reform, based on human rights, that is the mission of our organization. We also have ‘service’ projects helping drug users on the streets of Moscow, we go every night to the pharmacies to dispense condoms, ointment, quick tests for infection, we accompany people to hospitals, which in Moscow is a difficult process, and we also have a large advocacy role in drug reform and everything connected with that, preparing reports for the international human rights bodies, the UN, and we seek to influence the legal situation with regard for example access to therapy for hepatitis (which you just saw in our press conference), the arbitrary detention of drug users by the police, the criminalization and over-incarceration of drug users and so on. On top of all this we work on strategic litigation cases aimed at the European Court of Human Rights.
Q: Could you say a few words about how the attitude of organizations working in this area, for example the Ministry of Health or FSKN, has changed in the last few years?
A: In the last ten years the situation has very significantly changed. For example in 1997 we worked with the Ministry of Health on development of a training program on harm reduction for Russian doctors, and the Ministry took quite a supportive position. Since 1997-98 there were over 40 harm reduction programs, there were training programmes and the Ministry of Health supported training for specialists, issued several orders about necessity to focus on HIV prevention among drug users and they treated this question more or less normally. A few years ago, by 2009, this approach simply ceased. Measure to reduce prevalence of HIV/AIDs practically ceased, and there also came forth a more repressive position, particularly towards some international recommendations around harm reduction, the Ministry of Health openly opposed recommendations of the WHO for example, and in the past year they have taken a still more aggressive position towards harm reduction. On top of this you have the FSKN, an enormous agency, with a budget of billions of roubles, which wants complete control of this whole area, but it is completely unclear and confusing what their role is. If you look at drug cases in Russia – there were practically no cases with systematic work to turn down a real drug lord or king pin – people who are prosecuted are drug users who are set up while “selling” half a gram of heroin. In other words this service is in no condition to carry out any kind of serious work, they prosecute people who uses drugs, veterinarians and people making poppy-seed buns but they do nothing against the real drug lords as they claimed they would in the beginning of their existance. In connection with this agency there has also emerged a repressive discourse about throwing drug users in prison, arresting pharmacists, but of course they aren’t engaged in anything actually productive.
Q: Why in your opinion has the state attitude become more aggressive, and can you say something about public opinion changing on this subject-for example in Moscow?
A: It seems to me the tone of FSKN became more aggressive in order to justify this budget of billions of roubles, they started on 3 billion roubles, last year they asked for 220 billion, in other words they would like to increase their budget by hundreds of times, and in order to justify this they need to be seen to be throwing all these kinds of groups in jail, and from this emerges a kind of social paranoia regarding drugs in general. What was the second question?
Q: On public opinion
A: Well you know public opinion is a very broad subject…
Q. Of course. But for example someone like Evgenii Roizman appears to have become somewhat popular…
A: Well three years ago when one of Roizman’s associates was put on trial for kidnapping and torturing drug users in their ‘rehabilitation’ center people came out in his defence, views were expressed that what he did was right and that in fact it was the only effective approach to dealing with drug addicts. In this past year however attitudes have somewhat changed, some of the intelligentsia have begun to recognize that drug addicts are also human beings, that they too have human rights, in part in my opinion this change has come about through activity of our organization and engagement with broader groups of social and political activists.
Q: I have a question about head of the FSKN Victor Ivanov, who in 2011 announced the need for a rehabilitation program. To me- I just read about this-this seemed from one point of view a slightly more progressive approach, recognizing for example that past approaches hadn’t worked, proposing the creation of communes and so on. I wondered if I could ask you about this-is it propaganda, is it a real change, or what?
A: Well the first thing you have to understand about this rhetoric is that it was used to generate a lot of money. In the past three years the FSKN were to have built up a regulatory base for certification of rehabilitation centres, they were not to build their own centres but to bring existing centres up to these standards, and then disburse state funds to them, but even with this more simple task the FSKN haven’t managed to move forward in three years. Up to this day I haven’t heard of one person who has officially gone through a state rehabilitation centre. We have state rehabilitation centres in Moscow and St Petersburg, there are perhaps three or four in the whole country, however on the FSKN website there are centres ‘approved by’ the FSKN, and there you find the most diverse kind of centres, for example Roizman’s City witout drugs one in Ekaterinburg which is famous for kidnappig and torturing drug users, others which are known to everyone as charlatans-they simply made a list of all centres in the country and posted it on their website.
Q: So if I understand correctly they-on paper-set out to regulate everything but in practice aren’t regulating anything?
A: Well not quite, they simply continue their consultations, meetings, they spend money, but no kind of product has appeared yet. […] Let me add that another complication is that rehabilitation centres have become accessible only to local residents -in Moscow there are spaces in such establishments only for residents of Moscow. In regards to harm reduction and HIV prevention programs they are ceasing to exist in Russia due to opposition of the Ministry of Health that declared that they were harmful.
Q: Who decided that they were harmful?
A: In 2009 the Minister of Health has talked in front of the State Security Council specifically on harm reduction programs – needle and syringe provision to drug users and substitution treatment and expressed clear opposition.
Q: If I understand the Orthodox church also had a role in this?
A: They don’t work very strongly in this area, they work more against safe sex campaigns but in the area of drug policy they didn’t make any particularly harmful declarations. They also have some rehabilitation centres of their own which differ in quality and approaches but sometimes these are the only accessible rehab options for drug users.
Q: What do you see as the most harmful consequence of these policies in Russia?
A: The most harmful consequences are the high mortality rates amongst people who use drugs – of overdosis, of tuberculosis, of AIDS, of hepatitis complications. According to UNAID we have one and a half million people with HIV/AIDS infections but this estimate is already five years old, right now a minimum of 2 million people are living with the infection, and frequently a condition for them for receiving antiretroviral treatment is that they abstain from drug use, which they can’t do due to the absence of rehabilitation programs or substitution treatment, so the mortality rate of people with HIV is high.
Too many people end up in prisons – early in their lives and that forms their future as a criminals a future that could be avoided. Prisons are also full of disease and outrage upon personal dignity. People with HIV and TB are especially vulnerable as for many of them, due to absence of proper treatment in prisons, poor hygiene and infectious control and malnutrition a prison sentence is often equal death sentence. All of this would be avoidable if we had harm reduction programmes available throughout the country. The courts don’t think about this, and might say this person will sit in jail two years and then will be free, but in fact they’re sentencing them to death, if this person already has AIDs and then acquires tuberculosis in jail they will be likely to die – in prison or shortly after.
We started a project three years ago looking at the quality of tuberculosis treatment in Russia and rate of drop out. The tuberculosis in drug dependent people is practically untreatable due to high rate of drop out and many tuberculosis treatment centres in the regions are simply morgues. The consequences of the current drug policy are therefore in actual fact catastrophic, but they’re also completely invisible to wider society as a whole.
Q: Where do you think the origins of this whole problem lie-is it a Soviet legacy, a legacy of Soviet narcology, a cultural problem, an issue of too little money, or what?
A: Well Russia has a lot of money, really a lot of money-when you consider the Ministry of Health, the FSKNs budget -really you see a lot of money. But they don’t direct this money in any kind of useful way. The repressive policy and drug treatment does have a history, the Russian addiction treatment (narcology) grew out of repressive psychiatry of the Brezhnev times – when dissidents were ‘treated’ in psychiatric wards, this is indeed a hard legacy to overcome and the psychiatry in Russia is still very repressive and so is narcology. Plus you also have to consider the whole factor of corruption among the Ministries officials – these people are simply not interested in improving the public health situation, all they are interested in is to gain more personal profit from their high positions and access to large budgets. So I don’t expect any kind of solutions from the Ministry of Health or the FSKN.
