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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.