Eurasian States Pouring Money Into Incarceration, Not Harm Reduction

May 29, 2019

Harm reduction funding around the world is stalling. By extension, harm reductionists in Eastern Europe and Central Asia (EECA) are seeing firsthand how state funds are directed around life-saving resources and towards institutions that tear people out of communities and lock them up behind bars.

In the past year, the Eurasian Harm Reduction Association (EHRA) published a study comparing the annual cost of incarcerating people who use drugs (PWUD) with the prices of providing needle and syringe exchange services (NSP), opioid substitution therapy (OST) and unemployment benefits to such people. What they found is unfortunately no surprise: criminalization saw far more state funding than health services in most EECA countries.

The country allocating the most funds to harm reduction services (3,684 euros per person per year) is the Czech Republic—but even there, only a fifth of the amount put towards incarcerating drug users is expended on services tasked with keep them safe and healthy on the outside. More gloomily, Bulgaria pays 11 times more to incarcerate PWUD than to provide them with services, making it one of the smallest countries in the region (less than seven million, in contrast to Ukraine’s 43 million and Russia’s 143 million) that spends the most on criminalization, just behind the similarly small country, Slovenia.

Elsewhere, Russia incarcerates the most people in the EECA region. Promoting “drug-free” rhetoric, Russian President Vladimir Putin has overseen draconian drug laws—like one that prescribes 15 years in prison for people convicted of possessing more than two grams of cannabis.

“People are deprived of the opportunity to receive sufficient drug treatment in the first [place],” said Maxim Malyshev, an outreach worker for Andrey Rylkov Foundation (ARF), the only harm reduction organization of its kind in Moscow. As a result, incarceration only exacerbates their substance use disorder. Furthermore, Malyshev notes that “these people have co-morbidities such as HIV, hepatitis, disorders of the venous circulation,” which are then worsened since “medical assistance is not fully available” in prison. In part a result of this, Russia is one of the lowest spenders when it comes to daily costs associated with imprisoning an individual.

Similarly, Russia puts little money towards harm reduction resources, even though they have one of the highest populations of people who inject drugs in EECA, around 1.8 million people. The funding that is allocated only goes so far when the costs of naloxone and sterile syringes quickly add up. “There are few good programs in Russia, and where there are, they cost crazy money,” Anya Sarang, ARF president and co-founder, told Filter in November. Spending some of the least amongst other EECA countries (the equivalent of 247 euros per person per year), Russia’s  ban on a key resource, opioid substitution therapy, could also explain why costs are so low.

The devastating impact of the country’s austere policy can be seen on the ground with the precarious financial position of ARF. “The situation with the financing of harm reduction organizations is very bad,” said Malyshev. “The state does not support this approach and in every way complicates the work [by] recognizing organizations as foreign agents.”

But ARF faces more than just scarce funding; they’re also up against the government’s outright hostility. Last year, ARF was fined for distributing “drug propaganda” that outlined ways people can stay safe when using bath salts. The pamphlet did not encourage drug use, though. Receiving zero funds from the government, ARF turned to grassroots fundraising to stay afloat.

The organization also looks to donors from abroad, but even that source is tenuous. “Many international donors are cutting Russian funding, and it often seems dangerous and useless for them to do this,” wrote Malyshev. “This is the wrong approach that affects people who need help and support in a harm reduction context.”

In 2011, The Global Fund to Fight AIDS, Tuberculosis and Malaria cut donations to many EECA organizations, citing the higher incomes of or lower HIV prevalence in the countries served. In response to the defunding, the Eurasian Harm Reduction Network points out that, in countries like Russia, “income is not the determining factor for the availability of HIV services for PWID; rather, the decisive factor is political will. With few alternate funding sources available, there is the risk of the growth of the region’s concentrated HIV epidemic, and loss of the many gains made in the last decade.”

The EHRA study recognizes that it only captures the tip of the iceberg when it comes to the disparity between punitive and harm reduction programs. The nonprofit’s cost calculations for criminalization did not include “police work, investigation of the case, court proceedings,” and the loss of tax-paying citizens caused by incarceration.

For Eliza Kurcevič, the research coordinator of the study, Eurasian drug policy is an unfortunate budgetary mismanagement. “There are [sic] money for harm reduction services in all states, but they need to be reallocated within existing budgets,” Kurcevič told Talking Drugs. “Significant savings in state budgets can be made if the countries refer people who use drugs to harm reduction services such as substitution therapy, employment assistance and support of their social adaptation instead of imprisonment.”

The prospect of changing Russia’s drug policy is bleak, for Malyshev. “So far, there are very few such opportunities [for advocacy] because government structures are closed to dialogue,” he said. “In my opinion, only one way is possible today—building the capacity of civil society and gaining allies in it.”

Graphic by Eurasian Harm Reduction Coalition

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