Story

Crimea: Drug Users' Lives Uprooted

December 16, 2014 | Quartz
By
Misha Friedman

Georgiy—or Zhora, as he likes to be known—is a 28-year-old musician, who has been living in a dorm in Kiev since the summer. At first, he had to go to the clinic each day for his substitution therapy—a four-hour round trip. Image by Misha Friedman. Crimea, 2014.

In October he had earned his doctor’s trust, allowing him to get 10 days’ worth of drugs at a time, enabling him to get a job as a supermarket cashier. Image by Misha Friedman. Crimea, 2014.

Ira 38, and Yuri, 47 (in the bed), have been a couple since 2000 and drug users about equally as long. They spent two years on substitution therapy in Simferopol, the Crimean capital, before the program closed following the Russian annexation. Since May, they have been in Kiev. An NGO pays their rent and a daily subsistence allowance, but it’s not clear how long that will continue. Ira had worked for five years at the post office in Simferopol, and was up for a promotion. In Kiev, she is looking for similar work, but has to travel several hours across town every day to pick up a prescription, making it impossible to hold a steady job. Image by Misha Friedman. Crimea, 2014.

Igor, 49, has spent 19 years in prison and even longer using drugs. He decided to stay in Crimea after the annexation, saying that he was going to try to turn his life around and stop using drugs. Image by Misha Friedman. Crimea, 2014.

Entrance to the drug rehab clinic in Simferopol where it's operated like a penitentiary. Patients are prohibited from leaving, having guests or receiving parcels. Image by Misha Friedman. Crimea, 2014.

Irina is dressing her 24-year-old son Evgeny who lost both his arms in a childhood accident. Irina, a drug user for almost 30 years, has been receiving substitution therapy, a globally-recognized effective strategy for drug dependence treatment. In Russia substitution therapy is illegal, and Irina is left without any treatment. Image by Misha Friedman. Crimea, 2014.

Irina helping Evgeny in the bathroom. Image by Misha Friedman. Crimea, 2014.

Evgeny has prosthetic arms, which rarely come out of the closet. Image by Misha Friedman. Crimea, 2014.

A yard in Sevastopol littered with drug paraphernalia. Image by Misha Friedman. Crimea, 2014.

Igor Kouzmenko, 46, from the Crimean city of Sevastopol, has been a drug user for 25 years and on substitution therapy since 2008. A social worker, he has enough credibility to get a multi-day prescription on his visits to the clinic in Kiev, so he is able to travel between Crimea and Kiev and work with drug users in both places. Image by Misha Friedman. Crimea, 2014.

Under Ukrainian rule, Crimean doctors provided intravenous drug users with methadone, a heroin substitute, and buprenorphine, a drug used to ease dependence. Since many of intravenous drug users are HIV positive and have Hepatitis C needle-exchange programs were also widespread. According to Russian legislature substitution therapy is not a legal option for treatment of drug dependence, and needle-exchange programs are not supported.

Faced with a grim choice, a few dozen people have moved to Kiev. There they had to spend weeks earning confidence of doctors to receive several doses of methadone at a time rather than travel for hours across the city every day to get one dose. Of those who remained in Crimea, some returned to drug use, others committed suicide or overdosed. And now, many international health experts fear the number of those infected with HIV and Hepatitis C will increase too.