Bioethical differences between drug addiction treatment professionals inside and outside the Russian Federation

Abstract

This article provides an overview of a sociological study of the views of 338 drug addiction treatment professionals. A comparison is drawn between the bioethical approaches of Russian and foreign experts from 18 countries. It is concluded that the bioethical priorities of Russian and foreign experts differ significantly. Differences involve attitudes toward confidentiality, informed consent, compulsory treatment, opioid agonist therapy, mandatory testing of students for psychoactive substances, the prevention of mental patients from having children, harm reduction programs (needle and syringe exchange), euthanasia, and abortion. It is proposed that the cardinal dissimilarity between models for providing drug treatment in the Russian Federation versus the majority of the countries of the world stems from differing bioethical attitudes among drug addiction treatment experts.

Mandatory addiction treatment for people who use drugs: global health and human rights analysis: Table

“…55 More than 60% of Russian addiction care providers surveyed supported mandatory treatment of injecting drug users. 56 Others oppose registration of people with addiction and are concerned that mandatory treatment might prompt affected people to avoid healthcare. 57 WHO emphasises that treatment should be mandated for a limited period only if drug users risk immediate harm to themselves or others, lack mental capacity to consent to treatment, and there are no other reasonably available, appropriate, and less restrictive responses.…”

Opioid Use in the Twenty First Century: Similarities and Differences Across National Borders

“…Punitive strategies view drug addiction as a deviant behavior rather than as a disease and are characterized by the dominance of law enforcement and drug control policy [26]. Such strategies are exemplified by the drug policies of Russia, other former Soviet Republics, and China among others [11].…”

“…Overall, whereas both Russia and China view drug addiction primarily as a form of deviant behavior [26] rather than as medical or public health issue, and whereas the drug treatment and rehabilitation systems of both countries are under tight governmental control with a substantial degree of coercion; in practice, their approaches to treatment are notably different: China is characterized by a more pragmatic and evidence-based approach, “softening” the coercive approach to referrals for treatment without giving up governmental control, and introducing effective treatment modalities such as OST with methadone and buprenorphine along with traditional Chinese community rehabilitation practices [35]. This is paralleled by increased transparency and scientific productivity as evidenced by a large number of peer-reviewed publications in US and European journals and international research collaborations.…”

Methodological mistakes and contradictions in the ederal clinical recommendations on addiction medicine

“…Анализ клинических руководств Великобритании, США и России по терапии шизофрении [11] показал их со-поставимость. Следует признать, что в отличие от других клинических рекомендаций психиатриче-ского профиля лишь Федеральные клинические ре-комендации по лечению наркологических рас-стройств не корреспондируются с международными [19,[20][21][22][23].…”