Overdose: A major preventable cause of death in Eastern Europe and Central Asia Shona Schonning

 Founded in 1997, Secretariat in Vilnius, Lithuania  260 members: GOs, NGOs, drug user organizations  Exchange news, information, skills (over 700 people get listserve)  Generate, identify new knowledge (research)  Build partnerships  Support advocacy initiatives  Provide technical assistance (through the Harm Reduction Knowledge Hub and through the Civil Society Action Team (CSAT) Eurasian Harm Reduction Network (EHRN)

Eurasian Harm Reduction Network PROGRAM AREAS Networking and information work Harm Reduction Knowledge Hub Advocacy and policy work Special programs (including CSAT on GFATM and civil society role) PRIORITY TOPICS drug policy, overdose, opioid substitution therapy, stigma and discrimination

In Western Europe: OD is the number 1 of death of opiate injectors where data is collected systematically OD is the number 2 cause of death of youth in Europe So what’s up in Eastern Europe? Overdose

Countries studied: Latvia, Kyrgystan, Romania, Russia and Tajikistan Information gathered on: Epidemiology Services Knowledge & skills, Local & national policy Overdose in Eastern Europe and Central Asia

Epidemiology Data available was minimal, unreliable and likely to underestimate due to: Poor data collection Limited access to toxicological resources Stigma Concern about police involvement Drug user surveys done in Russia and Latvia provided useful information

Barriers to good data  Not a priority  Not understood as preventable  No responsible agency  Requires medical examiner / forensic infrastructure  Requires identification of overdose as indicator or reportable cause of death  Requires consistent definition of overdose death  Social stigma (+/- registry)  Financial consideration of providers and families

CountryEstimated number of IDU Expected number of ODs Expected number of OD deaths Kyrgystan25, Latvia10, Romania25, Russia355,568*71, (9354 recorded) Tajikistan33,0006, Estimates * Number of officially registered drug users Based on: 20% of IDU experience OD within a year 4 out of 100 OD result in death

Cause of death among people living with AIDS in Russia where over 80% of PLHIV are IDU N.N Ladnaya of the Federal AIDS Center of the Russian Federation made on November 1, 2007

OD death can be reduced! Distributing nalaxone reduces overdose death to drug users (through HR programs and pharmacies) to emergency services (ambulances & hospitals) Access to addiction treatment including OST programs have strong impact Safer injection rooms The good news about OD:

Cost-benefit ~10-20% of naloxone prescriptions are used in overdose X ~4% of opiate overdoses result in death = ~ % of naloxone kits may result in a life saved that would otherwise be lost at a price of $3 per 2 naloxone vials in each kit  $ per life saved (excluding program costs)

Services Hospital-based care was accessible but limited by Distance Ambulance availability Limited nalaxone availability Fear of police Few (but very successful) pilot programs to distribute nalaxone to drug users & their communities OST available only on pilot level and still prohibited in Russia and Tajikistan

NGO Volunter distributes nalaxone to Hospitals Emergency services Drug users and their family & friends Good practices in Khorog, Tadjikistan

Opiate ODs by EMS in Khorog Tajikistan

Opiate ODs in ER, Khorog Tajikistan

OD prevention program of Russian Harm Reduction Network “There were three of us shooting up at a friend’s place. One guy overdosed. I had nalaxon on me given to me by the project staff. After giving him an injection of nalaxon he got to his feet abruptly and didn’t even realize what had happened to him. Thanks to nalaxon his life was saved. Now I always have nalaxone with me and I am really gratful to the harm reduction program for educating me.” - Client in Biysk “ Two weeks after we started the project people having heard about a miraculous medication and the vials went like hot cakes at the next outreach session.” – project staff in Samara “It goes without say that we should continue this work” – outreach worker” – Naberezhni Chelni outreach worker

Policy Often not seen as a priority: rarely addressed in policy documents Not clear which agency is responsible In Tajikistan it is addressed in national policy documents Latvia considering addressing OD in their HIV program EU Action Plan on Drugs calls for OD programming Contradictory laws about reporting to police No laws to protect witnesses from police

POLICY Prioritize OD Identify responsible agency Use EU policy to advocate for national response SERVICES Nalaxone access (peer-driven & EMS) Scale-up of access to addiction care including OST RESEARCH FUNDING (for advocacy & services) Recommendations

EHRN contacts