The Harm Reductionist Imprisoned by Ukraine Separatists for Carrying Bupe

    For 10 months now, a Ukrainian harm reduction activist has been illegally detained by the Luhansk People’s Republic (LPR), an illegitimate Russian-allied occupation “government” in eastern Ukraine, for alleged large-scale drug trafficking. In reality, he was simply carrying his 10-day supply of legally-prescribed buprenorphine, the opioid subsitution therapy medication.

    Andrii Yarovyi, who was working as an external consultant for Alliance for Public Health (APH), a Ukrainian harm reduction organization, left Kyiv for LPR on August 25, 2018. It was one of his many trips to support APH-financed programs in occupied territories. At the time the programs were serving over 10,000 clients in Luhansk and Donetsk, another Russian-backed enclave in the region known as the Donbass. 

    Yarovyi was headed to Luhansk to study the accessibility of HIV treatment and prevention resources for at-risk populations, like people who inject drugs. The largest number of HIV-positive Ukrainians who inject drugs (45,000 people) live in Luhansk and Donetsk, according to UNAIDS. Overall, Ukraine is facing the second largest HIV epidemic in Eastern Europe and Central Asia, behind Russia.

    APH’s associate director for policy, Pavlo Skala, explained to Filter that Yarovyi was particularly qualified to do this work—and turned out to be “one of the best consultants”—because “he was a community member.”

    Yarovyi became a well-known activist, “defending rights of drug-dependent people.”

    Before getting involved in drug-user activism in 2009, Yarovyi had been a sailor. He began using opioids and eventually left his work because of it, Skala described.

    Since then, Yarovyi has become a “well-known” activist, “defending rights of drug-dependent people,” said APH Executive Director Andriy Klepikov. Yarovyi would have assisted with client satisfaction, walk-in hours and packaging of services, if he had been able to make it to his destination. Unfortunately, he did not.

    On August 26, Yarovyi arrived at an LPR checkpoint where officials seized 38 buprenorphine pills that he had obtained through a medical prescription from Kiev City Narcologic Hospital. He has been taking the medication—considered to be “one of the most effective treatment options for opioid dependence” by the World Health Organization—since 2009. 

    Yarovyi was arrested and detained in the LPR’s Ministry of Security. “It’s a basement prison” with “no possibility for contact except through his attorney,” said Skala. LPR did not appoint Yarovyi any legal representation, and it wasn’t until mid-October that he was able to access a lawyer hired by APH. On October 22, Kyiv’s Svyatoshyn Unit of Ukraine’s National Police opened a criminal case to investigate Yarovyi’s illegal arrest. 

    He was sentenced to “a long-term imprisonment and confiscation of property for the alleged smuggling of drugs.”

    Because of the lapse in contact, the conditions faced by Yarovyi in the first month of his illegal imprisonment, abruptly separated from his medication, remain a mystery. “I’m sure he was in poor condition,” said Skala, one of the few people to have been in communication with Yarovyi. But given few opportunities to speak, “We never had the discussion [about his withdrawal experience] because we were limited in time when he had the opportunity to call. We needed to know about his current status.”

    In early February 2019, Yarovyi was transferred to a pre-trial detention center. Later that month, he was sentenced to “a long-term imprisonment and confiscation of property for the alleged ‘smuggling of drugs,’” according to Skala.

    In April, Yarovyi he was moved to Sverdlovsk Prison, and a few days thereafter, the European Court of Human Rights (ECHR) opened priority proceedings to investigate his illegal sentencing.

    That same month, the Harm Reduction International conference in Porto presented him, in absentia, with an award for his work. Yarovyi’s message to the conference was read out:  “Dear colleagues, dear friends … I’m sure we will achieve our goals. The most important message—to believe and not to stop—has been achieved.”

     

    Drug War Rages Amid Armed Conflict in Donbass

    Yarovyi’s imprisonment is a high-profile case exemplifying the consequences of draconian Russian drug policies exported to the separatist territories. Countless other people who use drugs or have substance use disorders are also being persecuted.

    Opioid substitution therapy (OST) is banned in Russia on the grounds that it is a “misguided practice of issuing addicts a ‘narcotic ration,'” as described by Edward Babayan, a pioneering ‘narcologist’ in the former Soviet Union. The government and public health establishment prefer abstinence-based programs.

    In contrast, the Ukrainian government announced in 2017 that it would fully fund OST nationwide, increasing the number of patients 100-fold compared with 2005. Ukraine still, however, criminalizes drug possession, with convictions leading to up to eight years in prison. 

    OST had been available in Luhansk oblast since the mid-2000s, but that changed when the pro-Russian LPR was formed. The drug policies adopted by the illegitimate regime were basically “copied and pasted from Russian legislation,” explained Skala.

    Russia is known to be bank-rolling the separatists; because of that, Yarovyi’s mother, Taisiya Yarovyi, appealed his sentencing to the Investigative Committee of the Russian Federation on January 21, 2019, aruging that LPR’s “activities are organized and financed by the Russian Federation,” meaning that Russia has “‘effective control’ in this region.” Taisiya Yarovyi has urged Russia to open an investigation into the “illegal and wrongful” detention that allegedly violated the country’s Criminal Code of Conduct. 

    As a result of Russian influence and the draconian LPR, APH even had to close its operations in Ukranian-controlled areas of Luhansk at the end of 2018. “It became dangerous for our partners,” said Skala.

    Most treatment resources had already disappeared, though, three years prior. At the time, more than 500 Luhansk OST patients feared the consequences. “I am scared to even think what is going to happen when the [OST] program is closed,” said Sergei, an OST patient from Luhansk, in a 2015 documentary on which Yarovyi collaborated with filmmaker and fellow OST patient Igor Kuzmenko, just as the separatist governments formed in the region. 

    The deterioration in conditions faced by OST patients moved some to take their own lives. “We’ve got nine people jumping from roofs.”

    Even before the LPR banned OST, the lives of people with opioid use disorders were devastated by its scarcity. “It is very hard for me to go on without OST,” said Viktoria, a former patient from Luhansk, in the film. “My life was just fine: I had a job, I had a wonderful family, we were planning to have children. Now, I have no job, no money, no social benefits.”

    The deterioration in conditions faced by OST patients in 2015 moved some to take their own lives. “We’ve got so many people dying!” Victoria said, noting the increase in suicides. Likewise, Olga reported that “we’ve got nine people jumping from roofs.” 

    APH has been unable to calculate the total number of preventable deaths caused by the closure of its Luhansk programs. In Crimea, another occupied territory, an estimated 30 people who had been on OST died within a little over a year of the occupation, after the new Russian authorities reportedly publicly burned the remaining stocks of methadone. On July 25, the government of Ukraine expressed outrage when Russia’s voting rights on the Council of Europe were restored, despite its 2014 annexation of Crimea.

    The conditions in which people use drugs in these territories are increasingly dangerous. “Nobody wants to go back to the old times: to shots and shooting galleries,” said a former OST client from Donetsk. Skala added that “Injection practices are dangerous because of all this risk.”

    Prohibitionist policies, as they do everywhere, push drug use into stigmatized or unsanitary conditions, exacerbating potential consequences of risky injection practices, like abscesses and bacterial infections, as well as HIV and hepatitis C infection. 

    The drug supply itself is also becoming more harmful. “We get information from our sources about the illegal black market for drugs, that the quality of drugs is really poor because these people in these territories are in really devastating conditions,” said Skala. “They don’t have enough money for food, for nutrition. The quality of drugs—it’s poisonous stuff.”

    Heroin originating in Russia has reportedly flooded the drug supply in the territory held by the LPR, replacing the formerly-popular krokodil. One OST patient suggested that the demand for opioids emerged from the scarcity of medication. “If the methadone dose is reduced, you have to add something,” Andrey from Donetsk told journalist Lilly Hyde. “And under shelling all the time, you have to find some way to cope.”

    While the deaths increase—at still-unknown rates—Olga described how others are left wondering when the crisis will end. “Others are walking around and asking each other: ‘Have you heard anything? Have you heard anything good?’” 

    6.28.2019 Correction: Misspelling of Andriy Klepikov’s name


    Photograph of Andrii Yarovyi by Alliance for Public Health

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