Abstract
Using a self-administered questionnaire, we examined the characteristics of opiate overdose in 16 cities of the Russian Federation. As indicated by responses from 763 injection drug users who took part in this study, 59% experienced an overdose, 81% reported seeing others experiencing an overdose, and 15% stated that they had witnessed a fatal overdose. The most common drug that caused opiate overdose was heroin (74%), although we also found that, in smaller towns, home-produced opiates tended to be a major overdose-causing agent. There were a number of factors that increased the likelibood of overdose, such as mixing opiates with alcobol and tranquilizers or having a longer history of opiate use. We also found that injecting drug users were reluctant to seek medical assistance when their peers experienced an overdose because of the perceived ineffectiveness of ambulance services and fear of police prosecution. At the same time, 57% of respondents admitted that they lacked appropriate skills to treat overdose. We discuss the implications of these findings for overdose prevention programs in Russia.
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References
- 1.Koshkina EA. Spread of the use of narcotic drugs and other psychoactive substances in Russia. J Microbiol Epidemiol Immunobiol. 2000;4:15–19. [PubMed] [Google Scholar]
- 2.Illegal Drug Trade in Russia: Final Report 2000. Freiburg: Max Planck Institute for Foreign and International Criminal Law; October 2000. [Google Scholar]
- 3.Onishchenko G, Narkevich M. New strategies in preventing the spread of HIV infection in Russia. J Microbiol Epidemiol Immunobiol. 2000;4:5–9. [PubMed] [Google Scholar]
- 4.Burrows D, Trautmann F, Bijl M, Sarankov Y. Training in the Russian Federation on rapid assessment and response to HIV/AIDS among injecting drug users. J Drug Issues. 1999;29:811–842. [Google Scholar]
- 5.Dehne K, Grund J-PC, Khoakevich L, Kobyshcha Y. The HIV/AIDS epidemic among drug injectors in eastern Europe: patterns, trends and determinants. J Drug Issues. 1999;29:729–776. [Google Scholar]
- 6.Kontrol sa narkotikami i predypresdenie prestypnosti v Rossijskoj Federazii. Organisovannaja prestypnost i nesakonnij oborot narkotikov v Rossijskoj Federazii [Drug Control and Crime Prevention in the Russian Federation. Organized Crime and Illicit Drug Trafficking in the Russian Federation] Moscow: MVD; 2000. [Google Scholar]
- 7.Barr DA, Field MG. The current state of health care in the former Soviet Union: implications for health care policy and reform. Am J Public Health. 1996;86:307–312. doi: 10.2105/AJPH.86.3.307. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Sentsov V, Bogdanov S, Koshkina E, Ruzhnikov Y. Acute poisoning by opium surrogates and heroine: the Ekaterinburg experience. Issties Narcol. 2001;6:38–47. [Google Scholar]
- 9.Dolzhanskyi O. Forensic evaluation of morphological changes to the brain among chronic opioid addicts. Doctoral Dissertation Summary; Moscow; 2001;25.
- 10.Kidryapkina A. The 10-year pattern of death among people who abuse injected psychoactive substances in the Primorskyi Krai. Doctoral Dissertation Summary; Vladivostok; 2001:32.
- 11.Provadlo I, Zobnin Y, Gerasimov G, et al. Clinical signs, diagnostics and treatment of acute exogenous poisonings by opium surrogates. Curr Issues Prof Pathol Intern Med. 1994:202–205.
- 12.Sofronov A. Characteristics of acute intoxication and withdrawal syndrome in the abuse by home made opiates. Doctoral Dissertation Summary; Leningrad; 1990:26.
- 13.Yatsinuk B. Acute poisonings by opium alkaloids. Opium addiction in youth. Abstracts of Scientific Conference. Omsk; December 1998:75–78.
- 14.Pompidou Group Project on Treatment Demand: Final Report. Treated Drug Users in 23 European Cities. Strasbourg, France: Council of Europe Publishing; 1999:141.
- 15.Joe GW, Simpson D. Mortality rates among opioid addicts in a longitudinal study. Am J Public Health. 1987;77:347–348. doi: 10.2105/ajph.77.3.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Ghodse H, Oyefeso A, Kilpatrick B. Mortality of drug addicts in the United Kingdom, 1967–1993. Int J Epidemiol. 1998;27:473–478. doi: 10.1093/ije/27.3.473. [DOI] [PubMed] [Google Scholar]
- 17.Frischer M, Goldberg D, Rahman M, Berney L. Mortality and survival among a cohort of drug injectors in Glasgow, 1982–1994. Addiction. 1997;92:419–427. doi: 10.1111/j.1360-0443.1997.tb03373.x. [DOI] [PubMed] [Google Scholar]
- 18.Davoli M, Perucci CA, Rapiti E, et al. A persistent rise in mortality among injection drug users in Rome, 1980 through 1992. Am J Public Health. 1997;87:851–853. doi: 10.2105/ajph.87.5.851. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Orti RM, Domingo-Salvany A, Munoz A, Macfarlane D, Suelves JM, Anto JM. Mortality trends in a cohort of opiate addicts, Catalonia, Spain. Int J Epidemiol. 1996;25:545–553. doi: 10.1093/ije/25.3.545. [DOI] [PubMed] [Google Scholar]
- 20.Opiate Overdose: Trends, Risk Factors, Interventions and Priorities for Action. Geneva, Switzerland: World Health Organization; 1998. [Google Scholar]
- 21.Darke S, Zador D. Fatal heroin “overdose”: a review. Addiction. 1996;91:1765–1772. doi: 10.1111/j.1360-0443.1996.tb03800.x. [DOI] [PubMed] [Google Scholar]
- 22.Garrick TM, Sheedy D, Abernethy J, Hodda AE, Harper CG. Heroin-related deaths in Sydney, Australia. How common are they? Am J Addict. 2000;9:172–178. doi: 10.1080/10550490050173244. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Rhodes T, Stimson G, Judd A, Donoghoe M, Strang J, Vicente J. Opfoid overdose: prevention through social intervention. Unpublished paper; 2002.
- 24.Sporer K. Acute heroin overdose. Ann Intern Med. 1999;130:584–590. doi: 10.7326/0003-4819-130-7-199904060-00019. [DOI] [PubMed] [Google Scholar]