Skip to main content
Top
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Non-fatal overdoses and related risk factors among people who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia

Authors: Anneli Uusküla, Mait Raag, Sigrid Vorobjov, Kristi Rüütel, Alexandra Lyubimova, Olga S. Levina, Robert Heimer

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

This study seeks to identify the prevalence of, and risk factors associated with, non-fatal overdose among people currently injecting drugs (PWID) in St. Petersburg (Russia) and in Kohtla-Järve (Estonia).

Methods

Five hundred eighty-eight study participants in Kohtla-Järve (in 2012) and 811 in St. Petersburg (in 2012–2013) were recruited using respondent driven sampling for interviewing and HIV testing.

Results

Three-quarters (76 %) of the current PWID were male. Participants from St. Petersburg were older (mean age 32.1 vs. 29.6 years, p < 0.0001) and reported a longer average duration of injecting drugs (mean duration: 13.3 vs. 10.9 years, p < 0.0001). Main drugs injected were opioids (fentanyl in Kohtla-Järve, heroin in St Petersburg). HIV prevalence was 63 % (95 % CI 59–67 %) in Kohtla-Järve and 56 % (95 % CI 52–59 %) in St. Petersburg. Two thirds of the PWID in Kohtla-Järve and St. Petersburg reported ever having experienced a drug overdose involving loss of consciousness or stopping breathing. In Kohtla-Järve, 28 % (95 % CI 24–31 %) of participants and, in St Petersburg, 16 % (95 % CI 14–19 %) of participants reported an overdose within the previous 12 months. Characteristics of injection drug use practice (longer duration of injection drug use, main drug injected), correlates of high-risk injection behaviour (higher injecting frequency, sharing), and problem alcohol use were associated with the risk of overdose within the previous 12 months. The significant factors effects did not differ between the sites.

Conclusions

PWID are at high risk for overdose. Effective overdose prevention efforts at the public health scale are therefore warranted.
Literature
1.
go back to reference Mathers BM, Degenhardt L, Bucello C, Lemon J, Wiessing L, Hickman M. Mortality among people who inject drugs: a systematic review and meta-analysis. Bull World Health Organ. 2013;91(2):102–23.CrossRefPubMedPubMedCentral Mathers BM, Degenhardt L, Bucello C, Lemon J, Wiessing L, Hickman M. Mortality among people who inject drugs: a systematic review and meta-analysis. Bull World Health Organ. 2013;91(2):102–23.CrossRefPubMedPubMedCentral
2.
go back to reference Green TC, McGowan SK, Yokell MA, Pouget ER, Rich JD. HIV infection and risk of overdose: a systematic review and meta-analysis. AIDS. 2012;26(4):403–17.CrossRefPubMedPubMedCentral Green TC, McGowan SK, Yokell MA, Pouget ER, Rich JD. HIV infection and risk of overdose: a systematic review and meta-analysis. AIDS. 2012;26(4):403–17.CrossRefPubMedPubMedCentral
3.
go back to reference Darke S, Mattick R, Degenhardt L. The ratio of non-fatal to fatal heroin overdose. Addiction. 2003;98:1169–72.CrossRefPubMed Darke S, Mattick R, Degenhardt L. The ratio of non-fatal to fatal heroin overdose. Addiction. 2003;98:1169–72.CrossRefPubMed
4.
go back to reference Warner-Smith M, Darke S, Lynskey M, Hall W. Heroin overdose: causes and consequences’. Addiction. 2001;96:1113–25.CrossRefPubMed Warner-Smith M, Darke S, Lynskey M, Hall W. Heroin overdose: causes and consequences’. Addiction. 2001;96:1113–25.CrossRefPubMed
5.
go back to reference Kerr T, Fairbairn N, Tyndall M, Marsh D, Li K, Montaner J, et al. Predictors of non fatal overdose among a kohort of polysubstance-using injection drug users. Drug Alcohol Depend. 2007;87:39–45.CrossRefPubMed Kerr T, Fairbairn N, Tyndall M, Marsh D, Li K, Montaner J, et al. Predictors of non fatal overdose among a kohort of polysubstance-using injection drug users. Drug Alcohol Depend. 2007;87:39–45.CrossRefPubMed
6.
go back to reference Stoové MA, Dietze PM, Jolley D. Overdose deaths following previous non-fatal heroin overdose: record linkage of ambulance attendance and death registry data. Drug Alcohol Rev. 2009;28(4):347–52.CrossRefPubMed Stoové MA, Dietze PM, Jolley D. Overdose deaths following previous non-fatal heroin overdose: record linkage of ambulance attendance and death registry data. Drug Alcohol Rev. 2009;28(4):347–52.CrossRefPubMed
7.
go back to reference Bartu A, Freeman NC, Gawthorne GS, Codde JP, Holman DJ. Mortality in a cohort of opiate and amphetamine users in Perth, Western Australia. Addiction. 2004;99:53–60.CrossRefPubMed Bartu A, Freeman NC, Gawthorne GS, Codde JP, Holman DJ. Mortality in a cohort of opiate and amphetamine users in Perth, Western Australia. Addiction. 2004;99:53–60.CrossRefPubMed
8.
go back to reference Gossop M, Stewart D, Treacy S, Marsden J. A prospective study of mortality among drug misusers during a 4-year period after seeking treatment. Addiction. 2002;97:39–47.CrossRefPubMed Gossop M, Stewart D, Treacy S, Marsden J. A prospective study of mortality among drug misusers during a 4-year period after seeking treatment. Addiction. 2002;97:39–47.CrossRefPubMed
9.
go back to reference Engstrom A, Adamsson C, Allbeck P, Rydberg U. Mortality in patients with substance abuse: a follow-up in Stockholm county, 1973–1984. Int J Addict. 1991;26:91–106.CrossRefPubMed Engstrom A, Adamsson C, Allbeck P, Rydberg U. Mortality in patients with substance abuse: a follow-up in Stockholm county, 1973–1984. Int J Addict. 1991;26:91–106.CrossRefPubMed
10.
go back to reference Sanchez-Carbonell X, Seus L. Ten-year survival analysis of a cohort of heroin addicts in Catalonia: the EMETYST project. Addiction. 2000;95:941–8.CrossRefPubMed Sanchez-Carbonell X, Seus L. Ten-year survival analysis of a cohort of heroin addicts in Catalonia: the EMETYST project. Addiction. 2000;95:941–8.CrossRefPubMed
11.
go back to reference Vlahov D, Wang C, Galai N, Bareta J, Mehta SH, Strathdee SA, et al. Mortality risk among new onset injection drug users. Addiction. 2004;99:946–54.CrossRefPubMed Vlahov D, Wang C, Galai N, Bareta J, Mehta SH, Strathdee SA, et al. Mortality risk among new onset injection drug users. Addiction. 2004;99:946–54.CrossRefPubMed
13.
go back to reference Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45.CrossRefPubMed Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45.CrossRefPubMed
14.
go back to reference Coffin P, Tracy M, Bucciarelli A, Ompad D, Vlahov D, Galea S. Identifying injection drug users at risk of nonfatal overdose. Acad Emerg Med. 2007;14:616–23.CrossRefPubMed Coffin P, Tracy M, Bucciarelli A, Ompad D, Vlahov D, Galea S. Identifying injection drug users at risk of nonfatal overdose. Acad Emerg Med. 2007;14:616–23.CrossRefPubMed
15.
go back to reference Grau LE, Green TC, Torban M, Blinnikova K, Krupitsky E, Ilyuk R, et al. Psychosocial and contextual correlates of opioid overdose risk among drug users in St. Petersburg, Russia. Harm Reduction Journal. 2009;6:17.CrossRefPubMedPubMedCentral Grau LE, Green TC, Torban M, Blinnikova K, Krupitsky E, Ilyuk R, et al. Psychosocial and contextual correlates of opioid overdose risk among drug users in St. Petersburg, Russia. Harm Reduction Journal. 2009;6:17.CrossRefPubMedPubMedCentral
16.
go back to reference Sergeev B, Karpets A, Sarang A, Tikhonov M. Prevalence and circumstances of opiate overdose among injection drug users in the Russian Federation. J Urban Health. 2003;80(2):212–9.CrossRefPubMedPubMedCentral Sergeev B, Karpets A, Sarang A, Tikhonov M. Prevalence and circumstances of opiate overdose among injection drug users in the Russian Federation. J Urban Health. 2003;80(2):212–9.CrossRefPubMedPubMedCentral
20.
go back to reference Более 0500 человек погибли от передозировки в 2012 г в Петербурге. РИА Новости [Over 500 persons dead due to an overdose in 2012 in St Petersburg. RIA news] (29 Aug 2013). Available at http://m.ria.ru/spb/20130829/959505439.html (accessed on Aug 14, 2014) Более 0500 человек погибли от передозировки в 2012 г в Петербурге. РИА Новости [Over 500 persons dead due to an overdose in 2012 in St Petersburg. RIA news] (29 Aug 2013). Available at http://​m.​ria.​ru/​spb/​20130829/​959505439.​html (accessed on Aug 14, 2014)
21.
go back to reference Walley AY, Cheng DM, Coleman SM, Krupitsky E, Raj A, Blokhina E, et al. Risk factors for recent nonfatal overdose among HIV-infected Russians who inject drugs. AIDS Care. 2014;26(8):1013–8.CrossRefPubMedPubMedCentral Walley AY, Cheng DM, Coleman SM, Krupitsky E, Raj A, Blokhina E, et al. Risk factors for recent nonfatal overdose among HIV-infected Russians who inject drugs. AIDS Care. 2014;26(8):1013–8.CrossRefPubMedPubMedCentral
23.
go back to reference Uusküla A, Des Jarlais DC, Raag M, Pinkerton SD, Feelemyer J. Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: the case of Tallinn. Estonia AIDS Care. 2015;27(1):105–11.CrossRefPubMed Uusküla A, Des Jarlais DC, Raag M, Pinkerton SD, Feelemyer J. Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: the case of Tallinn. Estonia AIDS Care. 2015;27(1):105–11.CrossRefPubMed
24.
go back to reference Burke SE, Calabrese SK, Dovidio JF, Levina OS, Uusküla A, Niccolai LM, et al. A tale of two cities: stigma and health outcomes among people with HIV who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia. Soc Sci Med. 2015;130:154–61.CrossRefPubMedPubMedCentral Burke SE, Calabrese SK, Dovidio JF, Levina OS, Uusküla A, Niccolai LM, et al. A tale of two cities: stigma and health outcomes among people with HIV who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia. Soc Sci Med. 2015;130:154–61.CrossRefPubMedPubMedCentral
25.
go back to reference Degenhardt L, Mathers BM, Wirtz AL, Wolfe D, Kamarulzaman A, Carrieri MP, et al. What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010-2012? A review of the six highest burden countries. Int J Drug Policy. 2015;25(1):53–60.CrossRef Degenhardt L, Mathers BM, Wirtz AL, Wolfe D, Kamarulzaman A, Carrieri MP, et al. What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010-2012? A review of the six highest burden countries. Int J Drug Policy. 2015;25(1):53–60.CrossRef
26.
go back to reference Mathers BM, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet. 2010;375(9719):1014–28.CrossRefPubMed Mathers BM, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet. 2010;375(9719):1014–28.CrossRefPubMed
27.
go back to reference Eritsyan K, Heimer R, Barbour R, Odinokova V, Whit E, Rusakova MM, et al. Individual-, network-, and city-level factors associated with HIV prevalence among people who inject drugs in eight Russian cities. BMJ Open. 2013;3:6.CrossRef Eritsyan K, Heimer R, Barbour R, Odinokova V, Whit E, Rusakova MM, et al. Individual-, network-, and city-level factors associated with HIV prevalence among people who inject drugs in eight Russian cities. BMJ Open. 2013;3:6.CrossRef
28.
go back to reference Malekinejad M, Johnston LG, Kendall C, Kerr LR, Rifkin MR, Rutherford GW. Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS Behav. 2008;12(4 Suppl):S105–30.CrossRefPubMed Malekinejad M, Johnston LG, Kendall C, Kerr LR, Rifkin MR, Rutherford GW. Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS Behav. 2008;12(4 Suppl):S105–30.CrossRefPubMed
29.
go back to reference Des Jarlais DC, Perlis TE, Stimson GV, Poznyak V, WHO Phase II Drug Injection Collaborative Study Group. Using standardized methods for research on HIV and injecting drug use in developing/transitional countries: case study from the WHO Drug Injection Study Phase II. BMC Public Health. 2006;6:54.CrossRefPubMedPubMedCentral Des Jarlais DC, Perlis TE, Stimson GV, Poznyak V, WHO Phase II Drug Injection Collaborative Study Group. Using standardized methods for research on HIV and injecting drug use in developing/transitional countries: case study from the WHO Drug Injection Study Phase II. BMC Public Health. 2006;6:54.CrossRefPubMedPubMedCentral
30.
go back to reference O’Brien CP. The CAGE questionnaire for detection of alcoholism: a remarkably useful but simple tool. JAMA. 2008;300(17):2054–6.CrossRefPubMed O’Brien CP. The CAGE questionnaire for detection of alcoholism: a remarkably useful but simple tool. JAMA. 2008;300(17):2054–6.CrossRefPubMed
31.
go back to reference Berwick DM, Murphy JM, Goldman PA, Ware Jr JE, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991;29(2):169–76.CrossRefPubMed Berwick DM, Murphy JM, Goldman PA, Ware Jr JE, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991;29(2):169–76.CrossRefPubMed
32.
go back to reference Holmes WC. A short, psychiatric, case-finding measure for HIV seropositive outpatients: performance characteristics of the 5-item mental health subscale of the SF-20 in a male, seropositive sample. Med Care. 1998;36(2):237–43.CrossRefPubMed Holmes WC. A short, psychiatric, case-finding measure for HIV seropositive outpatients: performance characteristics of the 5-item mental health subscale of the SF-20 in a male, seropositive sample. Med Care. 1998;36(2):237–43.CrossRefPubMed
33.
go back to reference Green TC, Grau LE, Heimer R. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose prevention and response programs in the Unites States. Addiction. 2008;103:979–89.CrossRefPubMedPubMedCentral Green TC, Grau LE, Heimer R. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose prevention and response programs in the Unites States. Addiction. 2008;103:979–89.CrossRefPubMedPubMedCentral
34.
go back to reference Tuusov J, Vals K, Tõnisson M, Riikoja A, Denissov G, Väli M. Fatal poisoning in Estonia 2000–2009. Trends in illegal drug-related deaths. J Forensic Leg Med. 2013;20(1):51–6.CrossRefPubMed Tuusov J, Vals K, Tõnisson M, Riikoja A, Denissov G, Väli M. Fatal poisoning in Estonia 2000–2009. Trends in illegal drug-related deaths. J Forensic Leg Med. 2013;20(1):51–6.CrossRefPubMed
36.
go back to reference Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Stat Med. 2002;21:2409–19.CrossRefPubMed Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Stat Med. 2002;21:2409–19.CrossRefPubMed
37.
go back to reference Darke S, Williamson A, Ross J, Mills KL, Havard A, Teesson M. Patterns of nonfatal heroin overdose over a 3-year period: findings from the Australian treatment outcome study. J Urban Health. 2007;84(2):283–91.CrossRefPubMedPubMedCentral Darke S, Williamson A, Ross J, Mills KL, Havard A, Teesson M. Patterns of nonfatal heroin overdose over a 3-year period: findings from the Australian treatment outcome study. J Urban Health. 2007;84(2):283–91.CrossRefPubMedPubMedCentral
38.
go back to reference Frisher M, Baldacchino A, Crome I, Bloor R. Preventing opioid overdoses in Europe: a critical assessment of known risk factors and preventative measures. Lisbon: EMCDDA. Available at www.drugsandalcohol.ie/18701 (accessed on Aug 14, 2014) Frisher M, Baldacchino A, Crome I, Bloor R. Preventing opioid overdoses in Europe: a critical assessment of known risk factors and preventative measures. Lisbon: EMCDDA. Available at www.​drugsandalcohol.​ie/​18701 (accessed on Aug 14, 2014)
39.
go back to reference Yin L, Qin G, Ruan Y, Qian HZ, Hao C, Xie L, et al. Nonfatal overdose among heroin users in southwestern China. Am J Drug Alcohol Abuse. 2007;33(4):505–16.CrossRefPubMed Yin L, Qin G, Ruan Y, Qian HZ, Hao C, Xie L, et al. Nonfatal overdose among heroin users in southwestern China. Am J Drug Alcohol Abuse. 2007;33(4):505–16.CrossRefPubMed
40.
go back to reference Jenkins LM, Banta-Green CJ, Maynard C, Kingston S, Hanrahan M, Merrill JO, et al. Risk factors for nonfatal overdose at Seattle-area syringe exchanges. J Urban Health. 2011;88(1):118–28.CrossRefPubMedPubMedCentral Jenkins LM, Banta-Green CJ, Maynard C, Kingston S, Hanrahan M, Merrill JO, et al. Risk factors for nonfatal overdose at Seattle-area syringe exchanges. J Urban Health. 2011;88(1):118–28.CrossRefPubMedPubMedCentral
42.
go back to reference Ojanperä I, Gergov M, Liiv M, Riikoja A, Vuori E. An epidemic of fatal 3-methylfentanyl poisoning in Estonia. Int J Legal Med. 2008;122(5):395–400.CrossRefPubMed Ojanperä I, Gergov M, Liiv M, Riikoja A, Vuori E. An epidemic of fatal 3-methylfentanyl poisoning in Estonia. Int J Legal Med. 2008;122(5):395–400.CrossRefPubMed
43.
go back to reference Centers for Disease Control and Prevention (CDC). Non pharmaceutical fentanyl related deaths--multiple states, April 2005-March. MMWR. 2007;57(29):793–6. Centers for Disease Control and Prevention (CDC). Non pharmaceutical fentanyl related deaths--multiple states, April 2005-March. MMWR. 2007;57(29):793–6.
44.
go back to reference Mercado-Crespo MC, Sumner SA, Spelke MB, Sugerman DE, Stanley C. Notes from the field: increase in fentanyl-related overdose deaths – Rhode Island, November 2013-March 2014. MMWR. 2014;63(24):531.PubMed Mercado-Crespo MC, Sumner SA, Spelke MB, Sugerman DE, Stanley C. Notes from the field: increase in fentanyl-related overdose deaths – Rhode Island, November 2013-March 2014. MMWR. 2014;63(24):531.PubMed
45.
go back to reference Talu A, Rajaleid K, Abel-Ollo K, Rüütel K, Rahu M, Rhodes T, et al. HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: implications for intervention. Int J Drug Policy. 2010;21(1):56–63.CrossRefPubMed Talu A, Rajaleid K, Abel-Ollo K, Rüütel K, Rahu M, Rhodes T, et al. HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: implications for intervention. Int J Drug Policy. 2010;21(1):56–63.CrossRefPubMed
46.
go back to reference Bell S, Britton A, Kubinova R, Malyutina S, Pajak A, Nikitin Y, et al. Drinking pattern, abstention and problem drinking as risk factors for depressive symptoms: evidence from three urban Eastern European populations. PLoS One. 2014;9(8), e104384.CrossRefPubMedPubMedCentral Bell S, Britton A, Kubinova R, Malyutina S, Pajak A, Nikitin Y, et al. Drinking pattern, abstention and problem drinking as risk factors for depressive symptoms: evidence from three urban Eastern European populations. PLoS One. 2014;9(8), e104384.CrossRefPubMedPubMedCentral
47.
go back to reference Kinner SA, Milloy MJ, Wood E, Qi J, Zhang R, Kerr T. Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users. Addict Behav. 2012;37(6):691–6.CrossRefPubMedPubMedCentral Kinner SA, Milloy MJ, Wood E, Qi J, Zhang R, Kerr T. Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users. Addict Behav. 2012;37(6):691–6.CrossRefPubMedPubMedCentral
48.
go back to reference Bazazi AR, Zelenev A, Fu JJ, Yee I, Kamarulzaman A, Altice FL. High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study. Int J Drug Policy. 2014;pii: S0955-3959(14):00334-X. Bazazi AR, Zelenev A, Fu JJ, Yee I, Kamarulzaman A, Altice FL. High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study. Int J Drug Policy. 2014;pii: S0955-3959(14):00334-X.
Metadata
Title
Non-fatal overdoses and related risk factors among people who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia
Authors
Anneli Uusküla
Mait Raag
Sigrid Vorobjov
Kristi Rüütel
Alexandra Lyubimova
Olga S. Levina
Robert Heimer
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2604-6

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue