Narkomania: Drugs, HIV, and Citizenship in Ukraine

by Jennifer J. Carroll

Against the backdrop of a post-Soviet state set aflame by geopolitical conflict and violent revolution, Narkomania considers whether substance use disorders are everywhere the same and whether our responses to drug use presuppose what kind of people those who use drugs really are. Jennifer J. Carroll's ethnography is a story about public health and international efforts to quell the spread of HIV. Carroll focuses on Ukraine where the prevalence of HIV among people who use drugs is higher than in parts of sub-Saharan Africa and unpacks the arguments and myths surrounding medication-assisted treatment (MAT) in Ukraine. What she presents in Narkomania forces us to question drug policy, its uses, and its effects on "normal" citizens. Carroll uses her findings to explore what people who use drugs can teach us about the contemporary societies emerging in post-Soviet space. With examples of how MAT has been politicized, how drug use has been tied to ideas of "good" citizenship, and how vigilantism towards people who use drugs has occurred, Narkomania details the cultural and historical backstory of the situation in Ukraine. Carroll reveals how global efforts supporting MAT in Ukraine allow the ideas surrounding MAT, drug use, and HIV to resonate more broadly into international politics and echo into the heart of the Ukrainian public.

Genres: Nonfiction

252 pages, Hardcover

Published June 15, 2019

Reviews

[Emily · Rating 5 out of 5]

Excellent ethnography for anyone interested in Ukraine or in public health. Accessibly written and contextualized in current events, so I'd recommend for teaching across the social sciences.

[Dmitri Azrak · Rating 5 out of 5]

Really important and insightful book that deserves more attention

[Tom Schulte · Rating 4 out of 5]

Back on 18 November 2022, I attended the online event "Street Drugs Discussions: Global Impacts of War and Covid-19" put on by Drug Science. I was very impressed with the articulate and intelligent speaker Jennifer J. Carroll, an anthropologist with direct experience on drug treatment programs in Ukraine. She explained how, since it goes along with its anti-drug addict hysteria, Russian occupation authorities peremptorily canceled treatment clinics. She related how some caregivers snuck in treatment by backpack while possible. All this interested me in reading this book, which does cover the post-2014 annexation of Crimea, but not the 2022 invasion. When I discovered Cornell University Press made digital copies available for free download, it was a no-brainer.

Building on experience directly observing programs in Portland, Oregon, Carroll investigated realities in the troubled post-Soviet state and how the political and cultural realities there affect how substance use disorders are responded to as a part of public health and even international efforts to quell the spread of HIV, specifically with the Global Fund. From interviews with caregivers, patients, citizens she reports on medication-assisted treatment (MAT) in Ukraine through national drug policy and stigmas specific to the post-Soviet space. This includes vigilantism towards people who use drugs inflamed as part of political rhetoric.

Shirka is a dangerous street opiate, and here is a good summary quote explaining the role of prescription treatments:

These lasting effects prevent MAT patients from falling back into withdrawal every few hours, as they often do when using heroin or shirka. Furthermore, the relative “strength” with which both of these medications attach to the opioid receptors in the brain (called “binding affinity”) is high, which prevents most MAT patients from experiencing a sense of euphoria if they use illicit drugs while on their medication. The illicit drugs will not be strong enough to take the place of MAT medications on these receptors. Thus, as Maksim and so many other individuals who participated in my research attested, MAT is not simply a substitute narcotic that replaces one “addiction” for another. Regular shirka use is defined by a constant struggle to maintain a sense of self and a sense of control. MAT, on the other hand, is not. Risks are low. Stability is high.

One of the many things I encountered for the first time is coding, a catch-all term for various Russian and post-Soviet alternative therapeutic methods used to treat addictions, in which the therapist attempts to scare patients into abstinence from a substance they are addicted to by convincing them that they will be harmed or killed if they use it again. Each method involves the therapist pretending to insert a "code" into patients' brains that will ostensibly provoke a strong adverse reaction should it meet the addictive substance. This seems a practical application of the fearmongering around addiction deeply rooted in areas previously part of the USSR.

[Vivian Tran · Rating 5 out of 5]

Narkomania is a well-written ethnography that discusses the issues about the origins of drug use and abuse in Ukraine and how many aspects of drug abuse in Ukraine are deprived from its rich culture. The ethnography balances between educating readers about many programs, such as MAT, and providing personal stories of drug users in Ukraine. Carroll emphasizes heavily on the idea of harm reduction and how it can be beneficial to many societies that are fighting the war on drugs. An excellent read overall and recommended to anyone interested in learning more about how things such as drug policy or the effects drugs have on society!

[Amisha · Rating 5 out of 5]

Narkomania is an excellent book that covers post-Soviet Ukraine and its issues with drug abuse, addiction and treatment. The book makes use of narrative storytelling and Carroll’s own experiences to poignantly convey the reality of drug abuse, all of which will make you rethink what addiction and treatment really mean. Overall, Carroll has constructed a great ethnography that sheds new light about drug abuse.

[Nikolai Markovic · Rating 4 out of 5]

This book is not only about drugs and HIV but also a portrait of Ukraine before 2022. It is an ethnographic work full with personal stories and it offers valuable insight into the health systems and policies of Ukraine, Russia and even the United States. Informative and deeply engaging, it is a compelling read that I would recommend to anyone with even a passing interest in these issues.