The Magic Bracelet

Author: Olga Belyaeva, Advocacy Manager, EHRA

When I heard someone knocking on my hotel room’s door and shouting “She is dying!!!” I was in the bathroom. Just five minutes ago, I entered my room, took my coat and shoes off and… ran out straight away with Naloxone.

After that memorable meeting in Scotland, I carry it with me all the time.  

Glasgow. July 2018. My 45th birthday. “You know, we have a very serious problem with overdoses – those were almost the first words I heard from Stephen Malloy, part of the team of the European Network of People Who Use Drugs. I nodded and a routine though came across my mind: “Back at home, in Vilnius, up to 12 people are found dead in bad months. Under the guise of heroin, people are sold a mix of morphine and methadone together with fentanyl.”   

Looking at me attentively, Stephen went on: “My country has done very well with offering OST (methadone, buprenorphine) but everyone knows more MUST be done. People need easy access and doses that are suitable to them. There will be a small ‘Heroin Assisted Treatment’ program beginning in September 2019. and in time, if it is allowed to grow, it will change so many lives for the better; IT WILL SAVE LIVES.”

So here it is,” Stephen was holding an oblong narrow yellow box in his hand. “Are you ready to take it with you?”  I recognized it: once I saw such a box at a conference. It was convenient and stylish, with Naloxone inside. I said “Sure!” and took the box. “Then put this bracelet on. People will know that you have naloxone with you, if you overdose and they find you. They will be able to help you and you will be able to help others.”  Stephen watched me carefully, assessing my decision: was I really ready?

I put the bracelet on, found a place for the Naloxone box in my belt bag, where I already had my wallet, my phone and my beads. Then I continued my three-day work at the meetings on overdose response.

One of the meetings was dedicated to the topic of 48 hours after prison. There was a discussion with the experts in overdose theory on what should be done first: Naloxone injection and then artificial respiration or first artificial respiration and then Naloxone? My logic told me that first Naloxone is to be injected, which will help to ensure artificial respiration. “That’s a question of life, so it needs a correct answer. When I go to Ukraine, I will have to go and visit Vasiliy, he is an emergency doctor in the city of Dnepr. He saved my life more than once, so I believed him. He will tell what is to be done. He will also teach me how to do it,” I was thinking, packing my things to go to the EHRA headquarters in Vilnius.

Railway station. Stephen and Nicole’s birthday present – Scottish red and green check scarf – kept me warm. Standing at the platform, we gave each other goodbye hugs, listening to our heartbeats.  Making myself comfortable in my seat with a book, I realized that my eyes were constantly coming back to the yellow bracelet.  The sounds of the train, its rhythmic swing combined with polite and quiet travel companions – it all gave me a chance to think why it happened like this: I had 30 years of opoiod use behind me, but Naloxone became part of the things I always consciously carry with me only three days ago.

Why? With the daily use of opiates, which were cooked correctly using high-quality materials, overdoses were rare in our group. Usually they happened after the forced “treatments.” Since about 2005, if you hear someone had an overdose in Dnepr (Ukraine), the response would be: “He was lucky to survive.” Naloxone ampules were available in mobile clinics and from outreach workers since 2003. However, it was the first time in my life when I wore a bracelet saying “I have Naloxone.” We always tried to avoid carrying Naloxone ampules with us so that the police would not start working on us because of it: “Hey, Naloxone, so you’re a drug addict!” Then the standard scenario would follow: taking a bribe and letting us go for a while. Another scenario could be turning the life of the person and the family upside down, if they needed to show better “crime detection rate.” Quietly and invisibly, the bracelet started raising my level of consciousness about overdoses.  It became a part of me. I only take it off when I have my aikido practice. The rest of the time, I have the bracelet on my arm, which means I have Naloxone in my bag and my bag – on my belt.

The approach to have Naloxone “always at hand” helped me to save a person’s life at the hotel. I covered three floors – and 40 seconds after I heard someone knocking on my door, Naloxone was already doing its work in the body and helped us to keep our dear friend alive. We did artificial respiration, poured water, and our team of two people + naloxone helped to save our friend’s life. We prayed for Stephen and Nicole. I realized that I do not have practical reanimation skills, which work automatically. At the same time, wearing a bracelet saying “I have Naloxone” means that I have to be 100% sure about the things I am doing. So I still had the question: what should come first – Naloxone or artificial respiration? My trip to Dnepr was not coming soon, but the question was vital. So we invited a practitioner, an emergency care doctor to come to the EHRA office, share his experience and tell us what to do.

“After death, pinned pupils are seen only in people who died of opiate overdose. Sometimes it can also be an effect of cerebral hemorrhage, but in this case one pupil is constricted and the other is not,” told us an emergency care doctor from Vilnius. That is how easy it is to collect data and see how many people actually die of opiate overdose, who those people and their family members are and what can be done. Those are the things to be done:

First, 70% of people die as they are not able to breathe. When a person is unconscious, his tongue base goes down and closes the air passages.  What to do: put your hand on the person’s forehead, throw the head a little back and put the jaw down. Often you will hear a deep breath.  There are three ways to determine if the person is breathing: eye, ear next to the person’s mouth and watching the person’s chest. With your eye, you will always feel the air moving, with your ears you will hear it and the chest will help you to see it. A person makes 14-16 breaths per minute. So we wait for 10-15 seconds to see if we can hear or feel the person breathing or see the chest moving.

Second, we must fill the lungs with oxygen. “While an amputated limb or finger can be stitched back to the body even after three hours, a brain cell left without oxygen for four minutes, dies and this process is irreversible.” We breathe in 21% of oxygen, breathe out – 17%. So that’s what we need to do straight away: hold the nose and carefully breathe the air into the person’s lungs twice. This air will be enough to save the brain so that we have four minutes to inject Naloxone and ensure artificial respiration.

Third, make an intramuscular injection of Naloxone.

Fourth, artificial respiration: we press the chest 30 times and let go, going 4-6 centimeters deep, while breathing. You can watch the practical learning session by the emergency care doctor.

…Summer 2019. “Thank you, Stephen. Girls from the Narcofeminist movement and your Naloxone saved my friend’s life. As for the bracelet, it is a magic one. It helped me realize that I need to develop my skills to help people in different overdose scenarios.” When we met at the Harm Reduction International conference in Porto, we hugged each other tightly, not letting go for a while. 

Besides, I realized that consciousness means personal responsibility in action. People in our countries cannot carry Naloxone safely as they may have problems with police. Considering this, talented Sergey Bessonov and Dima Shvets came up with a way of how to make boxes and Naloxone packs, which are convenient to keep in a glove compartment in a car or at home. There is even an “excise label” to store the box until there is an emergency. They make those boxes for people, with love and understanding. They are stylish, nicely sized and pleasant to hold. Such boxes are made in the social dormitory of Ranar Charitable Foundation in Kyrgyzstan.

The yellow box, which came to me from Scotland, has already renewed its stock of Naloxone and now has other helpful things as well. The last thing I got from a friend of mine were tablets, which help in case of MDMA overdose.  In the center, there is a syringe with Naloxone. 

If someone needs help, I am ready.

“90% of successful reanimations are the ones when someone did something,” says the emergency care doctor.

 August 30-31, 2019

EHRA letter to support release of Andrey Yarovoy

Kobtseva Olga Anatolyevna

Representative of the Lugansk Republic in the humanitarian subgroup of the Tripartite Contact Group on the settlement of the conflict in the Donbass

Dear Olga Anatolyevna,

On behalf of the Eurasian Harm Reduction Association (EHRA) allow me to express our utmost concern about the fate, life and health of Andrei Mikhailovich Yarovoy, a citizen of Ukraine, date of birth 11/06/1967, who has been detained for 10 months in the territory of the Lugansk Republic.

Since 2009, Andrei has been a patient of opioid substitution therapy (buprenorphine). Andrei is a member of the Eurasian Harm Reduction Association (EHRA), the Eurasian Network of People who Use Drugs (ENPUD), the All-Ukrainian Association of People Who Use Drugs Volna, a human rights defender and a consultant to monitor the quality of services of the International Charitable Foundation “Alliance for Public Health”. Andrei worked in HIV / AIDS prevention programs that have been supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria since 2004. Andrei is a specialist in organizing HIV prevention and treatment programs for people who use drugs, who actively helped representatives of this group to access HIV treatment in Donbass since 2015, where programs supported by the Global Fund were implemented at that time.

On July 25, 2018, Andrei Yarovoy left Kiev for Lugansk as a consultant to the Alliance tfor Public Health o study the access of populations with a high risk of HIV infection to prevention services and life-saving treatment. On August 26, 2018, when Andrei crossed the checkpoint in the Krasnodonsky district, he was detained with 38 tablets of buprenorphine hydrochloride, a medicine used for opioid substitution therapy (OST), with a total weight of 0.152 mg. On the eve, Andrei legally received a 10-day supply of this drug (in total 0.16 g) for the treatment of his own chronic disease in a medical institution in Kiev. On August 27, 2018, Andrei was arrested, later convicted and sentenced to lengthy term with confiscation of property under Part 3 of Article 282 and Part 2 of Article 276 of the Criminal Code of the Lugansk Republic. At the moment, Andrei is being held in prison at 94420, p. Lininskoe, Sverdlovsk district, st. Profsoyuznaya, 16.

In November 2018, Professor Michel Kazatchkine, Special Adviser to the Joint United Nations Program on HIV / AIDS (UNAIDS) for Eastern Europe and Central Asia, published an explanation of the status of methadone and buprenorphine in the World Health Organization Model List of Essential Drugs for Basic Health and Treatment Systems most important diseases based on criteria of efficacy, safety and economic viability. These drugs are recommended by the World Health Organization for the treatment of opioid dependence as an opioid substitution treatment (OST). Opioid substitution therapy is one of the most studied medical practices for the treatment of addiction and the prevention of blood borne infections. It is endorsed by the World Health Organization (WHO), the Joint United Nations Program on AIDS (UNAIDS), the United Nations Office on Drugs and Crime (UNODC), medical professional organizations and researchers in the European Union and the United States and is widely used in most countries of Eastern Europe and Central Asia. The 1971 UN Convention on Psychotropic Substances provides for the possibility of transporting controlled drugs across borders for person’s own medical needs.

The humanitarian activity of Andrei Yarovoy is recognized by the world community. On April 28, 2019, during the grand opening of the 26th International Harm Reduction Conference in Porto (Portugal), Andrei Yarovoy was awarded the authoritative international aCarol and Travis Jenkins Award as a victim of human rights violations related to illegal imprisonment for storage of legally obtained medical drug. This award has been presented annually since 2005 to people who use drugs, who make an outstanding contribution to the potential harmful effects of substance use.

On behalf of the community of civil society organizations working and defending the rights of people who use drugs, activists and experts in the region of Eastern Europe and Central Asia, we ask you to consider the earliest possible release of Andrei Yarovoy and his return to his family, friends and his professional humanitarian work.

With respect and hope for a positive decision on the fate of Andrei Yarovoy,

Anna Dovbakh

Executive Director

Eurasian Harm Reduction Association

anna@harmreductioneurasia.org

* The Eurasian Harm Reduction Association (EASA) is a non-profit public organization, registered on the initiative of harm reduction activists and organizations from Central and Eastern Europe and Central Asia (CEECA) in 2017 and uniting 251 organizational and individual members from 29 countries of the region. The EHRA’s mission is the creation in CEECA region of favorable environment for sustainable harm reduction programs and decent lives of people who use drugs.

About Community Involvement

The Eurasian Harm Reduction Association (EHRA) approach to work with people who use drugs (PWUD) is based on the recognition of principle of greater involvement of PWUD in policy and advocacy work as well as in programs and services that affect their lives.

In an effort to provide skills, knowledge and capacity building support to PWUD community, we are developing programs which help PWUD to become experts and take leadership in advocacy on national, regional and international levels for better policies and services which correspond to their needs.

EHRA Secretariat’s expertise on wide spectrum of technical assistance and community mobilization is used to produce tools and provide technical support for PWUD community to facilitate cooperation and communications on international, regional and national level between civil society, PWUD community groups and decision makers in advocacy, community led monitoring of policies, services and funding of harm reduction programs.

All the activities and programs are implemented by EHRA Secretariat in close cooperation with Association members national PWUD community networks and leading regional and international drug user networks, harm reduction and drug policy organizations – Eurasian Network of People who Use Drugs (ENPUD), European Network of People who Use Drugs (EuroNPUD), International Network of People who Use Drugs (INPUD), International Drug Policy Consortium (IDPC), Harm Reduction International (HRI), Youth RISE and others.

Eurasian Harm Reduction Association (EHRA) is a membership-based organization. We encourage organizations and individuals from Central and Eastern Europe and Central Asia to review the goals and mission of the Association and consider applying for membership. Natural persons or legal entities who cannot fulfil geographical criteria for membership are welcome to become EHRA supporting members.

There are no membership fees, but members need to be committed to support the principles and approaches of harm reduction; respect and follow the Association’s regulations and decisions, including its by-laws; abide the Statute of the Association and the decisions of the bodies of the Association.

Germany. #Narcofeminism

The meeting “Development of Cooperation and Solidarity between Feminist Movements and Women Working in Drug Policy in Eastern Europe and Central Asia” was held in Berlin from 9 to 11 of May. During the meeting, participants from Kazakhstan, Kyrgyzstan, Ukraine, Estonia, Russia and Germany, together with AWID and Deutsche AIDS-Hilfe, discussed opportunities of cooperation and how repressive drug policies affect the lives of women and their relatives. We were inspired by new ideas and we hope to implement them this year! #inonebreath #womenanddrugpolicy #feminism#AWID #EHRA

Kyrgyzstan: “Fine for freedom”

Authors: Olga Belyaeva, Advocacy Manager, EHRA/Sergei Bessonov, “Harm Reduction Network” Association, Kyrgyzstan

“Don’t push us into the corner or we will shoot”. Who pushes people into the corner introducing new Criminal Codes under the guise of “humane reforms” and reducing the prison population in Kyrgyzstan while three grams of hashish are subject to a fine of 4000 dollars?! If you don’t pay the fine they’ll put you in prison for up to 5 years. And most importantly, how can we change the vector of drug policy toward regulation of psychoactive substances, safe drug use with adequate restrictions that keep people in the legal field and give possibilities of comfortable drug use?

This is the topic of our meeting during the Dialogue Platform “Challenges for the communities and definition of responsive measures”, organized by the Kyrgyzstan Harm Reduction Association with assistance from the Eurasian Harm Reduction Association and AFEW Kyrgyzstan.

Platform discussion topics: geopolitical relations between countries, stigma influenced by religion, the history of cannabis and opium in Kyrgyzstan. How and why did people change the methods of substance use, real risks and consequences of such actions and how can we respond to them in our harm reduction programs. In fact, we see that programs and approaches of harm reduction services are not in the same street with the actual needs of people. We also discussed the pilot project that would start in one of the districts in Bishkek in 2019, based on the LEAD model and led by AFEW. The basic indicators of the desired results of the pilot are community monitoring, including  street lawyers / public defenders, personal contacts, statistics monitoring of drug related cases in police, probation and courts.

The country is currently reviewing the Government Regulation № 543 on drug quantities: small, large and extremely large. Small quantity qualifies for a misconduct, while large and extremely large quantities are considered a criminal offense. Small quantities will remain in the Regulation, for example, a small quantity for heroin is up to 1 gram.  The big step forward is that the expertise on the drug purity was included to the Regulation. Basically, it’s a good topic to consider.  If a person is detained with 1.5 grams of a drug, the person perpetrates the Criminal Code, which means 4 000 dollars fine or a prison. Then, the expertise might show that the pure substance is less than one gram, this means the person breaks the law of the Misdemeanor Code and can be subject to a fine of 800 dollars and a restriction of freedom for 6 months (the person would also be banned from visiting certain places or will be subjected to treatment according to their consent and at their expense). The problem in this case is that the actual situation on the drug stage is not taken into account, where the minimum purchase of heroin begins at five or ten grams.

“Fine for freedom” (c). People who feel and understand their freedom may create such slogans.  And we know that our message will be convincing only if we accept ourselves as people for whom the use of psychoactive substances is a standard of living.  We should expose to the thinking people the causal relationship between bribes, provocations, blackmail by policy and suicide, homelessness, pain and all negative consequences of repressive drug policies, which could have been prevented.

1 000 dollars are spent for incarceration of one person per year while opiate substitution therapy and needle exchange programs cost only 280 dollars and give you freedom. Drug policy and appropriate use of public budget are two halves of the same objective: decriminalization as a step towards the regulation of substances and redirection of resources from repression to helping people with drug dependency. Tomorrow the participants of the Dialogue Platform will clarify the strategic goals and tactical plans to blaze a trail to freedom and implementation of the constitutional rights in their country.

Handle with Care: How to Document Human Rights Violations among the Most Vulnerable Groups of Key Populations

On 24 July, 2018, EHRA and Canadian HIV/AIDS Legal Network conducted a workshop “Handle with Care: How to Document Human Rights Violations among the Most Vulnerable Groups of Key Populations”.

Continue reading “Handle with Care: How to Document Human Rights Violations among the Most Vulnerable Groups of Key Populations”