Robert Heimer1, Aleksandra Lyubimova2, Russell Barbour3, Olga S Levina2. 1. Center for Interdisciplinary Research on AIDS and Department of the Epidemiology of Microbial Disease, Yale University School of Public Health, New Haven, CT, USA. Electronic address: robert.heimer@yale.edu. 2. NGOStellit, St. Petersburg, Russia. 3. Center for Interdisciplinary Research on AIDS and Department of the Epidemiology of Microbial Disease, Yale University School of Public Health, New Haven, CT, USA.
Abstract
BACKGROUND: The syndemic of opioid addiction, HIV, hepatitis, tuberculosis, imprisonment, and overdose in Russia has been worsened by the illegality of opioid substitution therapy. As part of on-going serial studies, we sought to explore the influence of opioid availability on aspects of the syndemic as it has affected the city of St. Petersburg. METHODS: We employed a sequential approach in which quantitative data collection and statistical analysis were followed by a qualitative phase. Quantitative data were obtained in 2013-2014 from a respondent-driven sample (RDS) of people who inject drugs (PWID). Individuals recruited by RDS were tested for antibodies to HIV and interviewed about drug use and injection practices, sociodemographics, health status, and access to medical care. Subsequently, we collected in-depth qualitative data on methadone use, knowledge, and market availability from PWID recruited at nine different locations within St. Petersburg. RESULTS: Analysis of interview data from the sample revealed the percentage of PWID injecting methadone in the 30 days prior to interview increased from 3.6% in 2010 to 53.3% in 2012-2013. Injection of only methadone, as compared to injecting only heroin or both drugs, was associated with less frequent injection and reduced HIV-related injected risk, especially a lower rate of injecting with a previously used syringe. In-depth questioning of methadone injectors corroborated the finding from serial quantitative surveys of PWID that methadone's black market availability is a recent phenomenon. Spatial analysis revealed widespread methadone availability but no concentration in any specific districts of the city. CONCLUSION: Despite the prohibition of substitution therapy and demonization of methadone, the drug has emerged to rival heroin as the most commonly available opioid in St. Petersburg. Ironically, its use is associated with reduced injection-related HIV risk even when its use is illegal.
BACKGROUND: The syndemic of opioid addiction, HIV, hepatitis, tuberculosis, imprisonment, and overdose in Russia has been worsened by the illegality of opioid substitution therapy. As part of on-going serial studies, we sought to explore the influence of opioid availability on aspects of the syndemic as it has affected the city of St. Petersburg. METHODS: We employed a sequential approach in which quantitative data collection and statistical analysis were followed by a qualitative phase. Quantitative data were obtained in 2013-2014 from a respondent-driven sample (RDS) of people who inject drugs (PWID). Individuals recruited by RDS were tested for antibodies to HIV and interviewed about drug use and injection practices, sociodemographics, health status, and access to medical care. Subsequently, we collected in-depth qualitative data on methadone use, knowledge, and market availability from PWID recruited at nine different locations within St. Petersburg. RESULTS: Analysis of interview data from the sample revealed the percentage of PWID injecting methadone in the 30 days prior to interview increased from 3.6% in 2010 to 53.3% in 2012-2013. Injection of only methadone, as compared to injecting only heroin or both drugs, was associated with less frequent injection and reduced HIV-related injected risk, especially a lower rate of injecting with a previously used syringe. In-depth questioning of methadone injectors corroborated the finding from serial quantitative surveys of PWID that methadone's black market availability is a recent phenomenon. Spatial analysis revealed widespread methadone availability but no concentration in any specific districts of the city. CONCLUSION: Despite the prohibition of substitution therapy and demonization of methadone, the drug has emerged to rival heroin as the most commonly available opioid in St. Petersburg. Ironically, its use is associated with reduced injection-related HIV risk even when its use is illegal.
Authors: Sarah K Calabrese; Sara E Burke; John F Dovidio; Olga S Levina; Anneli Uusküla; Linda M Niccolai; Robert Heimer Journal: AIDS Behav Date: 2016-01
Authors: Alla V Shaboltas; Olga V Toussova; Irving F Hoffman; Robert Heimer; Sergei V Verevochkin; Robert W Ryder; Kaveh Khoshnood; Tom Perdue; Benoit R Masse; Andrei P Kozlov Journal: J Acquir Immune Defic Syndr Date: 2006-04-15 Impact factor: 3.731
Authors: Javier A Cepeda; Linda M Niccolai; Alexandra Lyubimova; Trace Kershaw; Olga Levina; Robert Heimer Journal: Drug Alcohol Depend Date: 2014-12-02 Impact factor: 4.492
Authors: Elijah Paintsil; Sergei V Verevochkin; Elena Dukhovlinova; Linda Niccolai; Russell Barbour; Edward White; Olga V Toussova; Louis Alexander; Andrei P Kozlov; Robert Heimer Journal: Addiction Date: 2009-08-27 Impact factor: 6.526
Authors: D S Metzger; G E Woody; A T McLellan; C P O'Brien; P Druley; H Navaline; D DePhilippis; P Stolley; E Abrutyn Journal: J Acquir Immune Defic Syndr (1988) Date: 1993-09
Authors: Ksenia Eritsyan; Robert Heimer; Russell Barbour; Veronika Odinokova; Edward White; Maia M Rusakova; Tatiana T Smolskaya; Olga S Levina Journal: BMJ Open Date: 2013-06-20 Impact factor: 2.692
Authors: Linda M Niccolai; Sergei V Verevochkin; Olga V Toussova; Edward White; Russell Barbour; Andrei P Kozlov; Robert Heimer Journal: Eur J Public Health Date: 2010-08-26 Impact factor: 3.367
Authors: Peter Meylakhs; Samuel R Friedman; Anastasia Meylakhs; Pedro Mateu-Gelabert; Danielle C Ompad; Alisa Alieva; Alexandra Dmitrieva Journal: AIDS Behav Date: 2019-12