Fatal and non-fatal overdose after narcology hospital discharge among Russians living with HIV/AIDS who inject drugs

Abstract

Objectives Among Russians living with HIV/AIDS who inject drugs, we examined the incidence of fatal and non-fatal overdoses following discharge from a narcology hospital and the associations with more advanced HIV infection. Design Prospective cohort study of data collected at baseline, 3 and 6 months from HIV-infected patients with a history of injection drug use who were not treated with anti-retroviral therapy. Participants were recruited between 2012-14 from a narcology (addiction) hospital in St. Petersburg, Russia. Methods Fatal overdose was determined based on contact reports to study staff in the year after discharge. Non-fatal overdose was self-reported at the 3- and 6-month assessments. The main independent variable for HIV severity was CD4 cell count at the baseline interview (<200 cells/mm3 ≥ 200 cells/mm3). Secondary analyses assessed time since HIV diagnosis and treated with anti-retroviral treatment (ART) prior to enrollment as independent variables. We fit Cox proportional hazards models to assess whether HIV severity is associated with either fatal or non-fatal overdose. Results Among 349 narcology patients, 18 participants died from overdose within one year after discharge (8.7%, 95%CI 3.4-14.2 by Kaplan-Meier); an estimated 51% [95% CI 34-68%] reported at least one non-fatal overdose within 6 months of discharge. HIV severity, time since HIV diagnosis and ever ART were not significantly associated with either fatal or non-fatal overdose events. Conclusion Fatal and non-fatal overdose are common among Russians living with HIV/AIDS who inject drugs after narcology hospital discharge. Overdose prevention interventions are urgently warranted among Russian narcology patients with HIV infection.

Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: results from a national survey of Australian paramedics

“…In Australia, 1-in-520 21 to 1-in-1022 ambulance presentations involve clients with these conditions. Similar experiences with these client groups have been reported in the USA,23 UK,24 Canada25 and Russia 26. Traditionally, however, the training paramedics receive focuses primarily on life-threatening emergencies, trauma and resuscitation 18.…”

Patterns of Non-injection Drug Use Associated with Injection Cessation among Street-Involved Youth in Vancouver, Canada

“…Specifically, as abstinence-based models are still the norm in many youth addiction treatment services [24], these findings lend support to the notion that youth treatment models should consider a range of pathways to wellness including expanding strategies that can help youth transition to safer forms of drug use without requiring abstinence as the sole objective. This recommendation is consistent with prior research suggesting that abstinence from all substance use may not be common among many street-involved youth [45], and is made with careful consideration of the frequent shortcomings (e.g., dropout, relapse) [21][22][23][24] and risk of harm (e.g., overdose) [25][26][27][28] associated with abstinence-oriented treatment models.…”

“…Although many young individuals struggling with substance use disorders have benefitted from abstinence-based treatment models, it is also becoming increasingly clear, from high drop out and relapse rates [21][22][23][24], that they are far from universally beneficial and may even set the stage for severe drugrelated harms. For example, the many individuals who relapse after discharge from abstinence-oriented treatment programs are highly susceptible to fatal overdose as a result of reduced drug tolerance [25][26][27][28]. In many settings, there is a significant portion of youth who do not access substance use treatment for various reasons including choosing to Bhandle their drug problem on their own^ [29].…”

Homelessness and incarceration associated with relapse into stimulant and opioid use among youth who are street‐involved in Vancouver, Canada

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