Human rights in patient care: drug treatment and punishment in Russia

Mikhail Golichenko, Sandra Ka Hon Chu

An inherent feature of drug control in many countries has been an excessive emphasis on punitive measures at the expense of public health. At its most extreme, this approach has reduced health services for people who use drugs to an extension of the drug control system. In these environments, health services are punitive rather than supportive for people who use drugs, especially those who are drug dependent. In Russia, the government's official policy towards drug use is one of "social intolerance," which seeks to legitimize and encourage societal ill treatment of people who use drugs. In practice, this policy has materialized as widespread and systematic human rights violations of people who use drugs, including by subjecting them to unscientific and ideologically driven methods of drug prevention and treatment and denying them access to essential medicines and services. While such human rights violations are well-documented, there have been no attempts to date to consider the consequences of this approach through the lens of human rights in patient care. This concept brings together the rights of both patients and providers and interrogates the role of the state on the relationship between two core groups: drug-dependent people and drug treatment doctors or "narcologists" in Russia. In this article, we apply the concept of human rights in patient care to consider the narcologist's role in punitive drug policy and human rights violations against people who use drugs and to analyze how punitive drug policy manifests as human rights violations against narcologists themselves, who lose their professional independence and their ability to work according to professional standards and ethical norms. We conclude that both people who use drugs and narcologists suffer from punitive drug policy and should unite their efforts to ensure drug policy does not undermine patients' health and human rights.