Russia has millions of heroin addicts but little agreement on how to treat them.

By MICHAEL SCHWIRTZ

MOSCOW - The conference seemed innocuous enough: a Moscow hotel, slide shows and several dozen specialists gathered to discuss how to treat heroin addiction. But then members of a Kremlin youth group called the Young Guard arrived, crowding the hotel’s entrance and denouncing the participants as criminals and paid agents of the West.
The focus of their outrage was methadone, a drug prescribed by doctors around the world to wean addicts from heroin.
A synthetic form of opium, methadone is central to a therapy endorsed by the United Nations and 55 countries, including the United States.
But not Russia.
Methadone, typically taken by mouth in liquid form, blocks addicts’ cravings for heroin by binding to the brain’s opioid receptors.
Methadone has critics in many countries, who argue that it replaces one form of opiate addiction with another; in Russia even talking about it can provoke legal sanction.
“There is no possibility to have a normal discussion about this issue,” said Dr. Vladimir D. Mendelevich, director of the Institute for Research Into Psychological Health, in Kazan .
Estimates on the number of drug addicts in Russia range from three million to six million. Most use intravenous drugs like heroin that originate in Afghanistan and flow easily across the country’s borders.
Many international experts say methadone treatment is critical to controlling the epidemic of H.I.V. and AIDS in Russia, which is linked to heroin use. Coupled with needle exchange , the therapy could “largely stop the spread of H.I.V. among injecting drug users,” said Peter Piot, the executive director of Unaids, the United Nations agency .
Russia’s health establishment is not impressed.
At the same AIDS conference, Dr. Gennady G. Onishchenko, the country’s chief sanitary doctor , said health officials “are not convinced that this is effective,” and added, “There is little optimism for legalizing methadone therapy in the near future.”
But some Russian specialists, along with addicts, have begun to change their minds.
“Scientific arguments, evidencebased data, are not convincing them,” said Evgeny M. Krupitsky, the head of a laboratory that conducts research on drug addiction at St. Petersburg State Pavlov Medical University. Russian methodology regarding opiate addiction “is not evidence-based,” but relies on “subjective opinions of major leaders in this field.”
Researchers agree that only a small fraction of heroin users in Russia seek treatment. Most who do - some say more than 90 percent - relapse into drug use shortly after leaving. At such detoxification centers, doctors encourage immediate abstinence from drug use, rather than the gradual process that methadone substitution therapy entails.
Supporters of methadone treatment argue that if properly administered by medical professionals, the treatment method breaks addicts’ dependence on illegal narcotics and eases withdrawal symptoms, while decreasing the risk of overdose and H.I.V. ransmission.
“I am for any scientific, medical approach to treatment,” said Albert Y. Zaripov, a former heroin addict who counsels users in Kazan.
He began shooting heroin more than a decade ago with a group of 10 friends. Four are in jail, another four remain chained to their addictions, and two died. He alone quit, but after he had contracted H.I.V.
“If there is another treatment besides substitution therapy, there’s no problem,” he said. “But I haven’t heard of anything else that has helped or that is more effective.”