Title: Rapid Policy Assessment and Response
1Boltushka 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
2Odessa, 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
3Homemade 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.
4Rapid 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).
5Boltushka 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.
6Demographics of Boltushka users
N
Male 7 70
Female 3 30
Median age in year (range) 21.3 year 19 25 year
7Demographics 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)
8Making 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)
9Availability 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.
10Boltushka 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)
11Boltushka 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)
12Risk 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.
13Police 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)
14Reported 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
15Reported behavioral effects of boltushka use
- High level of activity and energy
- Talkativeness
- Reported loss of appetite for 2-3 days.
16Interventions 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