In a country with more than two million heroin addicts, Irina Teplinskaya was one of the first. It was back in 1981, as a 14-year-old girl in the Baltic port of Kaliningrad, that she first tried the drug. She came from a prestigious family of senior Communists and was one of just a few who could afford the exciting new drug. She became addicted and suddenly, instead of a move to Moscow to study, her life began to take a very different path. She spent over a decade in prison and contracted hepatitis C, tuberculosis and HIV.
During her last stay in jail, which ended in 2007, her HIV transitioned into full-blown Aids. Her life could have been very different, she says, if people had treated her drug addiction as an illness rather than a crime.
"The answer for me and for millions of others is simple," says Ms Teplinskaya, 44, who now works for an organisation advocating a more humane drug policy in Russia – substitution therapy. Almost every country in Europe allows treatment using methadone. Like heroin, it is an opiate, but is administered orally, meaning no risk of HIV transmission through needles.
Russia is the world's largest heroin consumer and, to add to that, risky injecting practices have fuelled one of the world's fastest-growing HIV epidemics. With tens of thousands of people dying every year, in a country where the population is shrinking, the twin epidemics are a catastrophe.
Campaigners say methadone would help tame both the heroin and HIV epidemics. As well as preventing HIV transmission, giving addicts methadone also brings them into the medical system, help steer them away from committing crimes to fund their habit and takes trade away from illegal dealers. Even China uses the technique to treat drug addicts. But Russian officials will have none of it. Government figures say it is perverse to treat drug addiction with other drugs and favour methods based on full withdrawal, sometimes against an addict's will. It's risky even to discuss methadone – advocates can be accused of "pro-drugs propaganda" and taken to court.
"There is no logical reason behind Russia's opposition to substitution therapy," says Anya Sarang, a campaigner who advocates the introduction of methadone. "I've been fighting this battle for 12 years and I don't understand the mentality at all. The scientific evidence is all there to prove that it works."
Ms Sarang and a group of Western academics published a study in the British Medical Journal last year which found that the widespread introduction of substitution therapy could cut rates of HIV transmission in Russia by up to 55 per cent. Estimates vary, but it's thought that more than two million Russians inject heroin and the drug causes 30,000 deaths per years, as well as tens of thousands of new HIV cases. Russia is located on the transit route for drugs from Afghanistan to Europe and cheap heroin is readily available – a dose of heroin on the streets costs about 600 roubles (£12). If methadone therapy is not available, activists say programmes that offer addicts clean needles and syringes to avoid HIV transmission are essential.
The government, however, is adamant that only aggressive punitive measures can work to tackle drug use. Needle-exchange programmes funded by foreign donors have been discontinued in recent years, leading many addicts to share injecting equipment.
While there is some discussion about whether needle exchanges should be reintroduced, methadone is completely taboo. Leading Russian drugs specialists denounce substitution therapy as a failed Western imposition and see it as a "legalisation" of drug use.
"We have no evidence from the international community that methadone is effective," said the Health minister, Tatyana Golikova, this week, reiterating a long-held government policy.
Others go further. Evgeny Roizman is a former Russian MP from the city of Yekaterinburg in the Ural mountains. He runs a series of clinics there where drug addicts go cold turkey, without methadone or any other drugs to ease the withdrawal symptoms.
He insists that methadone advocates are simply being disingenuous. "These people will say anything to get Western funding," says Mr Roizman. "I have worked with drug addicts for years, and I can tell you: methadone doesn't work."
He wants to bring in a range of policies, including harsher penalties for drug dealers and compulsory drugs testing in all Russian schools and colleges. "We need forced treatment for drug addicts," he says. "We need to force them into special institutions where there are no drugs and where they can be treated. This is the answer, not methadone."
Last year, a disciple of Mr Roizman was sentenced to three-and-a-half years in prison for kidnapping drug addicts. Yegor Bychkov said addicts' parents had given him permission to "cure" their children. "Patients were tortured, chained up to steel beds, starved," says Ms Sarang. "It was absolutely outrageous and when the court case against him started, we thought there would be a scandal."
But a huge wave of support for Mr Bychkov swept through the country. Even many from Russia's beleaguered human rights community joined with church figures and government officials to condemn his trial and in the end the court suspended his sentence and he was released. Mr Bychkov was "overenthusiastic", said Mr Roizman, but his heart was in the right place.
Ms Teplinskaya, who is still a heroin user, travelled to Moscow last week to meet Navi Pillay, the UN High Commissioner for Human Rights, and ask her to press the Russian government on substation therapy. "I think I could have done a lot of good things for my country," she said. "But instead, I've lost my home, my health and my family. Methadone could have helped me lead a normal life."
But her opponents are confident their views will prevail. Mr Roizman says: "They can shout as much as they want with their Western money. Methadone will never be legal in Russia."Reuse content