Eastern Europe and Central Asia (EECA) face a dual crisis in addiction treatment. On one side, Russian imperial legacies persist through punitive "narcology," now weaponized amid ongoing aggression. On the other, Western retrenchment, marked by abrupt aid suspensions and dwindling harm-reduction budgets, has weakened the evidence-based counterweight that once challenged authoritarian approaches. The result is a convergence of punitive logics that marginalizes people who use drugs, whether through active repression, such as the closure of methadone programs in Crimea, or sudden neglect, such as the withdrawal of donor funding for opioid agonist therapy in Tajikistan. We call for a decolonial, community-driven response grounded in non-reformist reform and transformative discomfort-one that reduces harm while dismantling punitive systems and embraces the tensions of shared authority and care. Drawing on the case of self-run addiction treatment in Kyrgyz prisons, we call for resourcing user-led infrastructures as models for decolonial directions in global health amid a splintering global health world order.
Azbel et al. (Mon,) studied this question.