Vladimir Mendelevich: fighting for drug substitution treatment.

摘要

It was not exactly what Vladimir Mendelevich had hoped for from his new website on substitution treatment for drug users. The idea was to promote a scholarly debate on the merits of methadone, buprenorphine, and other treatments for opiate misuse that are still highly controversial-and illegal-in Russia. But instead of a flurry of academic letters, something rather less pleasant came through his front door earlier this year: a request to visit the prosecutor's office. "Unfortunately, the opponents of substitution therapy chose not a scientific but a juridical approach to discussing the problem", he observes wryly.As Russia's leading proponent of substitution treatment, Mendelevich, who is director of the Institute for Research of Mental Health Problems in the city of Kazan, has struggled against almost overwhelming odds to persuade healthcare colleagues in his own country that its introduction is needed to help control a burgeoning drug-addiction crisis. It is an Uphill task. The big guns of Russia's health-care establishment believe methadone and other similar drugs used to wean addicts off heroin are unethical and wrong-headed because they replace one addiction with another. Gennady Onishchenko, Russia's chief public-health official, has warned methadone will not be introduced because the risk of it being "plundered" and misused is too high.