Non-fatal overdoses and related risk factors among people who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia

Uusküla, Anneli; Raag, Mait; Vorobjov, Sigrid; Rüütel, Kristi; Lyubimova, Alexandra; Levina, Olga S.; Heimer, Robert

doi:10.1186/s12889-015-2604-6

Cited by 31 publications

(25 citation statements)

References 40 publications

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“…PWID were recruited between May and July 2012 in Kohtla-Järve and from November 2012 to June 2013 in St Petersburg, using respondent driven sampling (RDS), a variant of chain referral sampling [ 42 – 44 ]. Comparable recruitment criteria (men and women aged 18 or over, “having injected drugs in the past 30 days”, lived in St Petersburg or Kohtla-Järve and had provided informed consent for the study), survey methodology and questionnaires were used, details of which have been previously published [ 10 , 16 , 23 , 45 – 47 ]. In brief, six seeds representing diverse PWID sub-groups in terms of gender, main drug used, age and HIV status, were selected through outreach programmes in Kohtla-Järve, and 16 seeds in St Petersburg.…”

Section: Methodsmentioning

confidence: 99%

“…In brief, six seeds representing diverse PWID sub-groups in terms of gender, main drug used, age and HIV status, were selected through outreach programmes in Kohtla-Järve, and 16 seeds in St Petersburg. Each seed recruited up to three PWID from their personal network, who on completing the survey recruited a maximum of three new participants [ 10 , 44 , 48 ]. Recruitment was tapered once the HIV outcome converged to a sample equilibrium and the target sample size was reached [ 43 ].…”

Section: Methodsmentioning

confidence: 99%

“…The study questionnaire for both sites included standardised items from established tools including the WHO Drug Injecting study Phase II survey (v2b) for risk behaviours [ 10 , 49 ]. Information on social and demographics, injection and sexual risk behaviours, testing and access to harm reduction services was elicited in a structured confidential face-to-face interview using a questionnaire administered by trained fieldworkers.…”

Section: Methodsmentioning

confidence: 99%

“…Polydrug use consists of the concurrent use of multiple illicit drugs and such practices have recently been facilitated by increased drug availability. These trends are worrisome as polydrug use among PWID has been associated with a greater risk of injury, infection, overdose and drug-induced deaths in many parts of the world [ 10 , 24 – 26 ]. Stimulants have been associated with greater injecting and sexual risks, and are known to adversely affect drug treatment outcomes and adherence to antiretroviral therapy among PWID [ 24 , 27 – 29 ].…”

Section: Introductionmentioning

confidence: 99%

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Polydrug Use and Heterogeneity in HIV Risk Among People Who Inject Drugs in Estonia and Russia: A Latent Class Analysis

et al. 2017

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Non-medical drug injection is a major risk factor for HIV infection in Russia and Estonia. Multiple drug use (polydrug) has further been associated with increased harms. We compared HIV, injecting and sexual risk associated with polydrug use among people who injected drugs (PWID) in 2012–2013 in Kohtla-Järve (Estonia, n = 591) and St Petersburg (Russia, n = 811). Using latent class analysis, we identified five (poly)drug classes, the largest consisting of single-drug injectors among whom an opioid was the sole drug injected (56% of PWID). The four remaining polydrug classes included polydrug-polyroute injectors who injected and used opiates and stimulants (9%), opiate-stimulant poly-injectors who injected amphetamine-type-stimulants with a primary opiate (7%) and opiate-opioid poly-injectors who injected opioids and opiates (16%). Non-injection stimulant co-users were injectors who also used non-injection stimulants (12%). In multivariable multinomial regressions, all four polydrug classes were associated with greater injection risks than single-drug injection, while opiate-stimulant and opiate-opioid poly-injection were also associated with having multiple sex partners. Riskier behaviours among polydrug-injectors suggest increased potential for transmission of blood-borne and sexually-transmitted infections. In addition to needles/syringes provision, services tailored to PWID drug and risk profiles, could consider drug-appropriate treatment and sexual risk reduction strategies to curb HIV transmission.Electronic supplementary materialThe online version of this article (doi:10.1007/s10461-017-1836-0) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Polydrug Use and Heterogeneity in HIV Risk Among People Who Inject Drugs in Estonia and Russia: A Latent Class Analysis

et al. 2017

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“…Emergency departments (EDs) represent the primary sites of medical care after opioid overdose, but often are ill-equipped to provide adequate substance use treatment referrals prior to a patient's discharge. This results in a cycle of successive resuscitations from overdose followed by discharges, often culminating in a final fatal overdose [3,4].…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of a Telemedicine-based Substance Use Disorder Evaluation to Enhance Access to Treatment Following Near-Fatal Opioid Overdose

Lai¹,

Chapman²,

Carreiro³

et al. 2020

Proceedings of the Annual Hawaii International Conference on System Sciences

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The opioid epidemic is a growing public health emergency in the United States, with deaths from opioid overdose having increased five-fold since 1999. Emergency departments (EDs) are the primary sites of medical care after near-fatal opioid overdose but are poorly equipped to provide adequate substance use treatment planning prior to discharge. In many underserved locales, limited access to clinicians trained in addiction medicine and behavioral health exacerbates this disparity. In an effort to improve postoverdose care in the ED, we developed a telemedicine protocol to facilitate timely access to substance use disorder evaluations. In this paper, we describe the conception and refinement of the telemedicine program, our experience with the first 20 participants, and potential implications of the platform on health disparities for individuals with opioid use disorder.

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Injection Drug Use Frequency Before and After Take-Home Naloxone Training

et al. 2023

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ImportanceConcerns that take-home naloxone (THN) training may lead to riskier drug use (as a form of overdose risk compensation) remain a substantial barrier to training implementation. However, there was limited good-quality evidence in a systematic review of the association between THN access and subsequent risk compensation behaviors.ObjectiveTo assess whether THN training is associated with changes in overdose risk behaviors, indexed through injecting frequency, in a cohort of people who inject drugs.Design, Setting, and ParticipantsThis cohort study used prospectively collected self-reported behavioral data before and after THN training of participants in The Melbourne Injecting Drug User Cohort Study (SuperMIX). Annual interviews were conducted in and around Melbourne, Victoria, Australia, from 2008 to 2021. SuperMIX participants were adults who regularly injected heroin or methamphetamine in the 6 months preceding their baseline interview. The current study included only people who inject drugs who reported THN training and had participated in at least 1 interview before THN training.ExposureIn 2017, the SuperMIX baseline or follow-up survey began asking participants if and when they had received THN training. The first THN training date that was recorded was included as the exposure variable. Subsequent participant interviews were excluded from analysis.Main Outcomes and MeasuresInjecting frequency was the primary outcome and was used as an indicator of overdose risk. Secondary outcomes were opioid injecting frequency, benzodiazepine use frequency, and the proportion of the time drugs were used alone. Fixed-effects generalized linear (Poisson) multilevel modeling was used to estimate the association between THN training and the primary and secondary outcomes. Time-varying covariates included housing status, income, time in study, recent opioid overdose, recent drug treatment, and needle and syringe coverage. Findings were expressed as incidence rate ratios (IRRs) with 95% CIs.ResultsThere were 1328 participants (mean [SD] age, 32.4 [9.0] years; 893 men [67.2%]) who completed a baseline interview in the SuperMIX cohort, and 965 participants completed either a baseline or follow-up interview in or after 2017. Of these 965 participants, 390 (40.4%) reported THN training. A total of 189 people who inject drugs had pretraining participant interviews with data on injecting frequency and were included in the final analysis (mean [SD] number of interviews over the study period, 6.2 [2.2]). In fixed-effects regression analyses adjusted for covariates, there was no change in the frequency of injecting (IRR, 0.91; 95% CI, 0.69-1.20; P = .51), opioid injecting (IRR, 0.95; 95% CI, 0.74-1.23; P = .71), benzodiazepine use (IRR, 0.96; 95% CI, 0.69-1.33; P = .80), or the proportion of reported time of using drugs alone (IRR, 1.04; 95% CI, 0.86-1.26; P = .67) before and after THN training.Conclusions and RelevanceThis cohort study of people who inject drugs found no evidence of an increase in injecting frequency, along with other markers of overdose risk, after THN training and supply. The findings suggest that THN training should not be withheld because of concerns about risk compensation and that advocacy for availability and uptake of THN is required to address unprecedented opioid-associated mortality.

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Non-fatal overdoses and related risk factors among people who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia

Cited by 31 publications

References 40 publications

Polydrug Use and Heterogeneity in HIV Risk Among People Who Inject Drugs in Estonia and Russia: A Latent Class Analysis

Polydrug Use and Heterogeneity in HIV Risk Among People Who Inject Drugs in Estonia and Russia: A Latent Class Analysis

A Pilot Study of a Telemedicine-based Substance Use Disorder Evaluation to Enhance Access to Treatment Following Near-Fatal Opioid Overdose

Injection Drug Use Frequency Before and After Take-Home Naloxone Training

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