ON 22 MARCH 2024, in Vienna, a significant resolution was passed during the 67th session of the United Nations Commission on Narcotic Drugs (CND). This resolution marked the first acknowledgment, by the CND, of ‘Harm Reduction’ as a crucial component of successful public health strategies.
It urges countries to create and put into action Harm Reduction strategies to reduce the negative health and social impacts stemming from the non-medical use of illegal drugs.
Harm Reduction principles fundamentally revolve around neither promoting nor denouncing drug use but rather focusing on addressing the associated risks. It entails supporting individuals to mitigate harm; responding to their specific needs; and recognising and supporting people to reach their potential.
This CND endorsement of Harm Reduction is important globally, but it is particularly timely with regard to Ukraine. The catastrophic consequences of the invasion and ongoing war with the Russian Federation have reportedly led to a significant increase in drug use and mental health disorders among military service personnel and war veterans in Ukraine. Colleagues within Ukraine have described to me how there is a new cohort of military service personnel and war veterans who actively use drugs — either while in service or after demobilisation. They have also described how the absence of Harm Reduction services is putting this group, and their families, at greater risk.
A 2024 report on the evolving drug trends in wartime Ukraine by the ‘Global Initiative Against Transnational Organised Crime’ has identified reported use of cannabis, often combined with synthetic stimulants; an illicit market for methadone, Subutex (buprenorphine) and other synthetic opioids; the use of synthetic cathinones, such as alpha-PVP (AKA ‘flakka’) and mephedrone; and concerns regarding the prevalence of illegal supply channels for strains of cannabis that are high in tetrahydrocannabinol (THC), the main psychoactive component of cannabis. Synthetic opioids and poly drug use in Ukraine are both worrying trends — among other harms, similar drug trends have fuelled an increase in overdoses in other countries.
During their military service, and after returning from the war, many Ukrainian soldiers and veterans experience Post Traumatic Stress Disorder (PTSD). PTSD is a psychological disorder that some people develop who have experienced a shocking, frightening or dangerous event. Symptoms of PTSD include trouble sleeping, anger/aggression, risk-taking behaviour (e.g. drugs/alcohol), trouble concentrating and much more. In the absence of treatment for their PTSD, people have turned to self-medicating — that is using drugs in an attempt to manage their PTSD symptoms.
Also, a significant number of returning soldiers have suffered major physical trauma because of the hostilities — including amputation or other severe physical injuries leading to disability. The number is growing as people return from the war with catastrophic physical injuries every day.
Military service personnel and war veterans who have suffered amputation or other severe physical injuries require daily pain relief and pain control for a long period of time. I have been told that access to controlled medication is limited. As such, many people receive substandard pain management, reportedly having gained access to controlled medications that have been delivered by some volunteer groups or humanitarian missions, often without any control or oversight from medical staff.
An increased use of drugs among Ukrainian military service personnel and war veterans for self-medication in response to crippling PTSD and during recovery from life changing injuries is likely to have serious consequences e.g. potential increases in HIV, Hepatitis C and non-fatal/fatal overdoses. Most of the military service personnel, as well as their family members, do not associate themselves with ‘traditional’ at risk groups and as such do not seek access to the information, resources and methods of Harm Reduction. This and the reported absence of Harm Reduction programs for drug use amongst military service personnel and war veterans compounds problems.
At the time of writing, Ukraine is facing yet another wave of mobilisation/conscription as the losses are tremendous. One of the changes being considered could see individuals with a history of drug use, or people who are on Opioid Substitution Therapy, eligible for conscription. This means that more individuals who otherwise would have access to Opioid Substitution Therapy will be deprived of such during military service. A frightening prospect for someone who is opiate dependent.
From a broader perspective, the overall narrative in Ukrainian society is that the armed forces of Ukraine are the guardian angels — “our kittens” who defend us. This idealisation of military service personnel makes having any discussion about drug use and dependency extremely difficult. This has led to the problem being hidden and impinging open professional discussions and evidence-informed decision making. Drug use among Ukrainian military service personnel and war veterans is stigmatised. Often this leads to a lack of knowledge, skills and understanding of Harm Reduction and a barrier to safer practices and access to drug treatment.
Stigma prevents people from coming forward to seek support; leaving people who use drugs at greater risk of harm for longer than otherwise would be the case.
The Ukrainian Government should be encouraged by the recent CND endorsement of Harm Reduction. There is a relevant goal in the operational plan for the implementation of the Ukrainian drugs strategy for 2024-2026 which is to, “ensure the expansion of Harm Reduction programs for persons with mental and behavioural disorders due to the use of psychoactive substances, including the introduction of new approaches to the provision of services.”
Prioritising this goal would help avoid further health and social difficulties down the track for military service personnel/war veterans, their families and other citizens impacted by the war and drug use.
A drug policy expert, Tony Duffin is the CEO of Ana Liffey Drug Project; and the Independent Chair of ‘Correlation — European Harm Reduction Network’ (C-EHRN). Founded in Dublin in 1982 Ana Liffey was the first service in Ireland to be established on the principles of Harm Reduction. C-EHRN is a network of organisations and individual members working in the field of drug use and Harm Reduction from across EU Member States and other European countries.
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