‘South Asian cocktail’ - the concurrent use of opioids, benzodiazepines and antihistamines among injecting drug users in Nepal and associations with HIV risk behaviour
Tóm tắt
Data of the Central Bureau of Statistic of Nepal from 2008 show a total of more than 46,000 illegal drug users, out of which 61% are injecting drug users (IDU). An injecting mix of medicines like opioids, benzodiazepines and antihistamines (the so-called South Asian cocktail) was prevalent. Furthermore, it is estimated that about 70,000 people are living with human immunodeficiency virus (HIV). The government of Nepal has started realizing and recognizing drug use and HIV as significant health and social issues. Harm reduction programs such as needle syringe exchange and opioid substitution treatment are being implemented. The aim of this study is to obtain specific knowledge on the drug use behaviour and the health status of drug users with a focus on HIV in drug users with concurrent injection of opioids, benzodiazepines and antihistamines. After an initial mapping of Kathmandu Valley, 300 drug users in contact with different treatment and counselling centres were randomly chosen for the interviews. The research questionnaire was designed according to the European Addiction Severity Index (EuropASI) and Maudsley Addiction Profile standards. Ninety-one percent of the respondents are male and 9% female. Mean age is 28.7 years. Ninety-five percent are injecting drug users with a mean of 8.7 years of drug use history. Eighty-six percent are injecting different ‘cocktails’, usually made of buprenorphine, diazepam, promethazine and/or other substances (30-day prevalence). Similarly, 48% use heroin, whereas only 2% take cocaine/crack. Among those tested for HIV (N = 223), 33% are positive (25% of the sample population). Compared to the other drug users (mainly heroin), the cocktail users show a higher HIV infection rate and more co-infections. Furthermore, risk behaviour, as e.g. needle sharing, is much more common among the cocktail users. Currently, the mixture of medicines, opioids, benzodiazepines and antihistamines, is the predominant drug in Nepal; the pharmaceutical drugs needed to prepare the cocktail are less expensive than heroin and relatively easy to acquire. The cocktail users show a higher risk behaviour regarding the transmission of HIV than heroin drug users. It needs to be considered which HIV prevention measures are necessary to target the specific needs of drug users who inject a mixture of opioids, benzodiazepines and antihistamines, since the available services (such as needle syringe exchange) do not seem to cover their specific needs (high percentage of needle sharing).
Tài liệu tham khảo
NCASC and ASHA Project: Integrated Biological and Behavioral Surveillance (IBBS) Survey Among Injecting Drug Users in Kathmandu Valley, Nepal. Round V -. 2011
Metzger DS, Woody GE, O'Brian CP: Drug treatment as HIV prevention: a research update. J Acquir Immune Defic Syndr. 2010, 55 (Suppl 1): S32-S36.
Vlahov D, Robertson AM, Strathdee SA: Prevention of HIV infection among injection drug users in resource-limited settings. Clin Infect Dis. 2010, 50 (Suppl 3): S114-S121.
World Health Organization (WHO), Regional Office for South-East Asia: Report on People Who Inject Drugs in the South-East Asia Region. 2010
Central Bureau of Statistics (CBS): Summary Report of the Survey on Hard Drug Users in Nepal – 2063. 2008, Government of Nepal. National Planning Commission Secretariat,http://cbs.gov.np/?p=174,
WHO, UNAIDS, UNICEF: Epidemiological Fact Sheet on HIV and AIDS: Nepal, 2008 update. 2008, Geneva: UNAIDS/WHO Working Group on Global HIV/AIDS and STI
NCASC: Factsheet N°6: HIV Surveillance in Nepal 2009. 2009, Teku, Kathmandu: National Centre for AIDS and STD Control
Recovering Nepal: New Insights into the Drug and Drug Service Situation in Nepal. Summary from a Needs Assessment Study. 2009
Larance B, Ambekar A, Azim T, Murthy P, Panda S, Degenhardt L, Marthers B: The availability, diversion and injection of pharmaceutical opioids in South Asia. Drug Alcohol Rev. 2011, 30: 246-254. 10.1111/j.1465-3362.2011.00304.x.
Basu D, Aggarwal M, Pratim Das P, Mattoo SK, Kulhara P, Varma VK: Changing pattern of substance abuse in patients attending a de-addiction centre in North India (1978–2008). Indian J Med Res. 2012, 135: 830-836.
Ambekar A, Rao R, Pun A, Kumar S, Kishore K: The trajectory of methadone maintenance treatment in Nepal. Int J Drug Policy. 2013, 24 (6): e57-e60. 10.1016/j.drugpo.2013.06.001.
Kokkevi A, Hartgers C: EuropASI: European adaptation of a multidimensional assessment instrument for drug and alcohol dependence. Eur Addict Res. 1995, 1: 208-210. 10.1159/000259089.
Marsden J, Gossop M, Stewart D, Best D, Farrell M, Lehmann P, Edwards C, Strang J: The Maudsley addiction profile (MAP): a brief instrument for assessing treatment outcome. Addiction. 1998, 93: 1857-1867. 10.1046/j.1360-0443.1998.9312185711.x.
SPSS Inc: IBM SPSS Statistics 19. Core System Manual. 2010
Mathers BM, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, Myers B, Ambekar A, Strathdee SA: HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet. 2010, 375: 1014-1028. 10.1016/S0140-6736(10)60232-2.