Treatment of opioid use disorder in Ukraine during the first year of the Russia–Ukraine war: Lessons learned from the crisis

• Published in: The International journal of drug policy 2023-07, Vol.117, p.104062, Article 104062
• Main Authors: Morozova, Olga, Ivanchuk, Iryna, Gvozdetska, Olga, Nesterova, Olena, Skala, Pavlo, Kuzin, Ihor, Dumchev, Kostyantyn
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid; Antisocial Personality Disorder; Buprenorphine; Displacement; Government; Humans; Medications for opioid use disorder; Methadone; Opiate Substitution Treatment; Opioid use disorder; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - epidemiology; Russia - epidemiology; Ukraine; Ukraine - epidemiology; War
• ISSN: 0955-3959; 1873-4758; 1873-4758
• DOI: 10.1016/j.drugpo.2023.104062

•At least 10% of MOUD patients have been internally displaced due to the war.•New policies allowed expansion of take-home doses and flexible medication supply.•During the first year of the war, the number of MOUD patients increased by 17%.•Most patients were receiving take-home doses, some experienced dose reductions.•All MOUD sites in Russian-occupied areas were shut down, many patients relocated. The Russian invasion of Ukraine in February 2022 caused major disruptions of societal functions, including health care. Patients receiving medications for opioid use disorder (MOUD) depend on receiving daily treatment and face a risk of withdrawal in case of medication supply disruption. MOUD are banned in Russia, making treatment continuation impossible in temporarily occupied areas. In this paper, we review the situation with MOUD delivery in Ukraine during the first year of the Russia–Ukraine war. Legislative changes and mobilization of efforts in the time of crisis ensured treatment continuation for thousands of patients. In areas controlled by Ukraine, most patients were receiving take-home doses for up to 30 days, some experienced temporary dosing reductions. Programs in temporarily occupied regions were shut down likely leading to abrupt withdrawal among many patients. At least 10% of patients have been internally displaced. One year into the war, the number of MOUD patients in governmental clinics of Ukraine increased by 17%, and the data suggest that the coverage of private clinics has also increased. But the risks for program stability remain high as the current medication supply relies on one manufacturing facility. Using lessons learned from the crisis, we provide recommendations for future response to minimize the risks of major adverse outcomes among patients treated for opioid use disorder.