Opiate substitution treatment in the former Soviet Union.

摘要

The Profile of Vladimir Mendelevich (July 22, p 279),1 which highlights his efforts to educate fellow physicians about opiate substitution treatment, brings much needed attention to the public health crisis created by the lack of methadone in Russia. However, the statement that most other former Soviet states have legalised substitution treatment obscures the true scope of the emergency facing the region.Legal status bears little relation to access to methadone treatment on the ground in the former Soviet Union. With the exception of the Baltic states, methadone is either unavailable or offered to only a tiny minority of those in need. In countries such as Kazakhstan and Ukraine, the governments have for years delayed the establishment of even small pilot programmes despite offers of financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Drug control agencies fearful of diversion and health ministries afraid to step out of the long shadow cast by Russia's prohibition have miredtreatment efforts in" bureaucracy. Patients and physicians committed to helping those dependent on illegal opiates are paying the price, since they are denied a treatment that could help prevent HIV infections and save thousands of lives.