Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia
Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia
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DOI：
10.1016/j.drugpo.2013.04.007
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发表时间：
2013-07-01
影响因子：
4.4
通讯作者：
Harris, Magdalena
中科院分区：
文献类型：
--
作者：
Grund, Jean-Paul C.;Latypov, Alisher;Harris, Magdalena
背景资料：Krokodil是一种自制的可注射阿片类药物，它的绰号来自于与其使用相关的过度伤害，如溃疡，截肢和变色的鳞片状皮肤。虽然这是一个相对较新的现象，但krokodil的使用在俄罗斯和乌克兰很普遍，估计2011年分别有至少10万人和大约2万人注射了这种药物。在本文中，我们回顾了现有的信息的生产和使用的krokodil，在该地区最近的社会history.Methods的背景下：我们搜索PubMed，谷歌高级搜索，谷歌学术，YouTube和媒体搜索引擎www.Mool.com同行评议或媒体报道，灰色文献和视频报告。咨询了艾滋病毒预防和治疗非政府组织的调查数据，以及区域专家和非政府组织代表。调查结果：Krokodil生产出现在共产主义垮台之前的非典型自制毒品生产和注射风险环境中。由可待因制成，活性成分据报道是去氧吗啡，但是-考虑到基本的“实验室”条件-注射的溶液可能包括各种阿片类生物碱以及高浓度的加工化学品，导致本文报道的局部和全身损伤。卫生保健与执法之间的联系、医务人员的污名化和虐待可能会阻碍使用者及时寻求医疗帮助。对krokodil的出现和相关危害的全面应对应侧重于该物质本身及其基本生产方法，以及其微观和宏观风险环境-即正在发生的注射毒品、艾滋病毒、丙型肝炎病毒、该区域的结核病和性传播感染以及最近当地和国际海洛因供应的急剧变化。对于注射克罗克迪尔的人来说，减少伤害策略的可行性可能更多地取决于政治意愿，而不是干预措施的实际实施。阿片类药物替代治疗在俄罗斯的法律的地位是一个案例。(C)2013爱思唯尔有限公司版权所有。
Background: Krokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated with its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon, krokodil use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively estimated to have injected the drug in 2011. In this paper we review the existing information on the production and use of krokodil, within the context of the region's recent social history.Methods: We searched PubMed, Google Advanced Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or media reports, grey literature and video reports. Survey data from HIV prevention and treatment NGOs was consulted, as well as regional experts and NGO representatives.Findings: Krokodil production emerged in an atypical homemade drug production and injecting risk environment that predates the fall of communism. Made from codeine, the active ingredient is reportedly desomorphine, but - given the rudimentary 'laboratory' conditions - the solution injected may include various opioid alkaloids as well as high concentrations of processing chemicals, responsible for the localized and systemic injuries reported here. Links between health care and law enforcement, stigma and maltreatment by medical providers are likely to thwart users seeking timely medical help.Conclusion: A comprehensive response to the emergence of krokodil and associated harms should focus both on the substance itself and its rudimentary production methods, as well as on its micro and macro risk environments - that of the on-going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend more on political will than on the practical implementation of interventions. The legal status of opioid substitution treatment in Russia is a point in case. (C) 2013 Elsevier B.V. All rights reserved.