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Rapid Policy Assessment and Response

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Boltushka is homemade preparation containing methcathinone. ... 1990's: In the effort to control homemade amphetamines, ephedrine was regulated. ... – PowerPoint PPT presentation

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Title: Rapid Policy Assessment and Response


1

Boltushka Use of Homemade Amphetamine in
Odessa, Ukraine
Repsina Chintalova-Dallas 1 Dmitry Lutzenko
2 Zita Lazzarini 1 Patricia Case 3 1
University of Connecticut Health Center, USA
2 Charity Fund The Way Home Odessa,
Ukraine 3 Fenway Community Health Center, USA

NIDA/NIH Grant 5 R01 DA17002-02
2

Odessa, Ukraine
  • Odessa is the third largest city in the Ukraine
    (Pop. 1.1 million)
  • One of the first rapidly escalating HIV
    epidemics in Ukraine and Eastern Europe, most
    cases attributed to injection drug use
  • 7,822 officially registered drug users in
    Odessa
  • Estimated real number ranges from four to five
    times higher (31,288 - 39,110) 1Source S.
    Matic, J. V. Lazarus, M.C. Donoghoe HIV/AIDS in
    Europe Moving from death sentence to chronic
    disease management, WHO/Europe 2006

3
Homemade Amphetamines have a long history in
Eastern Europe
  • 1980s Efforts to control Roma villages
    distributing opium resulted in police raids in
    Ukraine starting in late 1980s. This increased
    the price of opium and caused the shift to
    cheaper amphetamines
  • 1980s Users began making Vint a homemade
    preparation containing methamphetamine and
    obtained via ephedrine reduction
  • 1990s Users began making Boltushka using a less
    complicated process. Boltushka is homemade
    preparation containing methcathinone.
    Pseudoephedrine-containing cold medications
    oxidized with KMnO4 produce Boltushka.
  • 1990s In the effort to control homemade
    amphetamines, ephedrine was regulated. Now drug
    users use cold medications containing PPA and the
    same oxidation process to produce cathinone, a
    weak amphetamine. The drug is still called
    Boltushka or mix.

4
Rapid Policy Assessment and Response (RPAR)
Collect laws and epidemiological criminal
justice statistics
Action Plan
3 focus Groups
Community action change
Analysis
Report
  • Key Informants
  • 24 in system
  • 14 IDUs

Organize CAB
CAB 1
CAB 2
CAB 3
CAB 4
CAB 5
CAB 6
CAB 7
CAB includes participants from law enforcement
(police, judiciary, prisons), public and private
drug treatment providers, health care
(physicians, nurses) and social welfare agencies
(Family Support office).
5
Boltushka Research
  • Methods
  • Ten interviews with young IDUs (who have used
    boltushka once in the last three months and were
    between the ages of 18 to 25)
  • Four interviews with pharmacists
  • Informal interviews with volunteers at NEP,
    doctors at Charity Fund The Way Home and social
    workers.

6
Demographics of Boltushka users
N
Male 7 70
Female 3 30
Median age in year (range) 21.3 year 19 25 year
7
Demographics of Boltushka users
  • Boltushka has become increasingly popular among
    the very young and very poor of the city of
    Odessa in the late 1990s and 2000s 1
  • 1 Ukraine/Odessa/Interviews 1,3,4,5,7,8 with
    IDUs/RPAR Project/January 2006 (UKR/IDU/1,3,4,5,7,
    8)

8
Making boltushka
  • 10 tablets of cold medicine (Teffedrin, Koldack,
    Effect)
  • 10 cc of warm water
  • 1 cc of household vinegar
  • 3 5 g of KMnO4 (potassium permanganate)
  • Shake or mix until the substance smells of
    cherries
  • Sometimes aspirin is used instead of vinegar (or
    both ingredients used in half doses)

9
Availability of Boltushka ingredients in Odessa
  • Ephedrine-containing medicines are only sold with
    the prescription
  • PPA containing medicines are sold
    over-the-counter
  • KMnO4 is only sold openly in one pharmacy in
    Odessa, but is widely available at black market
  • Several pharmacies around the city are doing
    business with drug users
  • Needles and syringes are widely available and are
    inexpensive.

10
Boltushka and its use
  • Cost per dose - ltUS1.00
  • Prepared for personal use only
  • Mainly used by the very young and poor
  • Boltushka is a group drug (usually groups of 3-7
    people)
  • Usually injected 5-6 times a day (some reported
    up to 10 times a day)
  • Some IDUs reported to injecting for 2-3 days
    going without food and sleep
  • Only injected intravenously (most commonly in
    arms and legs)

11
Boltushka and its use
  • needles and syringes are the last thing to worry
    about you need to find money for pills thats
    whats important. In most cases after having gone
    a long way to buy the pills and hurrying back
    home to make boltushka you dont even remember to
    think about syringes. Theres at least one person
    in the group who will have the syringe if you
    dont have yours1.
  • 1 Ukraine/Odessa/Interview 4 with IDU/RPAR
    Project/January 2006 (UKR/IDU/4)

12
Risk of bloodborne disease
  • Common practice of sharing the equipment
  • Currently only 2 IDUs use NEP as needles and
    syringes are available and inexpensive or they
    can borrow from other people in the group
  • 9 IDUs confirmed the practice of front-loading
  • 6 IDUs reported having engaged in an unprotected
    sex following the injection
  • At least one respondent stated that boltushka is
    popular among young and uneducated female
    commercial sex workers to make their work easy
  • IDUs (aged 11-14) pick up needles and syringes on
    streets and use them.

13
Police and boltushka users
  • Police stop boltushka users mainly outside
    pharmacies, but usually they let us go the same
    day because police know they are wasting their
    time on us as most boltushka users are poor and
    have no money for bribes1.
  • IDUs reported police use physical abuse against
    them (most commonly against male IDUs)
  • Pharmacists will help IDUs conceal cold
    medication from police by switching boxes with
    other medications.
  • 1 Ukraine/Odessa/Interview 1 with IDU/RPAR
    Project/January 2006 (UKR/IDU/1)

14
Reported health effects of Boltushka use
  • Early effects (approximately after 1 month of
    use)
  • IDUs report shaking wildly
  • Grinding teeth
  • Abscess and skin burns when injected under the
    skin
  • After continued long use
  • Partial loss of cognitive function
  • Brain damage
  • Parkinsonian symptoms
  • Delayed mental and physical development in
    children age 11-14 who use boltushka

15
Reported behavioral effects of boltushka use
  • High level of activity and energy
  • Talkativeness
  • Reported loss of appetite for 2-3 days.

16
Interventions for Boltushka users
  • Boltushka users are at probable risk of Hepatitis
    C and HIV infection because of shared equipment
    and poor hygiene practices
  • Apparent need for drug treatment resources
    directly addressing the needs of boltushka users
  • Education/treatment specific to boltushka users
  • Screening for other physical harms to document
    the drugs other effects
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