A qualitative study of diphenhydramine injection in Kyrgyz prisons and implications for harm reduction

Abstract

Background To reduce opioid dependence and HIV transmission, Kyrgyzstan has introduced methadone maintenance therapy and needle/syringe programs into prisons. Illicit injection of diphenhydramine, an antihistamine branded as Dimedrol®, has been anecdotally reported as a potential challenge to harm reduction efforts in prisons but has not been studied systematically. Methods We conducted qualitative interviews in Kyrgyz or Russian with prisoners (n = 49), former prisoners (n = 19), and stakeholders (n = 18), including prison administrators and prisoner advocates near Bishkek, Kyrgyzstan from October 2016 to September 2018. Interviews explored social–contextual factors influencing methadone utilization in prisons. Transcripts were coded by five researchers using content analysis. Dimedrol injection emerged as an important topic, prompting a dedicated analysis. Results After drinking methadone, some people in prison inject crushed Dimedrol tablets, a non-prescription antihistamine that is banned but obtainable in prison, to achieve a state of euphoria. From the perspectives of the study participants, Dimedrol injection was associated with devastating physical and mental health consequences, including psychosis and skin infections. Moreover, the visible wounds of Dimedrol injecting contributed to the perception of methadone as a harmful drug and supporting preference for heroin over methadone. Conclusion Dimedrol injecting is a potentially serious threat to harm reduction and HIV prevention efforts in Kyrgyzstan and elsewhere in the Eastern European and Central Asian region and requires further investigation.

Cohort profile: the Kyrgyzstan InterSectional Stigma (KISS) injection drug use cohort study

“…Poly-drug use reflects the number of drug types injected in the past 6 months. This includes injection of diphenhydramine an antihistamine akin to Benadryl frequently used in the region [ 35 ]. Notably, salt use (i.e., bath salts) was added to the baseline and follow-up surveys beginning July 6, 2021 following observations by outreach workers that more clients were reporting salt use.…”

Implementation opportunities for scaling up methadone maintenance treatment in Kyrgyzstan: Methadone dosage and retention on treatment over two years

“…During the study period, opioids are the primary drug injected. Recent data from prisons, however, suggest increasing levels of diphenhydramine injection among those on MMT and since the COVID-19 pandemic, opioid access has decreased with new introduction of stimulants in the community ( Meyer et al, 2020 ). Methadone census increased from 729 in 2008 to 1200 in 2017 ( Subata et al, 2016 ); it has since declined due to increasing dropout and a sluggish enrollment of new patients ( Michels et al, 2021 ).…”

Interest without uptake: A mixed-methods analysis of methadone utilization in Kyrgyz prisons

“…This study began in October 2016 and remains ongoing in nine prisons in the Kyrgyz Republic. Methods for recruitment have been previously described [ 13 ]; ClinicalTrials.gov Identifier for Project MATLINK is NCT04947475. The study used a screening, brief intervention, and referral to treatment (SBIRT) strategy.…”

“…The initial coding of these interviews is discussed in a previous paper [ 13 ]. For the present paper, the authors used thematic analysis based on risk environment theory to sub-code the data, looking for factors relevant to methadone uptake and utilization before and after release from prison.…”