Extending a lifeline to people with HIV and opioid use disorder during the war in Ukraine

Oleksander navigates a bomb-shelled northern Ukrainian city between air raid sirens. He is on his way to the clinic to collect methadone for his opioid use disorder—a trip he has made regularly since 2016. However, this time the situation is quite different. 3 days earlier he sent his wife and children to Lviv for safety and has been living with 20 other men in the basement of his building, which doubles as a bomb shelter. Water has been disrupted and food is increasingly scarce. Yesterday, his doctor texted him a 30-min window to pick up his methadone, when emergency sirens are less common. The doctor dispenses a 10-day supply and Oleksander is relieved. He was not sure how much he would receive with the crisis worsening. Before the COVID-19 pandemic, he went to collect his methadone daily but, since the pandemic began, take-home doses have been permitted, making it easier for him to work and take care of his family. In non-occupied Ukraine, both methadone and buprenorphine are available as medications for opioid use disorder. Although grateful to receive today's supply of methadone, Oleksander asks for an increased supply, just in case the Russian army takes over. Even though Ukraine's Ministry of Health has just released new guidance allowing for a 30-day supply, his doctor is reluctant because he needs to keep enough for his other patients or for new patients that might be fleeing the east. His doctor is also concerned about disruptions in the supply chain and delivery of more medications for opioid use disorder.