Substitution maintenance treatment in Ukraine: Humanitarian and medical mission

Based on a request by the State Service of Ukraine on Drugs Control to support Ukraine with regards to the emergency situation of people undergoing substitution maintenance therapy (SMT) in Ukraine, the Pompidou Group put together a team consisting of medical experts from Norway, Poland, Switzerland, and Slovenia. The mission was organised by the Pompidou Group, together with the Ukrainian Drug Control Service (State Service of Ukraine on Drugs Control or SSDC) and the United Nations Office on Drugs and Crime (UNODC).

On 16-21 May 2014 the expert team travelled to Ukraine in order to assess the situation concerning opioid substitution treatment, and to provide assistance in developing an emergency plan aimed at supporting the continuation of SMT in times of crisis. The experts visited two cities, Kiev and the Dnepropetrovsk, close to the conflict zone in the east of Ukraine.

The experts met people who left their hometowns in Crimea due to the interruption of SMT on the peninsula. They also met people from Eastern Ukraine who left this conflict-striven region in order to continue their treatment in safer regions of Ukraine where SMT is currently not at risk of being interrupted. Meetings also took place with health professionals, NGOs such as International HIV/AIDS Alliance in Ukraine (Alliance Ukraine), international organisations (UNODC, WHO, UNAIDS) and SSDC.

SMT started in Ukraine in 2005 and is available to a minority of opioid users (9,000 in the whole country out of 310,000 people using drugs, 80% injecting opioids). Nevertheless, this treatment has been seen as effective in reducing the negative consequences of drug use, both at an individual level (clinical stabilisation, decrease of use of illicit opioid, reduction of overdoses, and prevention of blood-borne diseases) and for the community at large (reduced criminality for example) (WHO, UNODC et al. 2004).

The discontinuation of SMT in Crimea and lack of medical supply of methadone and buprenorphine in Eastern Ukraine poses a great challenge to the progress recently observed in the field of HIV prevention and drug treatment in the country.

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