The need to adapt its legislation to European standards within the framework of negotiation chapters.

One of the priority areas of such work is the reform of laws and policies on drugs in accordance with European norms.

That is, it is important for Ukraine to adopt a people-centered strategy for drug policy reform that would align with European standards and best practices. First of all, this refers to the EU acquis communautaire in the field of drug policy: the EU-Ukraine Association Agreement, the EU Drugs Strategy for 2021–2025 and its Action Plan, as well as the approaches enshrined in the documents of global international organizations (the UN).

“Health Solutions” is publishing the analytical study “Ensuring the Right to the Preservation of Mental Health and Access to Treatment for the Civilian Population and Veterans in Wartime and the Post-War Period.”

The purpose of the study is to formulate strategic recommendations for reforming Ukrainian drug policy in accordance with European standards and the needs of society.

This includes, in particular, an analysis of key European documents and documents of global international organizations in order to identify priorities for harmonizing Ukrainian legislation with the European Union and laying the foundation for long-term changes in the field of drug policy.

There are recommendations on aligning Ukraine’s criminal legislation and drug and psychoactive substances circulation policy with EU law in the context of European integration processes.

The main barriers and obstacles to the implementation in Ukraine of quality, evidence-based services for people who suffer from the use of psychoactive substances are described (with special attention to dependent military personnel, whose share is increasing due to the full-scale war). To a large extent, the analysis focuses on the issue of access to controlled medicines, especially for the treatment of pain and mental disorders.

European standards emphasize the importance of the availability of such medicines for medical purposes, while at the same time strengthening control over their illicit circulation. In wartime and the post-war period, this aspect becomes especially relevant for Ukraine. Below we briefly summarize the main points of the study.

At present, Ukraine’s drug policy is based on a punitive model.

Its essence: the fight against drugs usually means criminal prosecution and punishment of drug-dependent persons instead of their treatment, rehabilitation, and social integration. For example, official judicial statistics for 2023 show that under Article 309 of the Criminal Code of Ukraine (“Illegal production, manufacture, acquisition, storage, transportation, or transfer of narcotic drugs, psychotropic substances, or their analogues without intent to sell”), 10,831 people were convicted.

In 90% of cases, courts release the convicted from serving their sentence with probation, but do not oblige them to undergo addiction treatment. That is, the state invests more funds in prosecution than in real assistance, which in the future threatens the spread of infections (cases of HIV, hepatitis), increased mortality among dependent persons, deterioration of their health, social isolation, and stigmatization of dependents, who, due to the threat of punishment, are afraid to seek help.

In contrast, the medical-social approach applied in many progressive European countries is different. Its essence: drug dependence is a health problem, not a criminal offense.

The focus of EU countries’ drug policy is:

• reducing demand for drugs through prevention, treatment, rehabilitation, and social integration of dependent persons;
• reducing drug-related harm through the creation of safe drug consumption rooms, broad access to HIV and hepatitis testing for early detection of infections, etc.;
• reducing drug supply through combating drug trafficking and organized drug crime.

The medical-social approach does not provide for harsh criminal prosecution and punishment of ordinary users – those who consume and/or store drugs.

In different countries, approaches to the decriminalization of drug use and possession without intent to sell may differ: from complete abolition of punishment for personal use, as in Germany and Uruguay, to the replacement of criminal sanctions with administrative ones, which may include health interventions, as, for example, in the Czech Republic.

The war in Ukraine has significantly worsened people’s mental health: the level of depression, PTSD, and other disorders is growing, as is drug consumption among civilians and military personnel. Courts and law enforcement agencies are overloaded because they are focused on prosecuting drug users instead of fighting organized drug crime.

The UN drug conventions impose on member states the obligation to criminalize the illicit drug trade, but not possession for personal use.

The establishment of permissible amounts (threshold values) of drugs for legal possession and personal use will require balancing the interests of dependents in terms of their treatment and harm reduction (for example, through safe drug use) and the prosecution of dealers and traffickers.

The updated legislative framework should provide that a person will not be punished by a fine or criminal charges if they possess drugs for themselves in an amount less than the officially established state thresholds – the so-called threshold values.

Threshold values of psychoactive substances also require correction, taking into account pharmaceutically substantiated calculations of lethal doses for narcotic and psychotropic substances. This will correspond to EU best practice and will determine changes in the approaches of law enforcement and judicial bodies.

Significant attention should be paid to quality and evidence-based services for military personnel and veterans who, due to stress and the horrors of war, use psychoactive substances (having or developing addiction “without guilt”). This problem is currently taboo in society, but it exists and is growing. Programs for early screening and detection of military personnel with problematic psychoactive substance use that began during military service need to be developed and implemented. The state must ensure their access to such services and referral for intensive care if necessary. For this purpose, amendments should be made to Cabinet of Ministers Resolution of 12.01.2024 No. 32.

Military personnel with dependence, who are patients of opioid substitution therapy and have been declared fit for military service, must undergo treatment in civilian medical institutions. To organize and streamline this process, it is necessary to develop a joint interdepartmental order of the Ministry of Health and the Ministry of Defense.

When developing and updating medical care standards in the field of mental health, integration with services for early detection, diagnosis, and treatment of substance use and alcohol-related disorders should be envisaged.

The state currently has a standard for medical care for dependents and a standard for their socio-psychological rehabilitation. However, it is still not defined when services in a medical facility should end and referral to socio-psychological rehabilitation should be issued.

There is limited capacity to provide psychosocial services by narcologists and psychiatrists. By order of the Ministry of Health, such services in medical institutions may be provided only by family doctors or specialists with psychotherapeutic or psychological education. Motivational counseling and relapse prevention techniques (which are part of cognitive-behavioral therapy) are among the main tools and interventions for people with substance use and alcohol disorders. It is important that such interventions can be provided by a narcologist or psychiatrist (or a trained nurse), since not all institutions have psychologists and psychotherapists.

The shortage of staff is partly due to the lack of professional standards for certain specialists (psychotherapist doctor, psychotherapist, clinical psychologist, psychologist doctor, narcologist doctor, psychiatrist doctor, etc.). This situation leads to the absence of a clear division of functions between medical personnel and psychosocial service providers, and therefore to the excessive spending of state financial resources.

The issue of geographic inaccessibility of services also requires attention. The existing network of medical institutions is focused on inpatient psychiatric care, while many people need outpatient treatment of varying intensity. That is, there is a need to implement psychiatric care services on the basis of cluster and supra-cluster hospitals.

For the prevention of addiction among civilians, military personnel, and veterans, a national system for monitoring drug abuse, including prescription drugs (opioid analgesics, barbiturates, etc.), should be approved and operational. That is, current practices of prescribing and using analgesics by military personnel should be urgently assessed.

The issues of providing both civilians and military personnel with controlled medicines for pain relief and mental health require separate regulation and coordination. Currently, there is a catastrophically low number of pharmacies authorized to sell controlled medicines. This limits the availability of these drugs, especially for patients in rural areas, frontline zones, and de-occupied territories.

Approaches to financing comprehensive treatment and the provision of services for people with disorders due to substance use and alcohol should be changed. At present, within the existing NHSU packages, there is no adequate funding that could cover the costs of comprehensive treatment of such disorders.

The delay in finalizing and adopting the drug policy development strategy until 2030 and bringing it in line with European norms and trends is largely due to the absence of a single “center” for managing such policy in the state.

The leading role in implementing drug policy in Ukraine should belong to the Ministry of Health, which should not only shape such policy but also coordinate the activities of other executive bodies on these issues. However, the Regulation on the Ministry of Health does not normatively regulate the coordinating function in drug policy.

In Ukraine, the dispensary registration of dependent persons with personalized data (interdepartmental Order No. 306 of 10.10.1997) remains in effect. It has traditionally been used for the further application of various sanctions. Therefore, most dependent patients consider the existence of such registration to be one of the key factors that deters them from seeking treatment at a municipal medical facility. This procedure contradicts the Law of Ukraine “On Psychiatric Care.”

European acts establish the need to define at the country level a national coordinator for monitoring, who will carry out monitoring of the drug situation at the country level. According to EU directives and the plan developed by the state, monitoring functions are transferred to the Public Health Center of the Ministry of Health of Ukraine. To regulate in this part the coordinator’s powers, amendments must be made to Cabinet of Ministers Resolution No. 685. The absence of these amendments harms the effectiveness of the intersectoral data exchange system, the approval of reporting forms, and the data collection system.

High-quality data collection is also impossible without the introduction of modern methods of studying the drug scene, such as: DC (checking psychoactive substances for composition and purity), USA (analysis of psychoactive substances based on residues in syringes), W/DS (Darknet analysis in the field of psychoactive substances). None of these studies are conducted in Ukraine. To introduce these methods, the development of separate interdepartmental orders is required, in particular those regulating the early warning system.

An important human rights recommendation of international organizations in the field of drug control is the involvement of civil society organizations in decision-making in the field of drug policy. At the national level, there are a number of effective mechanisms for involving NGOs and the civil sector. In particular, through the implementation of a mechanism for monitoring the quality and availability of services by communities.

The full analytical report can be read below.