injection drug users’ knowledge about overdose prevention and take home naloxone in ukraine. icf...

Injection drug users’ knowledge about overdose prevention and take home

Naloxone in Ukraine.ICF 'International HIV/AIDS Alliance in Ukraine

Liudmyla Shulga

Anna Tokar

Presentation outline

• Reasons for paying attention to OD – Ukrainian context

• Data available

• Challenges and solutions

Background2008• Literature review on OD scale and use of Naloxone.• First training on OD prevention and Naloxone use. No systemic work on

organizational level.

2009• Start of OD prevention programs with take home Naloxone in 37 NGOs

– Training on programme implementation for social workers– Evaluation of Naloxone use efficacy

• During 12 months 500 ampoules of Naloxone distributed.

2010• 81 Alliance-Ukraine supported organizations implement OD prevention• 57 of them buy Naloxone (15 948 ampoules).

Addressing concerns

• Behavioral surveys (2007, 2009): 11-14%

• Peer Driven Intervention: 30-33%

• Survey, 2010: 49 (F) - 53 (M)%

Survey, 2010

• Location: 15 cities

• Sample size: 2821 IDUs (72% M, 28% F), aged 17 - 58 y.o.

• Recruited by word of mouth

• Interviewer-assisted questionnaires

Respondent Characteristics

17-24 25-30 31-35 36-580

5

10

15

20

25

30

35

15

29

24

30

17

34

20

27

male

female

OD cases

1 time 2 times 3-5 times 6 times and more Do not remember0

10

20

30

40

50

60

70

80

OD cases ever during lifetime (N=1461)

OD cases during last 6 months (N=391)

During Naloxone refill: which drugs did you use at last OD?

ATS+O

Benzo

s + O

+Met

hado

n

O+alcoh

ol O

ATS + a

lohol

Bupre

norp

hine

alcoh

ol

benz

oATS

met

hado

not

her

0

10

20

30

40

50

60

70

8079 78 77 77

18

23

1814

12

2 2

Series1

Challenges “behind the curtains”

• Naloxone is a prescription drug which makes its distribution more expensive and not anonymous.

• Absence of official statistic on OD prevalence and prevalence of OD-induced deaths.

• Death certificates contain information about “poisoning” without specification. This happens due to lack of equipment the cost of which is not affordable for the state.

• Naloxone is used as a method of IDUs control.

Instruction for naloxone use from the Ministry of Health documents

Alarming Issues

• Although there is educational programme on OD, absence of naloxone makes it less effective.

When observing OD in someone what did you do?

calle

d am

bulan

ce

took

to h

ospit

al

resc

ue b

reat

hing

reco

very

pos

ition

phys

ical p

ain

tried

to a

wake

injec

ted

stim

ulant

s

used

Nalo

xone

0

10

20

30

40

50

60

70

80

90

100

35

10

43

53

60 58

11

5

65

90

57

47

40 42

89

95

Yes

No

Alarming Issues: not calling ambulance

• 65% didn’t even try to cal an ambulance• Out of those who called the ambulance, it

arrived in 95% of cases

Common reasons:• fear of police: 35% - 67%• Fear of dealing with medical staff: 26% - 35%• Believed in being able to cope on their own: 42%

- 57%

Acknowledgement

• Anna Tokar, MSc

• Maryna Varban, PhD

• Ukrainian organizations that took part in the survey with no extra funding.