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In this document we present a number of Lessons Learned in the NPSinEurope.eu project and formula... more In this document we present a number of Lessons Learned in the NPSinEurope.eu project and formulate recommendations for future drug policy and drug service development in Europe. NPSinEurope.eu or "New Psychoactive Substances among People Who Use Drugs Heavily. Towards Effective and Comprehensive Health Responses in Europe" was funded by the European Union.
Until 1995 central and eastern Europe as well as the Asian republics of the former Soviet Union h... more Until 1995 central and eastern Europe as well as the Asian republics of the former Soviet Union have been more-or-less devoid of epidemic outbreaks of HIV infection. In this region with more than 450 million inhabitants (United Nations 1997), the total number of HIV infections was estimated lower than 30.000 (WHO 1995; UNAIDS 1996). Most of these infections resulted from sexual and nosocomial transmission. In 1995 this epidemiologically soporific picture started changing drastically in two ways. Firstly, reports on rapid HIV outbreaks in various parts of the former Soviet Union started to surface, and, secondly, these new infections were almost exclusively associated with another major public health crisis that until then had gone largely unnoticed: the rapid diffusion of drug injecting. Indeed, the social networks of drug injectors have provided an almost custom-tailored infrastructure for the virus to spread through the former Soviet Union and most HIV cases are reportedly related...
BACKGROUND: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central... more BACKGROUND: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformationhad significant consequences for drug policies in the region. A large number of the emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable,and closelyassociated with political decisions and insufficient institution building. A sharp distinction is made between health and social services, often without regard to client input.The main objectiveof the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution buildingwhich represents a major threatto the future of HR services in the region. METHODS: Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body ...
International Journal of Drug Policy, 2018
BACKGROUND Gamma-hydroxybutyrate (GHB) overdose is an important concern in the Netherlands and Fl... more BACKGROUND Gamma-hydroxybutyrate (GHB) overdose is an important concern in the Netherlands and Flanders, Belgium and accounts for most overdoses reported by emergency services. Few stu dies have focused on GHB overdose. Appropriate public health responses have yet to be developed. We report an explorative survey of people who use GHB and their experience with GHB overdose, aiming to identify risk and protective factors associated with comatose intoxication after GHB ingestion. METHODS We conducted a cross-sectional survey of GHB consumers from different GHB consumption contexts. Between May and October 2014, 146 respondents were recruited in both the urban Randstad and in smaller towns in the Netherlands and Flanders, using a variety of sampling methods. Descriptive statistics were used to describe demographic, social economic, drug use, environmental variables and the experience of overdose and GHB induced coma in the resulting convenience sample. Multivariate CHAID (Chi-quadrat automatic interaction detector) was used in exploring interactions with overdose. RESULTS All study respondents were poly drug consumers. We identified several factors associated with coma. The strongest relationship was found between coma and the lifetime number of GHB consumption episodes. Using alone, the number of doses per consumption episode (stacking) and the living region were strongly associated with GHB overdose as well. In the Netherlands, heavy, high risk GHB consumption is primarily found among poorly educated young adolescents in economically less privileged provincial communities. CONCLUSIONS We found extremely high rates of comatose intoxication after GHB use and the strongest association with GHB overdose concerned the lifetime number of GHB consumption episodes. Poly-drug consumption appears to be the norm in our entire sample, but does not necessarily distinguish heavy or high risk consumption from more recreational use. Using in the company of friends may offer some level of protection against GHB overdose. Overdose prevention, stabilizing heavy and harmful drug consumption patterns and reducing the harms associated therewith should become an important priority in the Dutch response to GHB.
Globally, young people under 25 accounted for an estimated 45% of all new HIV infections in 2007.... more Globally, young people under 25 accounted for an estimated 45% of all new HIV infections in 2007. Across the Eastern Europe and Central Asia region as many as 25% of injecting drug users (IDUs) are younger than 20. The Eurasian Harm Reduction assessment of young peoples' (under 25) drug use, risk behaviours and service availability and accessibility confirms, young people at risk of injecting, or those already experimenting with injecting drugs, find themselves isolated from health and prevention services, which increases the risks for health and social harms, while the approach towards young peoples' use rely heavily on law enforcement. Denying young drug users' access to life-saving drug treatment and other harm reduction services contributes to the risk environment surrounding their use and violates their right to health and well-being as identified in the Convention on the Rights of the Child. Governments, health care providers and harm reduction services should work together to create an environment in which young people can access needed services, including non-judgmental and low-threshold approaches offered by harm reduction programs.
Harm Reduction Journal, 2016
Several home-produced substances such as krokodil and boltushka are prevalent in many Eastern Eur... more Several home-produced substances such as krokodil and boltushka are prevalent in many Eastern European countries. Anecdotal reports of its use have been circulating in Germany and Norway; however, this has not been confirmed. Its use has also been reported by the media in the USA, although only one confirmed report of its use exists. Home-produced drugs are associated with high levels of morbidity and a number of complex health issues such as the spread of blood borne viruses, gangrene, and internal organ damage. The high incidence of HIV rates amongst people who inject home-produced substances is a public health concern. The resulting physical health consequences of injecting these crude substances are very severe in comparison to heroin or amphetamine acquired in black markets. Due to this fact and the increased mortality associated with these substances, professionals in the area of prevention, treatment, and policy development need to be cognisant of the presentation, harms, and the dangers associated with home-produced substances globally. This scoping review aimed to examine existing literature on the subject of home-produced heroin and amphetamine-type stimulant substitutes. The review discussed the many implications such research may have in the areas of policy and practice. Data were gathered through the use of qualitative secondary resources such as journal articles, reports, reviews, case studies, and media reports. The home production of these substances relies on the utilisation of precursor drugs such as less potent stimulants, tranquillizers, analgesics, and sedatives or natural plant ingredients. The Internet underpins the facilitation of this practice as recipes, and diverted pharmaceutical sales are available widely online, and currently, ease of access to the Internet is evident worldwide. This review highlights the necessity of prevention, education, and also harm reduction related to home-produced drugs and also recommends consistent monitoring of online drug fora, online drug marketplaces, and unregulated pharmacies.
EXECUTIVE SUMMARY This report presents the result of a pilot study on the use of drugs among the ... more EXECUTIVE SUMMARY This report presents the result of a pilot study on the use of drugs among the Roma minority of Central and Eastern Europe. It includes the results from a semi-structured Internet-based survey and an in-depth interview study, both with experts and key informers The former was distributed throughout the entire region, including the former Soviet Union, the latter was conducted in the Czech and Slovak Republics and Hungary. At this point we shortly summarize the study fi ndings. If this executive summary stirs the reader into further reading, chapter eight provides a more elaborate summary of the report, a discussion of the fi ndings and a set of recommendations. 1. DRUG USE IN ROMA COMMUNITIES IS NOT MERELY AN ISOLATED OR LOCALIZED PHENOMENON. ▪ In many parts of the region a substantial proportion of the Roma community is involved in drug injecting. ▪ While the rates of injection drug use in the studied cities across the region equal or greatly exceed those known in...
The International journal on drug policy, 2014
Nederlands tijdschrift voor geneeskunde, Jan 29, 1989
International Journal of Drug Policy, 2015
Forensic Science International, 2015
is the street name for the homemade injectable mixture that has been used as a cheap substitute f... more is the street name for the homemade injectable mixture that has been used as a cheap substitute for heroin. Its use begun in Russia and Ukraine and nowadays is being spread over several other countries. Desomorphine is the semi-synthetic opioid claimed to be the main component of krokodil and considered to be responsible for its psychoactive characteristics. The starting materials for desomorphine synthesis are codeine tablets, alkali solutions, organic solvent, acidified water, iodine and red phosphorus, all of which are easily available in retail outlets, such as supermarkets, drugstores, etc. The resulting product is a light brown liquid that is called krokodil. People who inject krokodil present a great variety of serious signs and symptoms, including thrombophlebitis, ulcerations, gangrene, and necrosis, quickly evolving to limb amputation and death. These effects are thought to result from the toxic components produced as byproducts during the homemade drug synthesis. In this work, we reviewed several aspects of krokodil use, including its epidemiology, pharmacology and the chemical properties of the main active ingredient (desomorphine). To enhance our understanding of the clinical and toxic effects and to support the implementation of harm reduction measures, we also describe the ''bathtub chemistry'' of krokodil and the content of the final solution.
In this document we present a number of Lessons Learned in the NPSinEurope.eu project and formula... more In this document we present a number of Lessons Learned in the NPSinEurope.eu project and formulate recommendations for future drug policy and drug service development in Europe. NPSinEurope.eu or "New Psychoactive Substances among People Who Use Drugs Heavily. Towards Effective and Comprehensive Health Responses in Europe" was funded by the European Union.
Until 1995 central and eastern Europe as well as the Asian republics of the former Soviet Union h... more Until 1995 central and eastern Europe as well as the Asian republics of the former Soviet Union have been more-or-less devoid of epidemic outbreaks of HIV infection. In this region with more than 450 million inhabitants (United Nations 1997), the total number of HIV infections was estimated lower than 30.000 (WHO 1995; UNAIDS 1996). Most of these infections resulted from sexual and nosocomial transmission. In 1995 this epidemiologically soporific picture started changing drastically in two ways. Firstly, reports on rapid HIV outbreaks in various parts of the former Soviet Union started to surface, and, secondly, these new infections were almost exclusively associated with another major public health crisis that until then had gone largely unnoticed: the rapid diffusion of drug injecting. Indeed, the social networks of drug injectors have provided an almost custom-tailored infrastructure for the virus to spread through the former Soviet Union and most HIV cases are reportedly related...
BACKGROUND: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central... more BACKGROUND: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformationhad significant consequences for drug policies in the region. A large number of the emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable,and closelyassociated with political decisions and insufficient institution building. A sharp distinction is made between health and social services, often without regard to client input.The main objectiveof the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution buildingwhich represents a major threatto the future of HR services in the region. METHODS: Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body ...
International Journal of Drug Policy, 2018
BACKGROUND Gamma-hydroxybutyrate (GHB) overdose is an important concern in the Netherlands and Fl... more BACKGROUND Gamma-hydroxybutyrate (GHB) overdose is an important concern in the Netherlands and Flanders, Belgium and accounts for most overdoses reported by emergency services. Few stu dies have focused on GHB overdose. Appropriate public health responses have yet to be developed. We report an explorative survey of people who use GHB and their experience with GHB overdose, aiming to identify risk and protective factors associated with comatose intoxication after GHB ingestion. METHODS We conducted a cross-sectional survey of GHB consumers from different GHB consumption contexts. Between May and October 2014, 146 respondents were recruited in both the urban Randstad and in smaller towns in the Netherlands and Flanders, using a variety of sampling methods. Descriptive statistics were used to describe demographic, social economic, drug use, environmental variables and the experience of overdose and GHB induced coma in the resulting convenience sample. Multivariate CHAID (Chi-quadrat automatic interaction detector) was used in exploring interactions with overdose. RESULTS All study respondents were poly drug consumers. We identified several factors associated with coma. The strongest relationship was found between coma and the lifetime number of GHB consumption episodes. Using alone, the number of doses per consumption episode (stacking) and the living region were strongly associated with GHB overdose as well. In the Netherlands, heavy, high risk GHB consumption is primarily found among poorly educated young adolescents in economically less privileged provincial communities. CONCLUSIONS We found extremely high rates of comatose intoxication after GHB use and the strongest association with GHB overdose concerned the lifetime number of GHB consumption episodes. Poly-drug consumption appears to be the norm in our entire sample, but does not necessarily distinguish heavy or high risk consumption from more recreational use. Using in the company of friends may offer some level of protection against GHB overdose. Overdose prevention, stabilizing heavy and harmful drug consumption patterns and reducing the harms associated therewith should become an important priority in the Dutch response to GHB.
Globally, young people under 25 accounted for an estimated 45% of all new HIV infections in 2007.... more Globally, young people under 25 accounted for an estimated 45% of all new HIV infections in 2007. Across the Eastern Europe and Central Asia region as many as 25% of injecting drug users (IDUs) are younger than 20. The Eurasian Harm Reduction assessment of young peoples' (under 25) drug use, risk behaviours and service availability and accessibility confirms, young people at risk of injecting, or those already experimenting with injecting drugs, find themselves isolated from health and prevention services, which increases the risks for health and social harms, while the approach towards young peoples' use rely heavily on law enforcement. Denying young drug users' access to life-saving drug treatment and other harm reduction services contributes to the risk environment surrounding their use and violates their right to health and well-being as identified in the Convention on the Rights of the Child. Governments, health care providers and harm reduction services should work together to create an environment in which young people can access needed services, including non-judgmental and low-threshold approaches offered by harm reduction programs.
Harm Reduction Journal, 2016
Several home-produced substances such as krokodil and boltushka are prevalent in many Eastern Eur... more Several home-produced substances such as krokodil and boltushka are prevalent in many Eastern European countries. Anecdotal reports of its use have been circulating in Germany and Norway; however, this has not been confirmed. Its use has also been reported by the media in the USA, although only one confirmed report of its use exists. Home-produced drugs are associated with high levels of morbidity and a number of complex health issues such as the spread of blood borne viruses, gangrene, and internal organ damage. The high incidence of HIV rates amongst people who inject home-produced substances is a public health concern. The resulting physical health consequences of injecting these crude substances are very severe in comparison to heroin or amphetamine acquired in black markets. Due to this fact and the increased mortality associated with these substances, professionals in the area of prevention, treatment, and policy development need to be cognisant of the presentation, harms, and the dangers associated with home-produced substances globally. This scoping review aimed to examine existing literature on the subject of home-produced heroin and amphetamine-type stimulant substitutes. The review discussed the many implications such research may have in the areas of policy and practice. Data were gathered through the use of qualitative secondary resources such as journal articles, reports, reviews, case studies, and media reports. The home production of these substances relies on the utilisation of precursor drugs such as less potent stimulants, tranquillizers, analgesics, and sedatives or natural plant ingredients. The Internet underpins the facilitation of this practice as recipes, and diverted pharmaceutical sales are available widely online, and currently, ease of access to the Internet is evident worldwide. This review highlights the necessity of prevention, education, and also harm reduction related to home-produced drugs and also recommends consistent monitoring of online drug fora, online drug marketplaces, and unregulated pharmacies.
EXECUTIVE SUMMARY This report presents the result of a pilot study on the use of drugs among the ... more EXECUTIVE SUMMARY This report presents the result of a pilot study on the use of drugs among the Roma minority of Central and Eastern Europe. It includes the results from a semi-structured Internet-based survey and an in-depth interview study, both with experts and key informers The former was distributed throughout the entire region, including the former Soviet Union, the latter was conducted in the Czech and Slovak Republics and Hungary. At this point we shortly summarize the study fi ndings. If this executive summary stirs the reader into further reading, chapter eight provides a more elaborate summary of the report, a discussion of the fi ndings and a set of recommendations. 1. DRUG USE IN ROMA COMMUNITIES IS NOT MERELY AN ISOLATED OR LOCALIZED PHENOMENON. ▪ In many parts of the region a substantial proportion of the Roma community is involved in drug injecting. ▪ While the rates of injection drug use in the studied cities across the region equal or greatly exceed those known in...
The International journal on drug policy, 2014
Nederlands tijdschrift voor geneeskunde, Jan 29, 1989
International Journal of Drug Policy, 2015
Forensic Science International, 2015
is the street name for the homemade injectable mixture that has been used as a cheap substitute f... more is the street name for the homemade injectable mixture that has been used as a cheap substitute for heroin. Its use begun in Russia and Ukraine and nowadays is being spread over several other countries. Desomorphine is the semi-synthetic opioid claimed to be the main component of krokodil and considered to be responsible for its psychoactive characteristics. The starting materials for desomorphine synthesis are codeine tablets, alkali solutions, organic solvent, acidified water, iodine and red phosphorus, all of which are easily available in retail outlets, such as supermarkets, drugstores, etc. The resulting product is a light brown liquid that is called krokodil. People who inject krokodil present a great variety of serious signs and symptoms, including thrombophlebitis, ulcerations, gangrene, and necrosis, quickly evolving to limb amputation and death. These effects are thought to result from the toxic components produced as byproducts during the homemade drug synthesis. In this work, we reviewed several aspects of krokodil use, including its epidemiology, pharmacology and the chemical properties of the main active ingredient (desomorphine). To enhance our understanding of the clinical and toxic effects and to support the implementation of harm reduction measures, we also describe the ''bathtub chemistry'' of krokodil and the content of the final solution.