‘If only we had the political will’

Why Russia’s rise in drug overdose deaths is unlikely to end soon

According to data from Russia’s Federal Statistics Service (Rosstat), over 10,000 Russians died from drug use in 2021. That’s 37 percent more than in 2020 — and twice as many as in 2019. To find out what’s causing the spike in overdose deaths, and what the government can do to prevent them, Meduza turned to Alexey Lakhov, former development director at the Humanitarian Action Foundation, creator of the Drugmap project, and a member of the Steering Committee of the Eurasian Harm Reduction Association.

In 2010, the Russian government published its State Anti-Drug Strategy, a 10-year plan for reducing illegal drug use in Russia. According to a report for the UN Human Rights Committee compiled at the end of the decade, the strategy was based on “a policy of social intolerance to drugs and drug use” — the exact approach most public health researchers advocate against.

Throughout the mid-2010s, Russia's State Anti-Drug Committee (GAK) consistently reported about 5,000 illegal drug overdose deaths per year. But according to Alexey Lakhov, former development director at the Humanitarian Action Foundation, there were a lot of deaths the GAK failed to capture.

“[Those numbers] don’t include deaths recorded as ‘acute kidney failure,’ which can be a sign of an overdose, or, for example, 'acute heart failure,'” he told Meduza.

And the oversight might be no accident, Lakhov said: it was likely part of an effort to show how well Russia was coping with its drug problem in contrast to the U.S., which was experiencing 60,000 to 70,000 drug overdose deaths annually in the mid-2010s. During the pandemic, however, Russia's overdose problem became harder to hide: according to Rosstat, 7,316 people died from overdoses in 2020, compared to 4,569 in 2019. In 2021, the number reached 10,043.

Other signs of the worsening situation in Russia come from the drug trade itself. “[Illegal drug] confiscation data shows that there’s been an increase [in trafficking of all types of drugs], including psychostimulants, a category that includes amphetamines, synthetic cathinones [Editor's note: these are commonly known as "bath salts" in the U.S.], and cocaine. [Statistics also show that] opiates aren’t going away completely, either,” said Lakhov.

GAK data also indicates that the number of drug users registered with government addiction services has gone down in recent years. But as always, Lakhov said, “the devil’s in the details. [Could the decrease] be related to a rise in deaths due to various causes like overdoses, HIV, tuberculosis, and other diseases? And how many of those people were removed from consideration due to long-term remission?” Additionally, he said, if you factor in the number of people who meet the criteria for latent drug addiction, the number of Russians suffering from addiction might be several times higher.

Finally, he said, the official decrease in Russian drug users is inconsistent with what we know about drug availability. In 2020, a Russian dark web site called Hydra, which was the world’s largest drug marketplace before being dismantled by German police, was at its peak, making illegal drugs more accessible than ever before.

“I can’t claim for certain that Russians have begun using more drugs, but I can’t leave out the fact that amidst the development of the DarkWeb and messenger apps, drug accessibility has risen significantly,” said Lakhov. “I shudder to think what would have happened if drug users had had access to modern communication systems during the heroin epidemic in the late 1990s and early 2000s.”

Naloxone, naloxone, naloxone

According to Lakhov, if the Russian government really cares about reducing drug overdose deaths, there’s a simple step it can take: increasing the accessibility of naloxone, a safe and inexpensive drug that reverses opioid overdoses. He doesn’t think the idea is outside the realm of political possibility, either: “Even in conservative countries, the practice of distributing naloxone among drug user communities is fairly widespread,” he said.

But so far, he’s been wrong. In April, he contacted the St. Petersburg Deputy Governor’s office with three overdose prevention proposals. Two of them directly involved naloxone. In June, he received a letter that said the proposals were “unviable.”

“[These proposals] were the three most obvious possible solutions [to the overdose problem], in my view: giving people over-the-counter access to naloxone, teaching drug users and their relatives how to use naloxone, and repealing the administrative penalty for non-medical drug use in the case of an overdose,” he said.

The third proposal has been implemented in Canada and parts of the U.S. in the form of “Good Samaritan laws,” which protect people from prosecution if they’re suffering from an overdose. “We had the beginnings of this law — they started discussing it [in the State Duma], and they used the ‘good Samaritan laws’ as a basis, but they were focusing mostly on [...] making sure that a person wouldn’t be held liable if somebody died while they the person was assisting them,” he said. The law failed to pass.

Other overdose prevention measures, such as information campaigns and labels about safe drug use practices, have been proven to work in other countries, too, but because Russian lawmakers have so far been unwilling to go for even the low-hanging fruit of naloxone, Lakhov is pessimistic about other approaches. “We don’t need to reinvent the wheel in Russia — we already know what to do. If only we had the political will to implement these kinds of programs. But unfortunately, right now, we don’t.”

Instead, Russian legislators still seem to be counting on a “policy of social intolerance” to solve the problem. A law against distributing “drug propaganda” has doubtless had a negative impact on the number of drug overdoses in Russia, said Lakhov. Luckily, information about safe drug use has continued to spread online.

“It scares me to think what would happen if we didn’t have so much information [online]. We would likely see a much higher overdose rate. In a sense, the drug market has corrected [for government inaction], providing people with information about safer usage,” he said.

But that could change. “In December, they lowered the minimum amount of [methadone] it takes to be criminally prosecuted, and now they’re discussing criminal liability for drug propaganda on the Internet,” said Lakhov. “That’s very alarming.”

Interview by Andrey Kaganskikh

Abridged translation by Sam Breazeale