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LaMonaca K, Dumchev K, Dvoriak S, Azbel L, Morozova O, Altice FL. HIV, Drug Injection, and Harm Reduction Trends in Eastern Europe and Central Asia: Implications for International and Domestic Policy. Curr Psychiatry Rep 2019; 21:47. [PMID: 31161306 PMCID: PMC6685549 DOI: 10.1007/s11920-019-1038-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Scaling up evidence-based HIV prevention strategies like opioid agonist therapies (OAT), syringe services programs (SSPs), and antiretroviral therapy (ART) to mitigate the harms of drug injection is crucial within Eastern Europe and Central Asia (EECA), the only region globally where HIV incidence and mortality are increasing. RECENT FINDINGS Though the proportion of new HIV cases directly attributable to drug injection has recently declined, it remains a critical driver of HIV, especially to sexual partners. Concurrently, scale-up of OAT, SSPs, and ART has remained low, contributing to a volatile HIV epidemic among people who inject drugs (PWID). Despite evidence that drug injection contributes to an evolving HIV epidemic in EECA, coverage of evidence-based harm reduction programs remains substantially below needed targets. Due to a combination of punitive drug laws, ideological resistance to OAT among clinicians and policymakers, and inadequate domestic and international funding, limited progress has been observed in increasing the availability of these programs.
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Affiliation(s)
- Katherine LaMonaca
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College Street Suite 323, New Haven, CT, 06510, USA
| | | | - Sergii Dvoriak
- Academy of Labour, Social Relations and Tourism, Kyiv, Ukraine
| | - Lyuba Azbel
- London School of Hygiene & Tropical Medicine, London, UK
| | - Olga Morozova
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College Street Suite 323, New Haven, CT, 06510, USA.
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Abstract
PURPOSE OF REVIEW To explore the consequences of policies implemented in the Russian Federation in response to syndemic of HIV-1 and opioid use disorder and compare the responses to the concomitant syndemic in rural America. RECENT FINDINGS The syndemic spread has not been reduced by policies implemented by the Russian government, which continues to underfund harm reduction efforts to reduce HIV transmission, refuses to approve evidence-based opioid agonist treatments for opioid use disorder, and relies on criminal justice and abstinence approaches to control illicit opioids. When effective measures have been undertaken locally, the lessons learned have not been transferred to other parts of the country and local programs have been allowed to wither. As in many parts of rural America, Russia has experienced intertwined epidemics of opioid misuse and HIV-1 that continue to expand. The expansion has been facilitated by adoption of policies that run contrary to medical and public health evidence.
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Affiliation(s)
- Robert Heimer
- Department of Epidemiology of Microbial Diseases and Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06520-8034, USA.
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Blokhina E, Krupitsky EM, Cheng DM, Walley AY, Toussova O, Yaroslavtseva T, Gnatienko N, Bridden C, Forman LS, Bendiks S, Samet JH. Evolution of illicit opioid use among people with HIV infection in St Petersburg, Russia, in the period 2004-2015. HIV Med 2019; 20:450-455. [PMID: 31034141 DOI: 10.1111/hiv.12741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In the late 1990s, when the current Russian opioid epidemic began, illicit opioids used in Russia consisted almost exclusively of heroin. The type of opioids used has evolved in the early 21st Century. The objective of this study was to describe the evolution of illicit opioid use among people living with HIV (PLWH) reporting recent opioid use in St Petersburg, Russia. METHODS We examined baseline data from four research studies conducted in the period 2004-2015 that included PLWH who used opioids [Partnership to Reduce the Epidemic Via Engagement in Narcology Treatment (PREVENT; 2004-2005; n = 17), HIV Evolution in Russia-Mitigating Infection Transmission and Alcoholism in a Growing Epidemic (HERMITAGE; 2007-2010; n = 281), Linking Infectious and Narcology Care (LINC; 2013-2014; n = 119) and Russia Alcohol Research Collaboration on HIV/AIDS (Russia ARCH; 2012-2015; n = 121)] and reported recent use of heroin and other opioids. RESULTS Although these studies spanned more than a decade, the participants represented similar birth cohorts; the mean age was 24.5 years in 2004 and 33.3 years in 2014. The use of opioid types, however, evolved across cohorts, with the use of any illicit drug other than heroin increasing from 6% [95% confidence interval (CI) 000.2, 29%] in PREVENT (2004-2005) to 30% (95% CI 25, 36%) in HERMITAGE (2007-2010) to 70% (95% CI 61, 78%) in LINC (2013-2014) to 77% (95% CI 68, 84%) in ARCH (2012-2015). Any heroin use consistently decreased over the 10-year period in the cohorts, from 100% (95% CI 80, 100%) in 2004-2005 to 54% (95% CI 44, 63%) in 2012-2015. CONCLUSIONS Among PLWH who use opioids in St Petersburg, Russia, illicit use of opioids other than heroin appears to be more common than heroin use.
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Affiliation(s)
- E Blokhina
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St Petersburg, Russia
| | - E M Krupitsky
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St Petersburg, Russia.,Department of Addictions, V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St Petersburg, Russia
| | - D M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - A Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - O Toussova
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St Petersburg, Russia
| | - T Yaroslavtseva
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St Petersburg, Russia
| | - N Gnatienko
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - C Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - L S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - S Bendiks
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - J H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA.,Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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Lancaster KE, Hoffman IF, Hanscom B, Ha TV, Dumchev K, Susami H, Rose S, Go VF, Reifeis SA, Mollan KR, Hudgens MG, Piwowar‐Manning EM, Richardson P, Dvoriak S, Djoerban Z, Kiriazova T, Zeziulin O, Djauzi S, Ahn CV, Latkin C, Metzger D, Burns DN, Sugarman J, Strathdee SA, Eshleman SH, Clarke W, Donnell D, Emel L, Sunner LE, McKinstry L, Sista N, Hamilton EL, Lucas JP, Duong BD, Van Vuong N, Sarasvita R, Miller WC. Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis. J Int AIDS Soc 2018; 21:e25195. [PMID: 30350406 PMCID: PMC6198168 DOI: 10.1002/jia2.25195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/26/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention. METHODS We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two-arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV-positive index and their HIV-negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours. RESULTS The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self-reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test - Alcohol Consumption Questions (AUDIT-C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions. CONCLUSIONS While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.
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Affiliation(s)
- Kathryn E Lancaster
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Irving F Hoffman
- Division of Infectious DiseasesSchool of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Tran Viet Ha
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Hepa Susami
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | - Vivian F Go
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Sarah A Reifeis
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Katie R Mollan
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Michael G Hudgens
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health PolicyKyivUkraine
- Academy of Labor, Social Relations and TourismKyivUkraine
| | - Zubairi Djoerban
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | | | | | | | - Carl Latkin
- Department of Health, Behavior, and SocietyJohns Hopkins UniversityBaltimoreMDUSA
| | - David Metzger
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - David N Burns
- Division of AIDSNational Institute of Allergy and Infectious DiseasesU.S. National Institutes of HealthBethesdaMDUSA
| | - Jeremy Sugarman
- Department of MedicineBerman Institute of BioethicsJohns Hopkins UniversityBaltimoreMDUSA
| | - Steffanie A Strathdee
- Department of MedicineSchool of MedicineUniversity of California San DiegoSan DiegoCAUSA
| | | | - William Clarke
- School of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | | | | | | | | | | | | | | | - Bui D Duong
- Vietnam Authority of HIV/AIDS Control ‐ Ministry of HealthHanoiVietnam
| | | | | | - William C Miller
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
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Trace-Level Screening of Chemicals Related to Clandestine Desomorphine Production with Ambient Sampling, Portable Mass Spectrometry. J CHEM-NY 2017. [DOI: 10.1155/2017/8571928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Desomorphine is a semisynthetic opioid that is responsible for the psychoactive effects of a dangerous homemade injectable mixture that goes by street name “Krokodil.” Desorption electrospray ionization (DESI) and paper spray ionization (PSI) are implemented on a portable mass spectrometer for the direct analysis of desomorphine and precursor reagent codeine from multiple substrates of potential relevance to clandestine drug laboratory synthesis and paraphernalia seizure. Minimal sample preparation required for analysis and portability of the instrument suggest the potential for rapid, on-site analysis of evidence, a highly desired benefit for forensic science and law enforcement practitioners. Both DESI-MS and PSI-MS can generate spectra consistent with preceding data obtained using traditional ionization methods, while demonstrating detection limits in the low- to sub-ng levels.
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Abdala N, Patel A, Heimer R. Recovering Infectious HIV from Novel Syringe-Needle Combinations with Low Dead Space Volumes. AIDS Res Hum Retroviruses 2016; 32:947-954. [PMID: 27548374 DOI: 10.1089/aid.2016.0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This study determines if detachable syringe-needle combinations redesigned to reduce their dead space volume may substantially reduce the burden of exposure to infectious HIV among people who inject drugs. Two novel, low dead space (LDS) syringe-needle designs-one added a piston to the plunger (LDS syringe) and the other added a filler to the needle (LDS needle) to reduce their dead space-were compared to standard detachable needle-syringe combinations and to syringes with fixed needles. LDS and standard syringes attached to LDS and standard needles of 23-, 25-, and 27-gauge size were contaminated with HIV-infected blood in the laboratory. The proportion of syringe-needle combinations containing infectious HIV was analyzed after syringes were (1) stored up to 7 days at 22°C or (2) rinsed with water. Detachable syringes attached to 25-gauge needles yielded comparable proportions of syringes with infectious HIV, whether the needle was standard or LDS. Among needles of greater diameter (23 gauge), LDS needles tended to reduce recoverable HIV to a greater extent than standard needles. Syringes with fixed needles showed superior results to LDS syringes attached to needles of equivalent diameter and were less likely to get clogged by blood. Detachable LDS syringe-needle designs must be recommended with caution since they still pose potential risk for HIV transmission. Distribution of LDS syringes and needles must be accompanied by recommendations and instructions for their proper rinsing and disinfection in order to reduce viral burden and chances of needle clogging.
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Affiliation(s)
- Nadia Abdala
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Amisha Patel
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Alves EA, Grund JPC, Afonso CM, Netto ADP, Carvalho F, Dinis-Oliveira RJ. The harmful chemistry behind krokodil (desomorphine) synthesis and mechanisms of toxicity. Forensic Sci Int 2015; 249:207-13. [PMID: 25710781 DOI: 10.1016/j.forsciint.2015.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
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Heimer R, Eritsyan K, Barbour R, Levina OS. Hepatitis C virus seroprevalence among people who inject drugs and factors associated with infection in eight Russian cities. BMC Infect Dis 2014; 14 Suppl 6:S12. [PMID: 25253447 PMCID: PMC4178532 DOI: 10.1186/1471-2334-14-s6-s12] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Behavioural surveillance among people who inject drugs (PWID) and testing for hepatitis C virus (HCV) and HIV is needed to understand the scope of both epidemics in at-risk populations and to suggest steps to improve their health. Methods PWID were recruited using respondent-driven sampling (RDS) in eight Russian cities. A standardized survey was administered to collect sociodemographic and behavioral information. Blood specimens were obtained for serological testing for HCV and HIV-1. Data across the eight sites were pooled to identify individual-, network-, and city-level factors associated with positive HCV serostatus. Results Among 2,596 PWID participating in the study, 1,837 tested positive for HCV (71%). The sample was 73% male and the mean age was 28. Very few PWID reported regular contact with harm reduction programs. Factors associated with testing positive for HCV were longer duration of injection drug use, testing positive for HIV-1, sharing non-syringe injection paraphernalia and water for rinsing syringes, and larger social network size. Factors negatively associated with HCV-positive serostatus were injecting with a used syringe and two city-level factors: longer mean RDS recruitment chain in a city and higher levels of injecting stimulants. Conclusions HCV prevalence in all eight Russian cities is at the higher end of the range of HCV prevalence among PWID in Europe, which provides evidence that more resources, better prevention programs, and accelerated treatment targeting PWID are needed to control the HCV epidemic.
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Dvoriak S, Karachevsky A, Chhatre S, Booth R, Metzger D, Schumacher J, Chychula N, Pecoraro A, Woody G. Methadone maintenance for HIV positive and HIV negative patients in Kyiv: acceptability and treatment response. Drug Alcohol Depend 2014; 137:62-7. [PMID: 24548802 PMCID: PMC3985084 DOI: 10.1016/j.drugalcdep.2014.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND With up to 40% of opioid injectors infected with HIV, Ukraine has one of the most concentrated HIV epidemics in the world, mainly due to unsterile injection practices and a historical absence of effective prevention services. Harm reduction programs, including syringe exchange and a small buprenorphine treatment program, were introduced in 2004 and methadone maintenance was allowed in 2007. Despite an initial expansion, by 2009, only 3221 injectors were receiving methadone treatment. A growing body of research on methadone maintenance has found high retention rates with reduction in opioid use and HIV risk behaviors. We report on the acceptability and initial outcome of methadone treatment as a function of HIV status, an issue that has not yet been reported for injectors in Ukraine. METHODS Longitudinal observational study of a 12-week course of methadone treatment in 25 HIV+ and 25 HIV- opioid addicted individuals recruited from a harm reduction program and the city AIDS Center. Drug use and HIV risk were assessed at baseline and weeks 4, 8, 12 and 20; all patients were offered continued methadone maintenance in the Kyiv city program at the end of 12 weeks. RESULTS Fifty-four individuals were asked if they were interested in the study and 50, demographically similar to other samples of opioid addicted Ukrainians, agreed to participate. Two died of non-study related causes; the other 48 completed assessments at weeks 4, 8 and 12, and 47 completed followups at week 20. Significant reductions were seen in use of heroin (p<0.0001), other opiates/analgesics (p<0.0001), and HIV risk behaviors (drug, sex, total; all p<0.0001). All 48 patients chose to continue methadone after the 12-weeks of study medication ended. Unlike most opioid treatment studies, sexual risk was somewhat higher than injecting risk at study intake. CONCLUSIONS Methadone maintenance was well accepted by HIV+ and HIV- opioid dependent individuals and has the potential for significant public health impact if made more widely available with sustained access and support.
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Affiliation(s)
- Sergii Dvoriak
- Director, Ukrainian Institute of Public Health Policy, 4 Malopidvalna Str. Of. 6 Kyiv 01001 Kyiv, Ukraine
| | - Andrey Karachevsky
- Department of Psychiatry and Drug Abuse, O.O. Bogomolets National Medical University 34, Peremogy Avenue, Kyiv, Ukraine, 01601
| | - Sumedha Chhatre
- Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106
| | - Robert Booth
- Department of Psychiatry, University of Colorado, 1741 Vine Street, Denver, CO 80206
| | - David Metzger
- Perelman School of Medicine at the University of Pennsylvania and Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106
| | - Joseph Schumacher
- School of Medicine, University of Alabama, 1530 3rd Avenue South, Birmingham, AL
| | - Nina Chychula
- Department of Veterans Affairs Medical Center, 39th & Woodland Avenues, Philadelphia, PA 19104
| | - Anna Pecoraro
- Perelman School of Medicine at the University of Pennsylvania and Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106
| | - George Woody
- Perelman School of Medicine at the University of Pennsylvania and Treatment Research Institute, Suite 600, 150 South Independence Mall (W), Philadelphia, PA 19106, United States.
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Van Hout MC. Kitchen chemistry: A scoping review of the diversionary use of pharmaceuticals for non-medicinal use and home production of drug solutions. Drug Test Anal 2014; 6:778-87. [DOI: 10.1002/dta.1622] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/18/2014] [Accepted: 01/20/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Marie Claire Van Hout
- School of Health Sciences; Waterford Institute of Technology; Cork Road Waterford City Co. Waterford Ireland
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Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal in Russian cities. J Med Econ 2013; 16:1051-60. [PMID: 23730942 DOI: 10.3111/13696998.2013.811080] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of distributing naloxone to illicit opioid users for lay overdose reversal in Russian cities. METHOD This study adapted an integrated Markov and decision analytic model to Russian cities. The model took a lifetime, societal perspective, relied on published literature, and was calibrated to epidemiologic findings. RESULTS For each 20% of heroin users reached with naloxone distribution, the model predicted a 13.4% reduction in overdose deaths in the first 5 years and 7.6% over a lifetime; on probabilistic analysis, one death would be prevented for every 89 naloxone kits distributed (95% CI = 32-260). Naloxone distribution was cost-effective in all deterministic and probabilistic sensitivity analyses and cost-saving if resulting in a reduction in overdose events. Naloxone distribution increased costs by US$13 (95% CI = US$3-US$32) and QALYs by 0.137 (95% CI = 0.022-0.389) for an incremental cost of US$94 per QALY gained (95% CI = US$40-US$325). In a worst-case scenario where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the incremental cost was US$1987 per QALY gained. If national expenditures on drug-related HIV, tuberculosis, and criminal justice were applied to heroin users, the incremental cost was US$928 per QALY gained. CONCLUSIONS Naloxone distribution to heroin users for lay overdose reversal is highly likely to reduce overdose deaths in target communities and is robustly cost-effective, even within the constraints of this conservative model.
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Affiliation(s)
- Phillip O Coffin
- Substance Use Research Unit, San Francisco Department of Public Health, San Francisco, CA, USA
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Grund JPC, Latypov A, Harris M. Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:265-74. [DOI: 10.1016/j.drugpo.2013.04.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 04/06/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
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Eritsyan K, Heimer R, Barbour R, Odinokova V, White E, Rusakova MM, Smolskaya TT, Levina OS. Individual-level, network-level and city-level factors associated with HIV prevalence among people who inject drugs in eight Russian cities: a cross-sectional study. BMJ Open 2013; 3:bmjopen-2013-002645. [PMID: 23794559 PMCID: PMC3686233 DOI: 10.1136/bmjopen-2013-002645] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To ascertain HIV prevalence among people who inject drug (injection drug users (IDUs)) in the Russian Federation and identify explanations for the disparity in different cities. DESIGN Cross-sectional survey with serological testing for HIV and hepatitis C virus prevalent infections. SETTING 8 Russian cities-Irkutsk, Omsk, Chelyabinsk, Yekaterinburg, Naberezhnye Chelny, Voronezh, Orel and St Petersburg. PARTICIPANTS In 2007-2009 active IDUs were recruited by respondent-driven sampling with a target sample size of 300 or more in each city. MAIN OUTCOME MEASURES Participants were administered a questionnaire covering sociodemographics, injection risk and protective behaviours, sexual behaviours, HIV knowledge, experiences with drug treatment and harm reduction programmes and social networks. Participants were tested for HIV and hepatitis C by enzyme immunoassay. Data were analysed to identify individual-level, network-level and city-level characteristics significantly associated with HIV prevalence. Factors significant at p≤0.1 were entered into a hierarchical regression model to control for multicollinearity. RESULTS A total of 2596 active IDUs were recruited, interviewed and tested for HIV and hepatitis C virus infection. HIV prevalence ranged from 3% (in Voronezh) to 64% (in Yekaterinburg). Although individual-level and network-level variables explain some of the difference in prevalence across the eight cities, the over-riding variable that seems to account for most of the variance is the emergence of commercial, as opposed to homemade, heroin as the predominant form of opioid injected. CONCLUSIONS The expansion of commercial heroin markets to many Russian cities may have served as a trigger for an expanding HIV epidemic among IDUs in that country.
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Affiliation(s)
- Ksenia Eritsyan
- NGO Stellit, St Petersburg, Russian Federation
- Department of Psychology, Saint-Petersburg State University, St Petersburg, Russian Federation
| | - Robert Heimer
- Center for Interdisciplinary Research on AIDS, Yale University, School of Public Health, New Haven, Connecticut, USA
| | - Russell Barbour
- Center for Interdisciplinary Research on AIDS, Yale University, School of Public Health, New Haven, Connecticut, USA
| | | | - Edward White
- Center for Interdisciplinary Research on AIDS, Yale University, School of Public Health, New Haven, Connecticut, USA
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Are major reductions in new HIV infections possible with people who inject drugs? The case for low dead-space syringes in highly affected countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:1-7. [DOI: 10.1016/j.drugpo.2012.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 07/03/2012] [Accepted: 07/04/2012] [Indexed: 11/17/2022]
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Harris M. The 'do-it-yourself' New Zealand injecting scene: implications for harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 24:281-3. [PMID: 22884541 DOI: 10.1016/j.drugpo.2012.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/11/2012] [Accepted: 06/14/2012] [Indexed: 10/28/2022]
Abstract
The review in this issue of the International Journal of Drug Policy (Grund, Latypov, & Harris, 2013) highlights the disturbing harms caused by the increasing use of 'krokodil' by people who inject drugs (PWID) in Eurasia. The growing use of this home produced injectable opiate poses a number of challenges for harm reduction policy, particularly when situated in restrictive regulatory environments where initiatives such as Opioid Substitution Treatment (OST) are prohibited or limited. In such contexts where OST access is restricted, how can these harms be minimised, and what alternatives can be offered? This commentary addresses these questions, by offering the rarely researched case of home produced injectable opioid use in New Zealand as an example.
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Roy E, Arruda N, Bourgois P. The growing popularity of prescription opioid injection in downtown Montréal: new challenges for harm reduction. Subst Use Misuse 2011; 46:1142-50. [PMID: 21370963 PMCID: PMC3161198 DOI: 10.3109/10826084.2011.552932] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Starting in 2007, a 2-year study based on ethnographic methodology was carried out downtown Montréal, Canada. A thematic analysis of observational and interview-based notes was conducted. Illicit prescription opioid (PO) use was widespread among street-based participants. Injection was the main mode of PO administration observed among users. Some injection practices such as "doing a wash" could pose new challenges in terms of prevention of infections. More research is needed to examine the role of illicit PO use in the development of opiate addiction and to better understand drug-using contexts that put PO users at risk of infections. The study's limitations are noted.
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Affiliation(s)
- Elise Roy
- Faculté de Médicine et des Sciences de la Santé, Université de Sherbrooke, Service de Toxicomanie, Longueuil, Québec, Canada.
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Paintsil E, He H, Peters C, Lindenbach BD, Heimer R. Survival of hepatitis C virus in syringes: implication for transmission among injection drug users. J Infect Dis 2010; 202:984-90. [PMID: 20726768 DOI: 10.1086/656212] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We hypothesized that the high prevalence of hepatitis C virus (HCV) among injection drug users might be due to prolonged virus survival in contaminated syringes. METHODS We developed a microculture assay to examine the viability of HCV. Syringes were loaded with blood spiked with HCV reporter virus (Jc1/GLuc2A) to simulate 2 scenarios of residual volumes: low void volume (2 microL) for 1-mL insulin syringes and high void volume (32 microL) for 1-mL tuberculin syringes. Syringes were stored at 4 degrees C, 22 degrees C, and 37 degrees C for up to 63 days before testing for HCV infectivity by using luciferase activity. RESULTS The virus decay rate was biphasic (t1/2alpha= 0.4 h and t1/2beta = 28 hh). Insulin syringes failed to yield viable HCV beyond day 1 at all storage temperatures except 4 degrees , in which 5% of syringes yielded viable virus on day 7. Tuberculin syringes yielded viable virus from 96%, 71%, and 52% of syringes after storage at 4 degrees, 22 degrees, and 37 degrees for 7 days, respectively, and yielded viable virus up to day 63. CONCLUSIONS The high prevalence of HCV among injection drug users may be partly due to the resilience of the virus and the syringe type. Our findings may be used to guide prevention strategies.
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Affiliation(s)
- Elijah Paintsil
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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Gyarmathy VA, Neaigus A, Li N, Ujhelyi E, Caplinskiene I, Caplinskas S, Latkin CA. Liquid Drugs and High Dead Space Syringes May Keep HIV and HCV Prevalence High – A Comparison of Hungary and Lithuania. Eur Addict Res 2010; 16:220-8. [PMID: 20798543 PMCID: PMC2969108 DOI: 10.1159/000320287] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despitevery similar political, drug policy and HIV prevention backgrounds, HIV and HCV prevalence is considerably different in Hungary (low HIV and moderate HCV prevalence) and Lithuania (high HCV and moderate HIV prevalence). Wecompared the drug use profile of Hungarian (n = 215) and Lithuanian (n = 300) injecting drug users (IDUs). Overall, compared with IDUs in Hungary, IDUs in Lithuania often injected opiates purchased in liquid form ('shirka'), used and shared 2-piece syringes (vs. 1-piece syringes) disproportionately more often, were less likely to acquire their syringes from legal sources and had significantly more experience with injected and less experience with non-injected drugs. It may not be liquid drugs per se that contribute to a higher prevalence of HCV and/or HIV, but it is probably factors associated with the injecting of liquid drugs, such as the wide-spread use and sharing of potentially contaminated 2-piece syringes acquired often from non-legal sources, and syringe-mediated drug sharing with 2-piece syringes. Scaling up substitution therapy, especially heroin replacement, combined with reducing the supply of liquid drugs may decrease the prevalence of high-risk injecting behaviours related to the injecting of liquid drugs and drug injecting-related infections among IDUs in Lithuania.
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Affiliation(s)
- V. Anna Gyarmathy
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal,Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA,*V. Anna Gyarmathy, European Monitoring Centre for Drugs and Drug Addiction, Cais do Sodré, PT–1249-289 Lisbon (Portugal), Tel. +351 21 121 0200, Fax +351 21 358 4441, E-Mail
| | - Alan Neaigus
- Mailman School of Public Health, Columbia University, New York, N.Y., USA
| | - Nan Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA
| | | | - Irma Caplinskiene
- Centre for Communicable Diseases and AIDS, Social Policy Faculty, Vilnius, Lithuania,M. Romerius University, Social Policy Faculty, Vilnius, Lithuania
| | - Saulius Caplinskas
- Centre for Communicable Diseases and AIDS, Social Policy Faculty, Vilnius, Lithuania,M. Romerius University, Social Policy Faculty, Vilnius, Lithuania
| | - Carl A. Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA
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Rachlis B, Brouwer KC, Mills EJ, Hayes M, Kerr T, Hogg RS. Migration and transmission of blood-borne infections among injection drug users: understanding the epidemiologic bridge. Drug Alcohol Depend 2007; 90:107-19. [PMID: 17485179 DOI: 10.1016/j.drugalcdep.2007.03.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 03/29/2007] [Accepted: 03/29/2007] [Indexed: 12/01/2022]
Abstract
Migration is one of many social factors contributing to the spread of HIV and other blood-borne or sexually transmitted infections (STI). Bringing together large numbers of people from diverse settings, the process of migration moves infected individuals to diverse geographic locations. Injection drug users (IDU) are a relatively mobile group, often moving between cities, smaller communities, and across international borders for reasons of work, security, or access to narcotics. This mobility indicates the potential for IDU who engage in risky behavior outside their home areas to transmit HIV infection to other IDU, their sex partners, and others in the population. The objectives of this review are to examine: (1) the influence of drug trafficking and the spread of drug use on the diffusion of HIV, (2) the influence of migration on drug use and HIV-related risk behaviors among migrants, and (3) the mobility patterns of IDU and its role in the spread of HIV. We also discuss the potential policy implications of addressing prevention and care issues in mobile drug using populations.
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Affiliation(s)
- Beth Rachlis
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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