YEKATERINBURG, Russia — The treatment center does not handcuff addicts to their beds anymore. But caged together on double-decker bunks with no way out, they have no choice but to endure the agonies of withdrawal, the first step in a harsh, coercive approach to drug treatment that has gained wide support in Russia.
“We know we are skirting the edge of the law,” said Sergei Shipachev, a staff member at the center, which is run by a private group called City Without Drugs. “We lock people up, but mostly we have a written request from their family. The police couldn’t do this, because it’s against the law.”
A thick silence fills the little room crammed with tall metal beds, obscuring the fact that there are 37 men lying shoulder to shoulder, each lost in a personal world of misery.
Outside the chamber, known as the quarantine room, 60 men who have emerged — after as long as a month with only bread and water or gruel — work at menial jobs, lift weights or cook in a regimen of continued isolation from the world that staff members said usually takes a year.
“To put someone in handcuffs, it calms them psychologically,” Mr. Shipachev said as he paged through photographs of men shackled to their beds or to each other. “Now, it’s the old-timers who calm the new ones. A guy shouts, ‘I’m going to die now!’ and everyone just laughs at him, because they’ve been there themselves. It would be much worse for him if he was alone. The best thing is to just go to sleep.”
The principle of this treatment “is just to stop taking drugs and tough it out,” said Yevgeny Roizman, 48, a founder of the program in 1999 whose celebrity as an antinarcotics vigilante won him a term in Parliament in 2003.
“The most important thing is to force them to quit and keep them clean a certain time, so the system cleans itself out,” he said. “If they behave, they can go home.”
Most experts in drug treatment condemn this approach as a primitive, brutal and ineffective way to address the problem, saying that addiction is a much more complex and intractable challenge and that simply drying out cannot bring a lasting cure.
“What they present as drug treatment has absolutely no basis in evidence,” said Diederik Lohman, a senior researcher at the monitoring group Human Rights Watch who took part in a recent study of narcotics use and treatment in Russia.
“What City Without Drugs does has little in common with international best practice standards based on research and is unlikely to have any beneficial effect on patients,” he said in an e-mail, calling the method “pseudo-medical treatment and abuse.”
The Human Rights Watch study noted that one of the most effective and common treatments elsewhere, methadone substitution, is banned in Russia and said that simple detoxification “does little to help a drug user achieve a lasting remission.”
Although the City Without Drugs center keeps thorough files on the addicts it takes in, Mr. Roizman said there was no formal follow-up when people were released and that he does not have data to support his claim of a 70 percent success rate.
Sergei Polyatykin, head of the medical department at an advocacy group called the Say No to Alcohol and Drugs, said of Mr. Roizman’s approach: “It’s not treatment, it’s jail. Imprisonment and torture can’t help drug addicts to kick the habit. Only a small percentage stay off drugs.”
But with Russia facing an epidemic of drug addiction and few government programs available, harsher treatments like Mr. Roizman’s have the backing of both the public and many officials, who simply want drug users off the streets.
Officials here say Afghan heroin has fed an explosive increase in drug abuse, but estimates of the number of addicts vary widely, suggesting that no comprehensive study has been made.
In a 2009 report, the International Narcotics Control Board, which monitors how United Nations guidelines are followed, quoted a Russian government estimate of 2.5 million addicts and 5.1 million abusers of drugs. In another report in 2010, the board cited a figure of 1.6 million to 1.8 million abusers of opioids, a category that includes heroin.
“The Russian Federation remains the European country with the highest number of people who abuse opioids,” it said.
Even the head of Russia’s drug control programs, Viktor Ivanov, has given oblique support to strong-arm programs, saying that desperate people turn to them because of the inadequacy of available treatments.
“When people see that that their son or daughter is going to the bottom and will simply die, and the state system does nothing, they start to look for ways out,” said Mr. Ivanov, chairman of the State Antinarcotics Committee and director of the Federal Drug-Control Service.
“The point is that at present, there is no legal mechanism in the Russian Federation law which would give addicts an incentive to free themselves from their addiction,” he said in an interview in April with the Kommersant newspaper.
A year ago, President Dmitri A. Medvedev ordered a new narcotics control strategy, saying, “Prophylactic activities, medical aid and rehabilitation of patients with drug addiction are not sufficiently effective.”
Mr. Ivanov said his goal was to put in place Western-style treatment programs, although like most Russian officials he opposes the use of methadone, calling it an unproven Western fad. Even possession of methadone tablets can lead to arrest.
The questions of harsh and even illegal handling of addicts became national news late last year when a judge in a nearby city, Nizhny Tagil, was pressed by a public outcry to revise a ruling and release a man he had sentenced to three and a half years in prison for kidnapping, illegal detention and torture.
According to court testimony, parents had paid the defendant, Igor Bychkov, 23, to seize addicts and detain them in a center affiliated with City Without Drugs. There, the addicts were handcuffed to their beds and given a diet of water, bread, onion and garlic.
The cold-turkey treatment, which could take weeks, is the first step in a process that runs a year or more, said Sergei Kolesnichenko, 31, a former addict who is the deputy administrator of the center in Yekaterinburg.
Support for Mr. Bychkov came from the Russian Orthodox Church, from celebrities and even from some human rights advocates who said his heart was in the right place. In October, 500 people rallied in his defense here, including representatives of city and regional government offices and of the public organization Mothers Against Drugs, according to the Interfax news agency.
“Is it wrong to rescue a drowning person by pulling their hair?” asked Yevgeny Malenkin, a founder of City Without Drugs, summing up the public view. “If people say it is cruel and inhumane, let them teach us how to do it otherwise.”
Mr. Ivanov, the head of Russia’s drug control programs, agreed. The support for Mr. Bychkov “is a spontaneous reaction of society to plunging into the abyss of drug addiction,” he told a news conference at the time. “Russia is virtually buried in Afghan heroin. In a situation like this I cannot but sympathize with Igor Bychkov.”
New York Times 2nd Sept 2011
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