Opioid substitution treatment in Ukraine: review of the published papers



opioid substitution treatment, OST, Ukraine, buprenorphine, methadone, opioid addiction, HIV/AIDS



To review published peer-reviewed papers regarding opioid substitution treatment (OST) in Ukraine and to describe the research agenda that has been in parallel with the development of opioid substitution treatment program in Ukraine. Further, to understand research gaps and future directions of scientific efforts concerning the OST implementation in Ukraine. 


Literature search using standardized research terms of PubMed, Science Direct, and Google Scholar was supplemented with consultations with relevant in-country researchers to identify any additional publications that were not found through on-line search. Original literature search has  been conducted during August, 2013, two refreshment searches were conducted during October, 2013 and February, 2014. The literature search and eligible papers selection were conducted applying PRISMA guidelines.


Eight papers were published in peer reviewed journals specifically scrutinizing the features of the OST program or patients’ outcomes in Ukraine. Demonstrating the feasibility of buprenorphine and methadone maintenance treatment in Ukraine was core aim of majority of the papers. Few discussed TB and HIV treatment outcomes and health-related quality of life (QoL). Program description and cost-effectiveness of OST in Ukraine were the topic of two other papers. Decreased injection risk behavior and high retention rates were reported for Ukrainian methadone and buprenorphine patients. Other treatment indicators (TB treatment outcomes, HIV initiation, and services utilizations) have been higher among those on substitution treatment compared to those who were not. QoL besides health-related indicators have been understudied among Ukrainian OST patients. 


Published papers provide evidence to conclude that OST in Ukraine is effective in terms of patients’ retention on treatment and decreasing self-reported HIV-related risk behaviors and also provides a background for wide scale-up of the program. Further research is needed to understand how the program could be improved to better meet the needs of the opioid dependent drug users accounting for Ukrainian context. 

Author Biographies

Alyona Mazhnaya, National University of Kyiv-Mohyla Academy, School of Public Health ICF "International HIV/AIDS Alliance in Ukraine"

Treatment department, project manager: research

School of Public Health National University of Kyiv-Mohyla academy, PhD student

Zahedul Islam, Management Science for Health, USA

Country director


Alistar, S. S., Owens, D. K., & Brandeau, M. L. (2011). Effectiveness and cost effectiveness of expanding harm reduction and antiretroviral therapy in a mixed HIV epidemic: a modeling analysis for Ukraine. PLoS Med, 8(3), e1000423. doi: 10.1371/journal.pmed.1000423

Amato, L., Davoli, M., Perucci, C. A., Ferri, M., Faggiano, F., & Mattick, R. P. (2005). An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat, 28(4), 321-329. doi: 10.1016/j.jsat.2005.02.007

Bachireddy, C., Soule, M. C., Izenberg, J. M., Dvoryak, S., Dumchev, K., & Altice, F. L. (2013). Integration of health services improves multiple healthcare outcomes among HIV-infected people who inject drugs in Ukraine. Drug Alcohol Depend. doi: 10.1016/j.drugalcdep.2013.09.020

Bruce, R. D., Dvoryak, S., Sylla, L., & Altice, F. L. (2007). HIV treatment access and scale-up for delivery of opiate substitution therapy with buprenorphine for IDUs in Ukraine--programme description and policy implications. Int J Drug Policy, 18(4), 326-328. doi: 10.1016/j.drugpo.2006.12.011

Carrieri, M. P., Rey, D., Loundou, A., Lepeu, G., Sobel, A., Obadia, Y., & Group, M.-S. (2003). Evaluation of buprenorphine maintenance treatment in a French cohort of HIV-infected injecting drug users. Drug Alcohol Depend, 72(1), 13-21.

Carroll, J. J. (2015). For lack of wanting: Discourses of desire in Ukrainian opiate substitution therapy programs. Transcult Psychiatry. doi: 10.1177/1363461515581543

Clausen, T., Waal, H., Thoresen, M., & Gossop, M. (2009). Mortality among opiate users: opioid maintenance therapy, age and causes of death. Addiction, 104(8), 1356-1362. doi: 10.1111/j.1360-0443.2009.02570.x

Cohen, J. (2010). Law enforcement and drug treatment: a culture clash. Science, 329(5988), 169. doi: 10.1126/science.329.5988.169

De Maeyer, J., Vanderplasschen, W., & Broekaert, E. (2010). Quality of life among opiate-dependent individuals: A review of the literature. International Journal of Drug Policy, 21(5), 364-380. doi: http://dx.doi.org/10.1016/j.drugpo.2010.01.010

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Des Jarlais, D. C., Feelemyer, J. P., Modi, S. N., Arasteh, K., Mathers, B. M., Degenhardt, L., & Hagan, H. (2012). Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: patterns in the international data. PLoS One, 7(3), e31227. doi: 10.1371/journal.pone.0031227

Dole, V. P., & Nyswander, M. (1965). A Medical Treatment for Diacetylmorphine (Heroin) Addiction. A Clinical Trial with Methadone Hydrochloride. JAMA, 193, 646-650.

Dvoriak, S., Karachevsky, A., Chhatre, S., Booth, R., Metzger, D., Schumacher, J., . . . Woody, G. (2014). Methadone maintenance for HIV positive and HIV negative patients in Kyiv: Acceptability and treatment response. Drug Alcohol Depend. doi: 10.1016/j.drugalcdep.2014.01.008

Dvoryak, S., Grishaeva, I. . (2008). First Experience of Opioid Therapy with Buprenorphine in Ukraine. Heroin Addiction & Related Clinical Problems, 10(1), 13-18.

Feelemyer, J. P., Jarlais, D. C., Arasteh, K., Phillips, B. W., & Hagan, H. (2013). Changes in quality of life (WHOQOL-BREF) and addiction severity index (ASI) among participants in opioid substitution treatment (OST) in low and middle income countries: An international systematic review. Drug Alcohol Depend. doi: 10.1016/j.drugalcdep.2013.10.011

Filippovych, S., Dumchev, K., Morenets, Y., Mikityuk, T., Tretskaya, T., Kolomiets, V., & Andrushchenko, M. (2013). Integration approach to medical and suchosocial service delivery for ST clients in Ukraine [Press release]

Golovanevskaya, M., Vlasenko, L., & Saucier, R. (2012). In control?: Ukrainian opiate substitution treatment patients strive for a voice in their treatment. Subst Use Misuse, 47(5), 511-521. doi: 10.3109/10826084.2012.644117

Gowing, L., Farrell, M. F., Bornemann, R., Sullivan, L. E., & Ali, R. (2011). Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev(8), CD004145. doi: 10.1002/14651858.CD004145.pub4

Izenberg, J. M., Bachireddy, C., Soule, M., Kiriazova, T., Dvoryak, S., & Altice, F. L. (2013). High rates of police detention among recently released HIV-infected prisoners in Ukraine: Implications for health outcomes. Drug Alcohol Depend. doi: 10.1016/j.drugalcdep.2013.05.018

Lawrinson, P., Ali, R., Buavirat, A., Chiamwongpaet, S., Dvoryak, S., Habrat, B., . . . Zhao, C. (2008). Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction, 103(9), 1484-1492. doi: 10.1111/j.1360-0443.2008.02249.x

MacArthur, G. J., Minozzi, S., Martin, N., Vickerman, P., Deren, S., Bruneau, J., . . . Hickman, M. (2012). Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ, 345. doi: 10.1136/bmj.e5945

Malta, M., Strathdee, S. A., Magnanini, M. M., & Bastos, F. I. (2008). Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review. Addiction, 103(8), 1242-1257. doi: 10.1111/j.1360-0443.2008.02269.x

Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev(3), CD002209. doi: 10.1002/14651858.CD002209.pub2

Mattick, R. P., Kimber, J., Breen, C., & Davoli, M. (2008). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev(2), CD002207. doi: 10.1002/14651858.CD002207.pub3

Mimiaga, M. J., Safren, S. A., Dvoryak, S., Reisner, S. L., Needle, R., & Woody, G. (2010). "We fear the police, and the police fear us": structural and individual barriers and facilitators to HIV medication adherence among injection drug users in Kiev, Ukraine. AIDS Care, 22(11), 1305-1313. doi: 10.1080/09540121003758515

Morozova, O., Dvoryak, S., & Altice, F. L. (2013). Methadone treatment improves tuberculosis treatment among hospitalized opioid dependent patients in Ukraine. Int J Drug Policy, 24(6), e91-98. doi: 10.1016/j.drugpo.2013.09.001

Opioid treatment in Ukraine risks losing momentum. (2013). Bull World Health Organ, 91(2), 87-88. doi: 10.2471/BLT.13.020213

Polonsky, M., Azbel, L., Wickersham, J. A., Taxman, F. S., Grishaev, E., Dvoryak, S., & Altice, F. L. (2015). Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS. Drug Alcohol Depend, 148(0), 47-55. doi: http://dx.doi.org/10.1016/j.drugalcdep.2014.12.008

Schaub, M., Chtenguelov, V., Subata, E., Weiler, G., & Uchtenhagen, A. (2010). Feasibility of buprenorphine and methadone maintenance programmes among users of home made opioids in Ukraine. Int J Drug Policy, 21(3), 229-233. doi: 10.1016/j.drugpo.2009.10.005

Schaub, M., Subata, E., Chtenguelov, V., Weiler, G., & Uchtenhagen, A. (2009). Feasibility of buprenorphine maintenance therapy programs in the Ukraine: first promising treatment outcomes. Eur Addict Res, 15(3), 157-162. doi: 10.1159/000217586

Strathdee, S. A., Hallett, T. B., Bobrova, N., Rhodes, T., Booth, R., Abdool, R., & Hankins, C. A. (2010). HIV and risk environment for injecting drug users: the past, present, and future. Lancet, 376(9737), 268-284. doi: 10.1016/S0140-6736(10)60743-X

Wolfe, D., Carrieri, M. P., & Shepard, D. (2010). Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet, 376(9738), 355-366. doi: 10.1016/S0140-6736(10)60832-X

Zaller, N., Mazhnaya, A., Larney, S., Islam, Z., Shost, A., Prokhorova, T., . . . Flanigan, T. (2015). Geographic variability in HIV and injection drug use in Ukraine: implications for integration and expansion of drug treatment and HIV care. Int J Drug Policy, 26(1), 37–42. doi: 10.1016/j.drugpo.2014.09.004






Literature review