Past 12-month nonfatal overdose among people who inject drugs in Ukraine: City-level estimates and risk factors from a cross-sectional study

Alyona Mazhnaya, Renee M. Johnson, Yana Sazonova, Danielle German, Jill Owczarzak

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Nonfatal overdose contributes to high morbidity and is among the strongest proxies for the occurrence of overdose fatality – the leading cause of death among those who use opioids. In Ukraine, a majority of people who inject drugs (PWID) use opioids, but little is known about the relationship between drug market characteristics, nonfatal overdose (NFOD) prevalence, and risk factors for NFOD. Methods: We used cross-sectional respondent-driven sampling (RDS) data to explore the variability of recent (past 12 months) NFOD among PWID across Ukrainian cities and associations with individual factors. The population-averaged -cross-sectional associations were estimated and compared using generalized linear models for the binary outcome (NFOD vs. not) with robust variance estimates. Results: Recent self-reported NFOD varied between 1% and 14 % across Ukrainian cities. In adjusted analyses, overdose was associated with fewer years of injecting drugs; a higher number of types of drugs used in the past 12 months; using desomorphine, methadone, tramadol, heroin, amphetamine-type drugs or cocaine within past 12 months; using alcohol daily or weekly; recent drug treatment; and history of incarceration. Buying drugs or their ingredients through “stashes” (i.e., drugs secretly hidden in various places) and the perception of drug price increase were associated with higher odds of reporting NFOD. Conclusion: The identified risk factors underscore the importance of evidence-based prevention efforts, such as scaling-up opioid agonist therapy, providing naloxone in the community and upon prison release, targeting those most likely to witness overdose and sharing overdose prevention strategies with them, and continuous monitoring of trends and contributing factors.

Original languageEnglish (US)
Article number108513
JournalDrug and alcohol dependence
Volume220
DOIs
StatePublished - Mar 1 2021

Keywords

  • Drug market
  • Nonfatal overdose
  • Opioids
  • PWID
  • Ukraine

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

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