A policy window and a network of global and local policy entrepreneurs: The introduction of opioid substitution therapy in Belarus

Ararat Babayan,Caroline Schlaufer,Artem Uldanov

doi:10.2478/cejpp-2021-0008

Abstract

Abstract Why does a regime that is predominantly characterised by conservative ideology introduce opioid substitution therapy (OST), a liberal policy? This article applies the Multiple Streams Framework (MSF) to examine the introduction of OST in Belarus. Methodologically, the research draws on qualitative content analysis of drug policy documents and reports as well as on interviews. Results show how an increased HIV prevalence among injecting drug users opened a policy window in the problem stream. The increase in HIV cases could be used by a network of global and local policy entrepreneurs to frame OST as a public health policy instead of a drug policy measure. Findings suggest that, in nondemocratic regimes, global policy entrepreneurs can play a dominant role in introducing new policy ideas. However, the sustainability of the policy change remains questionable when acquiescence by key policymakers is lacking.

Highlights

In 2007, Belarus introduced opioid substitution therapy (OST)
During the transition period in the 1990s, drug use significantly increased in Belarus, and homemade opiates were increasingly substituted by heroin (Aizberg, 2008; Lelevich & Vinitskaya, 2008; Lelevich et al, 2009; Poznyak et al, 2002; WHO, 2004)
Belarusian drug policy continued to focus on prohibition and criminalisation, as well as the provision of abstinence-oriented detoxification treatment offered by the governmental narcological service

Summary

Introduction

In 2007, Belarus introduced opioid substitution therapy (OST). OST aims to reduce some of the negative consequences of drug use by substituting intravenous drugs, such as heroin, with medically prescribed replacement drugs. OST is seen as an effective measure to reduce the risk of HIV transmission and to improve the lives of intravenous drug users. Several Western European states that follow a liberal drug policy have introduced OST since the 1990s. Drug policy in Belarus, focuses on repression and the criminalisation of drug users.

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