Regular article
Injection drug users’ perceptions of drug treatment services and attitudes
toward substitution therapy: A qualitative study in three Russian cities
Natalia Bobrova, (M.Sc.)
a,
4
, Ron Alcorn, (M.B.Ch.B.)
b
, Tim Rhodes, (Ph.D.)
c
,
Iurii Rughnikov, (M.D.)
d
, Elena Neifeld, (M.D.)
e
, Robert Power, (Ph.D.)
f
a
Department of Epidemiology and Public Health, University College London, London, UK
b
East London and The City Mental Health NHS Trust, London, UK
c
Center for Research on Drugs and Health Behavior, London School of Hygiene and Tropical Medicine, London, UK
d
Yekaterinburg Regional Psychiatric Hospital, Yekaterinburg, Russia
e
Altai Krai Narcological Dispensary, Altai Krai, Russia
f
Center for Harm Reduction, Burnet Institute for Medical Research and Public Health, Victoria, Australia
Received 1 September 2006; received in revised form 12 February 2007; accepted 16 February 2007
Abstract
This study explored injection drug users’ (IDUs) perceptions of drug abuse treatment and treatment providers in three Russian cities as
well as their attitudes toward opiate substitution therapy, which is currently not available in Russia. Data were collected from 121 qualitative
interviews with IDUs conducted in 2003–2004. Negative perceptions of available treatments were related to poor treatment outcomes,
judgmental service providers, lack of psychologic services, and short lengths of stay in treatment. Positive perceptions were associated with
receiving psychosocial care and nonjudgmental attitudes from providers. Most participants had heard about opiate substitution therapy, and
some had treated themselves using methadone from the black market. Although respondents had doubts that opiate substitution therapy could
work effectively in Russia, most agreed that this type of treatment would help IDUs function better in the society. D 2007 Elsevier Inc. All
rights reserved.
Keywords: Drug treatment; Perceptions; Russia; Substitution therapy
1. Introduction
Injection drug use and the associated epidemic of HIV
have been major health problems in posttransitional
Russia, with approximately 80% of cumulative HIV cases
in Russia attributed to drug injections (Aceijas, Stimson,
Hickman, & Rhodes, 2004; Osborn, 2005; Rhodes et al.,
2002, 2006). It is estimated that 3 million people, or 3%
of the total adult population, are using drugs and that 2%
of the adult population in Russia are injection drug users
(IDUs; United Nations Office of Drugs and Crime, 2003).
According to the International Narcotics Control Board
(2004), Russia is the largest heroin market in Europe, with
approximately 1 million heroin users, and heroin abuse
continues to increase. However, only approximately 1 in
every 10 IDUs in Russia reaches drug abuse treatment
services (United Nations Office of Drugs and Crime,
2005). Moreover, substitution therapy for opiate addiction
(methadone or buprenorphine) is illegal in Russia and is
discouraged by treatment providers (Mendelevich, 2004;
Parfitt, 2006).
1.1. The drug abuse treatment system in Russia
Drug abuse treatment services in Russia include both
inpatient and outpatient care that concentrate on short-term
medical care for withdrawal symptoms associated with
drug- and alcohol-addicted individuals. Such care is mostly
0740-5472/07/$ – see front matter D 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.jsat.2007.02.002
4 Corresponding author. Department of Epidemiology and Public
Health, University College London, 1-19 Torrington Place, London
WC1E 6BT, UK. Tel.: +44 20 76791921; fax: +44 20 7813 0242.
E-mail address: n.bobrova@ucl.ac.uk (N. Bobrova).
Journal of Substance Abuse Treatment 33 (2007) 373 – 378