Ukraine exempts patients on opioid substitution therapy from military service. Some are still being drafted

Officially, these soldiers don't exist

Under Ukrainian Defense Ministry regulations, people with severe drug dependence are considered unfit for military service. The ministry has also explicitly clarified that patients enrolled in state opioid substitution therapy programs are not subject to mobilization.

In practice, however, such patients continue to enter the military. The military ombudsman's office received more than 120 complaints involving patients on substitution therapy in the first six months of 2026.

The exact number is unknown. Ukraine's Public Health Center recorded a decline of nearly 1,500 men in state-run substitution therapy programs between January and July 2026 - the first drop of this scale. The figure does not show how many were mobilized, but rights advocates say they use such declines as one indicator because there is no official count.

In Kropyvnytskyi, addiction specialist Tetiana Hurenko told Hromadske that her clinic had identified 162 patients who disappeared from its program after being mobilized. She said the problem was particularly acute in December, January and February.

The military's Medical Forces Command says it does not track service members receiving substitution therapy because, under existing rules, such patients should not be serving in the first place.

From treatment to the military

Vitalii had used opioids for 25 years and had spent the last 12 receiving state-funded opioid substitution therapy. In November 2025, he was stopped by a recruitment patrol while on his way fishing.

He says he showed officials a document confirming his participation in the treatment program. At the recruitment center, however, he was told the document would be sent for verification because officials suspected it could be fake. Hromadske asked the recruitment center about his account but received no response.

Within a day, Vitalii was in military uniform and no longer had access to his medication.

He spent the following weeks experiencing severe withdrawal. During his service, he self-harmed twice and eventually left his unit without authorization. After he was detained, he was able to resume substitution therapy in pretrial detention, where such treatment has been available in Ukraine since 2012.

Vitalii later agreed to return to military service rather than face a possible five-year prison sentence for leaving his unit. This time, he brought documentation from the detention facility confirming that he was receiving substitution therapy.

Six months after his initial mobilization, a new military medical examination found him unfit for service. He returned to civilian life and treatment.

Vitalii told Hromadske that he had not opposed serving in the military. What he needed, he said, was a way to continue his treatment while performing duties he was medically able to do.

How patients fall through the system

One problem is access to medical information. The military ombudsman's office says military medical commissions have limited access to records showing whether a person is enrolled in an opioid substitution therapy program.

Rights advocates told Hromadske that some patients had their treatment documents or prescriptions ignored or confiscated during mobilization. In Kropyvnytskyi, doctor Tetiana Hurenko said some patients also had medication issued by the state taken away from them.

What happens after a patient enters the military varies widely between units. Some commanders have helped soldiers reach treatment centers and continue receiving medication, including in frontline areas. Others have tried to make them stop treatment altogether.

Rights advocates told Hromadske they were aware of at least six military units where soldiers with opioid dependence had been subjected to physical labor in an attempt to force them to overcome their dependence. Hromadske could not establish how widespread the practice was.

Medical experts say abruptly stopping treatment is not a reliable way to overcome opioid dependence and can instead increase the risk of relapse. The World Health Organization recommends opioid substitution therapy as a standard treatment for opioid dependence.

There is no military-wide system regulating access to substitution therapy for those who have already been mobilized. That leaves much dependent on individual commanders - even though, under the rules, these patients should not have entered the military in the first place.

Fixing the consequences

The military ombudsman's office has discussed the issue with representatives of the Armed Forces and the Defense Ministry. Following public attention and additional clarification from the ministry, patients receiving substitution therapy have increasingly been sent for new military medical examinations and discharged from service when found unfit.

But that addresses people who have already entered the military rather than preventing such cases in the first place.

While reporting this story, Hromadske contacted Ukraine's National Police. Police departments in several regions said they had received no complaints about officers taking part in recruitment patrols. Police in Kirovohrad Oblast said their officers were acting within the law.

Hromadske also sent questions to the Defense Ministry, the General Staff and the Ground Forces. The agencies referred the questions to one another, but none provided substantive answers.