Russian Federation

Stigmatization and Inhumane Treatment of Krokodil Users

(Stigmatization and Inhumane Treatment of Krokodil Users) "In Russia and many other post-Soviet countries, the old ideology lingers on in narcological institutes, out of sync with modern public and mental health concepts (Grund et al., 2009). Many narcologists continue to view addiction as criminal or moral deviance and not as a disease. Narcological dispensaries continue to share information with law enforcement (Mendelevich, 2011). The threat of removal of child custody rights may impede women’s access to health care in particular (Shields, 2009).

Harms Associated with Krokodil Use

(Harms Associated with Krokodil Use) "In recent years, harm reduction and drug treatment services from Russia, Ukraine, Georgia and Kazakhstan began reporting severe health consequences associated with krokodil injecting. Although serious localized and systemic harms have previously been associated with injecting homemade opiates and stimulants in the region (Grund, 2002; Volik, 2008), the harms associated with krokodil injecting are extreme and unprecedented.

Krokodil - Reasons and Risks

(Krokodil - Reasons and Risks) "In sum, these observations suggest that the relatively limited availability of black market opiates and stimulants and the relative ease of harvesting legal precursors to powerful analogues from the countryside and pharmacies inspired and sustained a Soviet-style homemade drug culture in the Eastern European region that remains radically different from those observed in countries where narco-traffickers dominate the production and distribution of drugs (Booth, Kennedy, Brewster, & Semerik, 2003; Grund et al., 2009; Grund, 2005; Subata &

Prevalence of Krokodile Use

(Prevalence of Krokodile Use) "The estimated number of PWID in Russia was close to 2 million in 2008 (Mathers et al., 2008). 2.3% of the Russian population uses opioids annually and 1.4% heroin, compared to an annual prevalence of 0.4% opioid use in Western and Central Europe (UNODC, 2012).

Krokodil Production

(Krokodil Production) "In considering the drug krokodil, two aspects are of importance, its pharmacology and its chemistry. The short half-life, limited high after the impact effect and, in particular the need for frequent administration may narrow the attention of users on the (circular) process of acquiring, preparing and administering the drug, leaving little time for matters other than avoiding withdrawal and chasing high, as reported in several popular magazines (e.g. Shuster, 2011; Walker, 2011).

Potential Impact on HIV Transmission in Russia if Opioid Substitution Treatment Were Available

(Potential Impact on HIV Transmission in Russia if Opioid Substitution Treatment Were Available) "A dynamic model of HIV transmission among people who inject drugs in Russia suggests that assuming a baseline HIV prevalence of 15%, increasing coverage of OST from 0% to 25% of all people who inject drugs could decrease HIV incidence by between 44% and 53%108."

Legal and Policy Barriers to Harm Reduction and Disease Prevention Services in Russia

(Legal and Policy Barriers to Harm Reduction and Disease Prevention Services in Russia) "The main reasons cited for restricting the opportunity of drug users to obtain medical and social aid, including prevention services, are the legislative barriers and official policy course that emphasizes reducing supply through law enforcement and reducing demand by promotion of 'healthy lifestyle'. The Strategy of the Anti-Narcotic Policy of the Russian Federation until 202061 and the plan to implement the strategy reaffirmed that approach.