No abstract

No abstract

Purpose To the best of the authors’ knowledge, no study has previously examined the use of psychoactive substances (PASs) at electronic dance music (EDM) events in Ukraine. Addressing this gap in the research literature, this study aims to: describe the recreational drug scene associated with Ukrainian EDM culture; identify clusters of EDM participants who use PAS, based on their drug use patterns; and assess the uptake of drug checking and investigate associations between drug checking and subsequent drug-related behaviour. Design/methodology/approach A series of cross-sectional surveys were conducted in 2021 (N = 1,307) among EDM festival participants in Ukraine. The authors performed cluster analysis to identify distinct profiles of PAS users. Trends in drug checking were analysed based on cross-sectional surveys conducted at one recurring festival in 2018 (N = 99), 2019 (N = 195) and 2021 (N = 237). Findings The substances most often used at EDM events were 3,4-Methylenedioxymethamphetamine (37%), amphetamine (16%), lysergic acid diethylamide (11%) and cocaine (9%). Between 2018 and 2021, the proportion of participants who reported to have ever tested their drugs has increased from 2% to 26% (p < 0.001). Unexpected or inconclusive test results led to a significantly lower chances of drug consumption (p = 0.003). The authors identified three distinct clusters of PAS users among the EDM festival attendees in Ukraine. Originality/value This study will inform the development of harm reduction interventions tailored to various subgroups of recreational PAS users taking into account gender-specific patterns of use suggested by the authors’ cluster analysis. Increased availability of drug checking is crucial to reduce the risks of drug-related harm associated with the consumption of mis-sold, mislabeled and/or adulterated substances.

Methadone treatment is prescribed by evidence-based medicine as the most effective tool for the treatment of opioid addiction. Its implementation into high-need prison settings worldwide has been met with challenges, particularly in Eastern Europe and Central Asia where the opioid epidemic continues to expand. To address these impasses to intervention translation, we turn to post-structural approaches to policy analysis. These approaches open space for (re)thinking the ways that translated interventions emerge locally, by treating policy texts as social practices that make interventions in specific, sometimes unexpected, ways. We leverage Carol Bacchi’s post-structuralist analytic framework to interrogate how the object of methadone is constituted in Kyrgyz prisons through an analysis of the national legislative document, the “Government Program,” which provides the legislative basis for opioid addiction treatment administration in the Kyrgyz Republic. Rather than the medicalized methadone for the treatment of opioid use disorder, contained in the distinct objectivization of methadone emerging from this policy text, is the previously unexamined assumption that methadone is a particular type of governance. We describe a methadone object tied up with the shifting social structures that govern Kyrgyz prisons, divided between formal (state-run) and informal (prisoner-run) governance. In Kyrgyz prisons, where opioid policy discourse produces a divide between formal and informal governance, methadone emerges as a tool of the formal prison administration to regain control of the prisons from the practices of prisoner subculture. Although this study takes the Kyrgyz case as an example, the enactment of methadone as formal governance is likely to resonate throughout Eastern Europe and Central Asia, where there is a strong legacy of self-governing prisons. We conclude with a call for global health policymakers to consider how opioid addiction treatment is constituted within local governing relations, in ways that may depart sharply from the evidence base.

HIV incidence continues to increase in Eastern Europe and Central Asia (EECA), in large part due to non-sterile injection drug use, especially within prisons. Therefore, medication-assisted therapy with opioid agonists is an evidence-based HIV-prevention strategy. The Kyrgyz Republic offers methadone within its prison system, but uptake remains low. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a framework for identifying people who would potentially benefit from methadone, intervening to identify OUD as a problem and methadone as a potential solution, and providing referral to methadone treatment. Using an SBIRT framework, we screened for OUD in Kyrgyz prisons among people who were within six months of returning to the community (n = 1118). We enrolled 125 people with OUD in this study, 102 of whom were not already engaged in methadone treatment. We conducted a pre-release survey followed by a brief intervention (BI) to address barriers to methadone engagement. Follow-up surveys immediately after the intervention and at 1 month, 3 months, and 6 months after prison release assessed methadone attitudes and uptake. In-depth qualitative interviews with 12 participants explored factors influencing methadone utilization during and after incarceration. Nearly all participants indicated favorable attitudes toward methadone both before and after intervention in surveys; however, interest in initiating methadone treatment remained very low both before and after the BI. Qualitative findings identified five factors that negatively influence methadone uptake, despite expressed positive attitudes toward methadone: (1) interpersonal relationships, (2) interactions with the criminal justice system, (3) logistical concerns, (4) criminal subculture, and (5) health-related concerns.