“You’re asking me how it’s going? That’s how things work,” Serhiy wrote in an online chat, before sending a photo of a high-caliber sniper rifle set up in his room in Kyiv as the Ukrainian capital tried to hold off Russian forces.
“My job is to open fire when the enemy passes by my house. Otherwise we will all be destroyed.”
Anyone ready to fight, like Serhiy, got a rifle. But in addition to dodging Russian bombs, he suffers agonizing withdrawal as a drug-addicted Ukrainian.
“I’ll take Lyrica [pregabalin],” he said.
“It reduces withdrawal, but you don’t find it every day. You must go in search of an open pharmacy, of which perhaps one of seven that were open before the war remains.
“Today I went through five pharmacies where I used to get methadone on prescription. None was open. Another place was open today but there was a line of at least 200 people and I didn’t want to go to rehab right there so I went home.”
Eventually, Serhiy managed to find a private pharmacy where an acquaintance sold him pregabalin under the counter.
Before the war, Kyiv-based Vitalii Lavryk was a committee member of the Eurasian Harm Reduction Association, representing Ukraine, Moldova and Belarus; Harm reduction is the practice of helping drug users remain as stable and healthy as they can be under their circumstances.
He told Al Jazeera: “The problem is that there is a huge number of paid support programs for opiate addiction in Ukraine.
“On average, a typical fee-based center serves 30 to 70 opiate dependent patients per day. There are more than 45 such paid centers in Kyiv, which were closed when the doctors were evacuated.
“Prescriptions were written there for medicines bought in one of the pharmacy chains licensed to sell narcotics. Now many pharmacies are closed due to the curfew or are only open for three hours.”
In Ukraine, harm reduction included giving addicts methadone to get them off street drugs like heroin. More than 1,300 such patients are registered in Kyiv alone.
Russia, on the other hand, does not accept methadone as a treatment, considering it just another harmful narcotic.
When Russian troops seized the Crimean peninsula from Ukraine in 2014, they closed methadone clinics.
Addicts returned to heroin, and within a year, of about 800 registered methadone users, at least 80 had fatal overdoses, suicides, or died of other narcotic causes.
Meanwhile, in the self-proclaimed Donetsk and Luhansk People’s Republics, pro-Russian rebels forced addicts to dig trenches at gunpoint and there were reports of dealers being taken into the countryside and executed.
Al Jazeera has not been able to independently verify these reports.
Now that Russia is at war in Ukraine, addicts are feeling the effects on their health.
“Cans [of substitute drugs] were cut off and the only supplies of methadone and buprenorphine stopped in the city of Kharkiv,” Lavryk said. “Due to the war, other deliveries have also been interrupted.”
Looking to the future, he added: “I expect many drug users will start using again after the war is over. It all depends on the number of victims. The more suffering, the more addiction.”
People involved in the illegal drug economy are also affected.
As in Russia, much of the black market is served by the dark web, with customers placing orders online and then picking them up at a hidden drop-off point known as a ‘treasure’, and those storing the goods at the special location are called out “Treasurers”.
“While the problem lies in the unleashing of a humanitarian crisis by the occupiers, it is now almost impossible to get drugs in Kyiv,” Serhiy explained.
“Treasurers’ work has been paralyzed and prices have skyrocketed. My dose used to be $4-6, now it’s $70-80. They can’t find a trader anywhere because if our military and territorial defenses spot someone planting treasure, they might think they’re leaving a signal for an airstrike and use force.”
Meanwhile, alcohol has also become out of reach for many as several areas of Ukraine have banned the sale of liquor under martial law.
Dessa Bergen-Cico, a professor of public health and addiction studies at Syracuse University, told Al Jazeera via email, “Ukraine’s civilian population is plagued by conflict and instability, increasing the risk factor for drug use and trauma.”
She added that consumption of alcohol and drugs increases during the war as security and normal law enforcement mechanisms break down.
“Civilians and military combatants alike seek relief from relentless fear — and alcohol and other drugs offer quick and reliable means of mentally escaping otherwise inevitable trauma,” she said.