Population146,800,000 [4]
PWID1,815,000 [5]
OSTIt is prohibited.
NSPAvailable in 51 operational sites.[6]
HIVPrevalence among PWID – 25,6%.[7] Between 2011-2016, HIV prevalence increased by 65%.[8]
Hepatitis CPrevalence among PWID – 68.7%.[9] Hepatitis C treatment is only available to those who can cover the cost in full themselves.[10]
Hepatitis BPrevalence among PWID – 9%.[11]
TuberculosisRussia is a high-burden country that has seen rates of TB in decline, dropping 13% between 2013-2017; but it still remains one of the three countries that account for almost half of the world’s cases of multi-drug resistant TB.[12]
Overdose preventionNaloxone is not accessible in the pharmacies at all, or without prescription, but ambulances/hospitals have it; it is also possible to get it in harm reduction services.
HR in closed settings· ART is available in prisons
· OST is not available in prisons.
· NSP is not available in one prison.
Criminalization costs [13]

· Money spent on a prisoner/per year – €912.5.

· Money spent for harm reduction and social services – €242.

· Average sentence for drug law offence – from 3 to 5 years.

Drug laws [14]

· Consumption of drugs is an administrative offence.
It is punished by a fine of €55 -70 or administrative detention of up to 15 days.· Possession of small amount – an administrative offence, punishable with fine approx. 55 -70 € or Administrative Detention for 15 days. Possession of considerable, large and extremely large amounts –  a criminal offence, punishable with fine approx. 550 € or imprisonment from up to 3 to 10-15 years and possible fine up to approx. 7,000 €, depending on the amount involved.

· Available alternatives: Enrollment in treatment services may help to avoid administrative sanctions.

There are many problems with the rights of people who use drugs in Russia which affect both problematic users living with drug dependence and those who use drugs recreationally. The existing methods of drug dependence treatment in the country are based solely on abstinence. Russia is the only country among 47 member states of the Council of Europe where opioid substitution therapy (OST)[1] is prohibited. At the same time, methadone and buprenorphine, drugs for substitution therapy, are included in the WHO List of Essential Medicines and lack of access to them is a violation of the right to health.

Attempts to introduce substitution therapy in Russia have been going on since mid 1990. Since 2009, OST has been sought through international legal mechanisms such as various complaints submitted to the UN human rights treaty bodies, the European Court of Human Rights (ECHR), and with the help of special rapporteurs attempting to draw attention to the situation. This tactic has led to some achievements, for instance, the recommendation to urgently legalize substitution therapy in Russia from the Committee on Economic, Cultural, and Social Rights in 2011 and then in 2017[2]. However, it has not yet been possible to achieve any progress due to the state’s political reluctance.

An example of attempts to advocate access to OST through international legal mechanisms is the case of Alexei Kurmanaevsky, Irina Abdusheva, and Ivan Anoshkin[3]. Initially filed separately, all three official proceedings were consolidated into one by the Strasbourg Court in 2014. All the applicants tried to undergo abstinence-oriented treatment of drug addiction in Russia but quit and returned to drug use. In the litigation, the ECHR refused to consider the proceedings of Kurmanaevsky and Anoshkin due to the allegedly achieved remission. In the case of Abdusheva, who was not in remission, the court rejected to return verdict whether she should be prescribed substitution therapy, citing the fact that the assessment of the effectiveness of treatment belongs to the field of medicine and not to a forensic examination. Accordingly, the Court has decided that the question of a particular form of treatment falls within the State’s margin of appreciation and therefore the Court is not entitled to interfere with it.

Such verdicts were based primarily on the facts that Russia provided for the court. In the case of Kurmanaevsky and Anoshkin, the Russian state informed the EHRC that both applicants had been in remission when filing the complaint and that they had received medical help on several occasions but refused it. However, the problem with offered treatment is that it involves 21 days of detoxification that not everyone can bear which in turn results in treatment interruption. Moreover, when applying for free drug treatment in Russia, the patient is registered as a person with drug dependence in the specialized drug user registry. This registration negatively affects person’s chances to find a job, get an education and obtain driver’s license, and other civil rights.

For these reasons, few people in Russia want to get registered, try to deregister as fast as possible and try to get treatment in private anonymous rehabilitation centers. This is what the third applicant, Abdusheva, did. The Russian State, defending its position, referred to the fact that Abdusheva received state treatment for the last time in 1984 and did not take cases in anonymous centers into account. Abdusheva could not undergo state treatment because of its unbearable conditions, which, however, the court did not take into account, rendering the final verdict.

The ECHR decision regarding OST is a gross miscarriage of justice committed by the ECHR under the influence of two factors. The ECHR did not understand the particular vulnerability of people living with drug dependence to human rights violations in a situation where only abstinence-based treatment is available in the country. Additionally, under the influence of misinformation provided by the Russian side, the ECHR concluded that OST is an experimental type of treatment and therefore Russia has wide discretion to place this type of treatment under a complete legislative ban. Nevertheless, attempts to change the situation for the better continue.

Substitution therapy is only a part of the harm reduction approach. Other harm reduction services in Russia do exist but faces many obstacles and rely mainly on the enthusiasm of NGOs. Some non-profit organizations, such as, for example, the Humanitarian Action Foundation[4]  in St. Petersburg and the Andrey Rylkov Foundation[5] in Moscow, run syringe exchange programs, provide counseling to people who use drugs, testing for HIV and Hepatitis, and relevant referrals to treatment. Officially, there is no state budget for harm reduction, although there are, for example, cases of presidential grants provision to work with vulnerable groups. In general, it seems fair to say that the resources allocated for harm reduction in Russia are insignificant and incomparable with the efforts to maintain the anti-drug strategy.

In the previous Russian anti-drug strategy, approved by a presidential decree that was in place from 2010 till 2020[6], the syringe exchange program and substitution therapy are deemed inadmissible. In 2018, the methodological guidance[7] was issued in the framework of the development of the HIV strategy implementation plan. This document recognized the distribution of so-called ‘motivation packages’ for injecting drug users (a set of prevention materials reducing the risk of HIV infection, including needles, syringes, and other necessary supplies) as one of the comprehensive prevention interventions among this group for non-medical purposes. However, the methodological guidance carries no legal weight and contradicts the anti-drug strategy signed by the president, which says the exact opposite. It is worth noting that the new 2020 strategy does not contain direct or indirect prohibition of syringe exchange programs, but substitution therapy remains banned.

Since the lack of financial and political support from the state, activities of harm reduction organizations in Russia largely depend on international donors. However, with the enactment of the law on foreign agents and the approval of a list of undesirable organizations, they practically lost this funding[8]. Furthermore, the regulation of so-called drug propaganda has been tightened. It is accompanied by an increase in fines[9] and the introduction of criminal liability[10]. Such an increase in penalties for propaganda is nothing more than another restriction on freedom of speech. At the same time, changes in laws will affect the work and hinder information activities of NGOs that provide harm reduction services in Russia. However, it is worth mentioning that despite all the obstacles, NGOs promoting harm reduction in Russia demonstrate excellent work. In many aspects of their activities (for example, outreach and web outreach[11] in particular), they can give a head start even to their international colleagues, in whose countries there are no similar legal barriers.

Concerning changes in the police and judicial system, since the closure in 2016 of the Federal Drug Control Service of the Russian Federation (FDCS), the number of reported drug-related offenses and sentences started to decline[12]. In 2015, there were almost 237,000 drug-related offences registered in Russia. In 2017, this number was 209,000, and by 2019 it dropped to 190,000, which means a 20% decrease in the number of offences in 4 years.

Despite all the changes, the attitude towards people who use drugs within the justice system has not changed and the majority of people in the penal system still are regular drug users. In 2019, 59,000 people[13] were convicted under Article 228, which provides for liability for illegal possession of narcotic substances without the intention to sell. From them 17,000 people were convicted under Article 228.1, e.g. selling of drugs. It means that of all legal cases under Article 228, more than 77.6% account for regular drug users. However, it is worth noting that in 2018 this figure was 78.7%, in 2017 – 80.2%, and in 2014 it was 81%. That demonstrates a slight trend towards a decrease in the proportion of people who use drugs.

Among the negative consequences of the FDCS closure is the absence of social rehabilitation on the current agenda. In Russia, rehabilitation services consist of social and medical rehabilitation. Social rehabilitation implies establishing and supporting civil society organizations in systematic work on the reintegration of people who use drugs. Viktor Ivanov, head of the FDCS, argued that the social rehabilitation of people with drug addiction is crucial in the anti-drug policy[14]. Thus, the FDCS was engaged in monitoring and coordinating the entire sphere of rehabilitation and resocialization[15]. After the collapse of the FDCS, neither the Ministry of Internal Affairs (MIA) nor the Ministry of Health undertook this responsibility and engaged in social rehabilitation. Besides, there is no more budget allocation to social rehabilitation.

If we touch upon the rehabilitation in more detail, it is possible to admit the following facts. Currently, there are fewer violations in rehabilitation centers in Russia, although they have not disappeared completely. Torture[16] in private institutions used to be a common practice[17]. People were forcibly taken to rehabilitation centers, which they could not escape, and centers’ personnel tortured them there. For example, personnel beat them, poured cold water over them in the frost, deprived them of sleep and food, and forced to carry weights[18]. Many such institutions have been closed, resulting in a decrease in torture cases and the normalization of rehabilitation centers’ practices. In particular, it was achieved through the activities of such an organization as Rehab Control[19].

In 2020 Russia adopted the new anti-drug strategy. It does not differ substantially from the previous one, but there are also positive changes. The new anti-drug strategy has many prerequisites for moving towards the application of alternative sanctions such as suspended sentences, treatment, and fines. According to Mikhail Golichenko, a leading human rights analyst at the HIV Legal Network[20], these changes could increase the application of referral schemes for treatment and prevention. Consequently, this will positively affect both the Ministry of Internal Affairs (the opportunity to show good work in its prevention, improve crime rates) and the courts’ workload.

At the same time, the legal support for people who use drugs become much better. Organizations such as Hand Help[21] and Agora[22]together with NGO Zona Prava, provide legal support in cases related to Article 228. They also conduct workshops and develop information materials for people who use drugs. Many online media started to publish educational articles on the rights of a person during the arrest, communication with the police, and behavior when someone plants drugs on you[23]. These publications allow more citizens to be informed about their rights. Although planting[24], beating, extortion of bribes[25], and intimidation by the police did not disappear anywhere, and became an instrument of pressure on political activists. The so-called Golunov’s Case – when drugs were planted on journalist Ivan Golunov[26], to accuse him of selling drugs – and the subsequent public campaign[27] in his support did not have any significant impact on the system.

Key facts

  • Russia’s first mobile harm reduction center opens in St. Petersburg in 1996.
  • Russia, along with Azerbaijan and Turkmenistan, is one of the countries in the region that does not have harm reduction provisions in its national policies. There is a national ban on OST and extremely limited NSP site provision, despite increasing rates of HIV and hepatitis C in the country among people who inject drugs.[1]
  • Reportedly, there are approximately 100,000 new HIV diagnoses each year, with a high proportion believed to be attributed to unsafe injecting drug use and a lack of harm reduction provision and funding.[2]
  • Around 23% of people in prisons in Russia have been convicted of drug-related offences.[3]

Please let us know about any errors or updated information in your country by email, subject “Country profiles”



[1] WHO/UNODC/UNAIDS position paper on the effectiveness of the OST. ‘WHO/UNODC/UNAIDS position paper: Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention’:

[2] UN Committee on Social, Economic and Cultural Rights, Concluding observations on the sixth periodic report of the Russian Federation, E/C.12/RUS/CO/6, October 2017, paras 50 and 51.

[3] How Russia convinced the ECHR that substitution therapy is not necessary:



[6] The Strategy of the State Anti-Drug Policy:

[7] Methodological guidelines:

[8] Report on Russia to the Special Rapporteur on the Rights to Freedom of Peaceful Assembly and of Association:

[9] The State Duma introduces fines of up to 1.5 million rubles for the propaganda of drugs on the Internet:

[10] Another bill on the terms of imprisonment for drug propaganda on the Internet was submitted to the State Duma:

[11] Davitadze, A., Meylakhs, P., Lakhov, A. et al. Harm reduction via online platforms for people who use drugs in Russia: a qualitative analysis of web outreach work:

[12] Legal statistics portal:

[13] Data compiled by the Judicial Department:

[14] Head of the FDCS: social rehabilitation of drug addicts is underestimated:

[15] FDCS has been allowed to rehabilitate:



[18]12 steps on the way to court:

[19] Rehab Control:

[20] HIV legal network:


[22] Factory 228:

[23] What should you do if someone plants drugs on you?

[24] Extra weight. Brief encyclopedia of police drug provocation:

[25] The price of freedom:

[26] Ivan Golunov’s Case:


[1] Harm Reduction International. Global State of Harm Reduction 2018.Available from:
[2] Varentsov I (2017) The HIV Epidemic in Russia as the Consequence of State Political Ideology. Amsterdam: AFEW International. Available from:
[3] Federal Penitentiary Service (2017) Official Statistics. Moscow: Federal Penitentiary Service of the Russian Federation.
[4] Federal office of governmental statistics
[5] Harm Reduction International. Lost decade Harm Reduction 2018.Available from:
[6] Harm Reduction International. Global State of Harm Reduction 2018.Available from:
[7] Harm Reduction International. Global State of Harm Reduction 2018.Available from:
[8] UNAIDS (2017) Ending AIDS: Progress Towards the 90-90-90 Targets. Geneva: Joint United Nations Programme on HIV/AIDS. Available from:
[9] Harm Reduction International. Global State of Harm Reduction 2018.Available from:
[10] Harm Reduction International. Global State of Harm Reduction 2018.Available from:
[11] Harm Reduction International. Global State of Harm Reduction 2018.Available from:
[12] WHO (2017) Global Tuberculosis Report. Geneva: World Health Organization. Available from:
[13] EHRA (2018) Criminalization Costs. Eurasian Harm Reduction Association. Available from:
[14] EHRA (2018) Penalties for drug law offences in East Europe and Central Asia at a glance [beta]. Available from: