"We were already kind of prepared for it."
Anton Basenko was 14 when he started using drugs. In the course of the years, he survived six overdoses until he became one of the first patients of opioid agonist therapy in Ukraine. Since then, he is advocating for the provision of Harm Reduction services and is now Chair of the Ukrainian Network of People Who Use Drugs and programme manager at the European Aids Treatment Group. Talking to the GPDPD, he explains how previous crises prepared Harm Reduction provisioners in Ukraine for the work in war times and how Germany and other EU-countries can effectively support Ukrainian refugees who use drugs.
GPDPD: Mr. Basenko, you are the living proof that Harm Reduction works.
Anton Basenko: One could say that. I started using drugs when I was a teenager. It was the mid-90s and I was trying to be a DJ. Substances like amphetamine, cocaine, and ecstasy appeared in Ukraine unexpectedly – an independent Ukraine already in the post-Soviet reality. No one knew anything about these substances. At the age of 14, I tried my first dose of ecstasy. Working as a DJ and using stimulants brought me insomnia and depression. When I was 16, I tried heroin as a sleep aid, not even as a drug for getting high, but to calm down. It was recommended to me by one of my friends and it was cheap and easy to access.
Taking heroin was an unfortunate fate because opioids are very addictive, especially if you are a teenager. From then on, everything went downhill pretty fast. I lost contact with my family, and my friends and I interrupted my studies at the university. I got infections.
Harm Reduction didn’t exist at that time. The first Harm Reduction programmes appeared in 1996, formally. But they were very limited and I had no access. Then came a period of different kinds of treatments and use again. Given that there was no substitution therapy at the time, the treatment was just detoxification and charlatans who proposed some ‘pseudo treatment’. I survived six overdoses. In my life, I have often been on the verge of ending up in the cemetery, like many of my friends. Harm Reduction appeared at the worst moment of my life.
How did Harm Reduction differ from the medical care you had received before?
First of all, we were treated like human beings. We drug users were welcomed with a smile and without being stigmatised. Given the repressive post-Soviet legal framework and the bad attitude of all kinds of people, be it common people or law enforcement, or even doctors – drug users were often treated as if their lives had no value.
In the Harm Reduction facility, you meet people who also have experienced drug use. They are interested in you and understand your situation.
They also provide you with things that you usually try to access as a drug user: clean needles, medication, and food. And when you are offered something for free, like syringes and needles, or cream for your veins, you want to come back immediately. That's how a first connection is formed.
People who use drugs are under psychological and social pressure every minute of every day, and when you find a place where that pressure dissolves, at least temporarily, it's relieving. That's what makes Harm Reduction unique and at the same time the entry point to permanent change.
Unfortunately, during the health check at the facility, I was diagnosed with HIV and hepatitis C. But the staff immediately told me, "Don't worry, treatment is possible."
In 2004, substitution therapy became available. I immediately took my girlfriend, who is my wife today. We were part of the thirty people who got a lucky ticket and got accepted. I don't know how positive the outlook would have been if I had just kept using the needle and syringe programmes. There are different scenarios, but for me, being dependent on opioids, substitution therapy was the final rescue.
And now you're helping to save others?
It's not just that I stayed alive and fought my way through those tough times. Harm Reduction is also my work, part of my professional career, which has now lasted more than 13 years since I started as a volunteer. I have helped hundreds of thousands of people with my experience. In Ukraine alone, there are Harm Reduction programmes for more than 220,000 people out of the estimated 350,000 people who inject drugs. It is good to know that my experience can be an example, not only in Ukraine but in the region and around the world. Frankly speaking, I’m a bit proud. Also, I have a family now. My son is my biggest achievement.
In recent years, Ukraine has made enormous progress toward implementing Harm Reduction. Now there is war. What is at stake and what are people experiencing now?
War was not unknown to us because we already had experienced this with Russia's invasion of Crimea in 2014 and 2015, and some parts of Donetsk and Luhansk. We were already kind of prepared for it. The Corona pandemic also prepared us for switching into the crisis mode. We had experience with emergencies and how to react to them. This prior experience with conflict and crisis resulted in Harm Reduction programmes being saved, at least in the areas not occupied by Russian troops. Of the more than 200 facilities for substitution treatment, 51 are currently closed.
But given the danger to the lives of people, I think what was needed most was the evacuation of people from the hotspot places of the invasion to safer regions and then access to treatment for them. As for Harm Reduction measures - they are still being offered, at least as far as possible. Of course, the approaches have changed. There is certain flexibility. For instance, now there is a launch of online orders, the so-called Help Boxes with syringes or needles, condoms, and stuff like that. There is no need to go personally to some place anymore or if you go you can receive your medication not just for one or two days but for a week or a month. The same applies to substitution therapy. There also was an approved special Ministry of Health Act, which allowed to have take-home dosages for up to 30 days in the territories that are under active military engagement.
You explained the Help Box – what were other adaptions to the war?
One of the main problems is the disruption of logistics chains and supplies. All regions face the problem of limited supplies of medicines for treatments and therapies. They already started to reduce the dosage of methadone for people. One very innovative solution was to use mobile vans to access people. These vans turned into humanitarian convoys and helped to supply substitution therapy to the territories and to evacuate people. They were able to transport methadone and other medications. But of course, it is dangerous, especially in areas under active bombing. But these mobile vans are very helpful.
Do you know anything about the situation of people who use drugs in the areas occupied by Russian forces?
Yes, for example in the occupied region of Kherson, there is a new ‘fake’ governor now. We are in contact with doctors who have told us that substitution therapy is still working, but only because they are using up their last medication. And since new deliveries are not possible, they have already realised that therapy will be over soon. Now they are probably adjusting to the regime of detoxification and slowly reducing the dosages for the patients.
In some cities in the Mykolaiv region and the Lugansk and Donetsk regions, the facilities for substitution therapy are closed and we call for the evacuation of all patients. There are many volunteers and people who want to help, especially from key populations.
But communication is difficult. In the areas where Russia has a massive presence, they started to completely block Ukrainian mobile operators and sell SIM cards of Crimean mobile operators. They are doing everything to deny people access to information and connection to the Ukrainian side. When you lose all connection with people, when you don't know what's going on - that's the most terrible thing.
The uncertainty must be very difficult. What gives hope is what you mentioned before: people stepping up in this very difficult situation. Do you know anything about the challenges people who use drugs that are fleeing Ukraine are facing? Many refugees have come to Germany.
First of all, of course, there is the language barrier. Then there are the problems of stigma. People who use drugs often try to hide their dependency out of fear of repressive drug policies they experienced. They do not disclose their status as HIV-infected or drug users to the state. Of course, they do not want to reveal this fact in the registration centres – but at the same time, they need help. And then there is the problem that they are often accommodated in small villages and towns. They need to drive several hours by train every day to a larger city to get their substitution therapy.
In Germany and other EU countries, many non-governmental organisations are doing an excellent job. But of course, they were not prepared for this and often do not receive any additional funds. Now they have to deal with people who do not speak their language, and who have experienced terrible things – this requires translators, social workers, and psychologists. We see that the EU Commission opened a call for a proposal for mental health services for Ukrainian refugees. As Ukrainians, we are grateful for the commitment from the people, who have opened their doors for accommodation and work in local NGOs without any additional salaries just because they want to help. We are grateful for that, but we understand that there is some physical limit, and, at some point, people will be completely burned.
What should Germany do to support people who use drugs from Ukraine?
Germany is a federal state. The care system varies from one federal state to another. I think it would be helpful to have a more standardised approach to supporting refugees from Ukraine who have drug issues. And of course, we need more funding for the grassroots organisations that do a fantastic job.