Drug preparation, injection, and sharing practices in Tajikistan: a qualitative study in Kulob and Khorog

Abstract

BackgroundSharing injection equipment remains an important rout of transmission of HIV and HCV infections in the region of Eastern Europe and Central Asia. Tajikistan is one of the most affected countries with high rates of injection drug use and related epidemics.The aim of this qualitative study was to describe drug use practices and related behaviors in two Tajik cities – Kulob and Khorog.MethodsTwelve focus group discussions (6 per city) with 100 people who inject drugs recruited through needle and syringe program (NSP) outreach in May 2014. Topics covered included specific drugs injected, drug prices and purity, access to sterile equipment, safe injection practices and types of syringes and needles used. Qualitative thematic analysis was performed using NVivo 10 software.ResultsAll participants were male and ranged in age from 20 to 78 years. Thematic analysis showed that cheap Afghan heroin, often adulterated by dealers with other admixtures, was the only drug injected. Drug injectors often added Dimedrol (Diphenhydramine) to increase the potency of “low quality” heroin. NSPs were a major source of sterile equipment. Very few participants report direct sharing of needles and syringes. Conversely, many participants reported preparing drugs jointly and sharing injection paraphernalia. Using drugs in an outdoor setting and experiencing withdrawal were major contributors to sharing equipment, using non-sterile water, not boiling and not filtering the drug solution.ConclusionQualitative research can provide insights into risk behaviors that may be missed in quantitative studies. These finding have important implications for planning risk reduction interventions in Tajikistan. Prevention should specifically focus on indirect sharing practices.

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

“…This increased risk among the unstably housed may be a consequence of inability to maintain safe and hygienic injection practices when injecting in public places, where injections may be hurried, with a lack of clean surfaces, poor lighting and difficulties in accessing clean water to use as a drug solvent [11][12][13][14][15]. The use of water from toilets, cisterns, ditches and puddles has been noted [11,[15][16][17][18][19][20][21][22][23], and these sources are likely to be contaminated with particulates and microorganisms. Although few studies have specifically explored the role of water used to prepare injections in relation to SSTI among PWID, there are indications that the use of puddle and toilet water is a risk [20,21].…”

Drug use in business bathrooms: An exploratory study of manager encounters in New York City

“…Public injection has been associated with a variety of health risks and risk behaviours such as syringe sharing, overdose, HIV/HCV/HBV transmission, abscesses, endocarditis, rushed injection and incarceration (Kerr, Fairbairn et al, 2007; Kinner et al, 2012; Koester, Glanz, & Barón, 2005; Leung et al, 2013; Milloy et al, 2008; Otiashvili, Latypov, Kirtadze, Ibragimov, & Zule, 2016; Rhodes et al, 2006; Schoenbaum et al, 1989; Topp et al, 2008; Weeks et al, 2001). And while there are a growing number of syringe exchange programs (SEP) across the US that provide people who inject drugs (PWID) with sterile injecting equipment, they are not authorized to offer a safe and sanitary space for injection.…”

The Misuse and Abuse of Ophthalmic Preparations: a Scoping Review of Clinical Case Presentations and Extant Literature

“…Cognitive impairment and weight loss are common (Bersini et al 2015). IV injections of tropicamide were reported in heroin users to intensify the effect and when self-medicating to delay withdrawals (Spagnolo et al 2013;Bersani et al 2013;Bozkurt et al 2014;Kuliev 2014, 2015;Bersani et al 2015;Otiashvili et al 2016;Ponté et al 2017). These injections are concerning, particularly given the clinical outcomes such as psychosis, dependence, injecting harms, and cardiovascular toxicity Kuliev 2014, 2015).…”

“…Prilutskaya and Kuliev (2015) in their observational study described clinical characteristics of patients (n=118) with poly-drug dependence, which included tropicamide. Otiashvili et al (2016) conducted 12 focus groups with 100 male participants at needle exchanges in Khorog and Kulob, where one participant reported using tropicamide to relieve opiate withdrawals. The first patient case of IV injection was reported in Italy (Spagnolo et al 2013), where a heroin dependent 22-year-old female entered a methadone substitution programme and was admitted with palpitations and visual and auditory hallucinations.…”