title: Social and structural aspects of the overdose risk environment in St. Petersburg, Russia.
abstract: BACKGROUND
  While overdose is a common cause of mortality among opioid injectors worldwide, little information exists on opioid overdoses or how context may influence overdose risk in Russia. This study sought to uncover social and structural aspects contributing to fatal overdose risk in St. Petersburg and assess prevention intervention feasibility.
  
  
  METHODS
  Twenty-one key informant interviews were conducted with drug users, treatment providers, toxicologists, police, and ambulance staff. Thematic coding of interview content was conducted to elucidate elements of the overdose risk environment.
  
  
  RESULTS
  Several factors within St. Petersburg's environment were identified as shaping illicit drug users' risk behaviours and contributing to conditions of suboptimal response to overdose in the community. Most drug users live and experience overdoses at home, where family and home environment may mediate or moderate risk behaviours. The overdose risk environment is also worsened by inefficient emergency response infrastructure, insufficient cardiopulmonary or naloxone training resources, and the preponderance of abstinence-based treatment approaches to the exclusion of other treatment modalities. However, attitudes of drug users and law enforcement officials generally support overdose prevention intervention feasibility. Modifiable aspects of the risk environment suggest community-based and structural interventions, including overdose response training for drug users and professionals that encompasses naloxone distribution to the users and equipping more ambulances with naloxone.
  
  
  CONCLUSIONS
  Local social and structural elements influence risk environments for overdose. Interventions at the community and structural levels to prevent and respond to opioid overdoses are needed for and integral to reducing overdose mortality in St. Petersburg.
authors.affiliation: Department of Epidemiology and Public Health, Yale School of Medicine, PO Box 208034, 60 College Street, New Haven, CT 06520-8034, USA. traci.c.green@yale.edu
authors.forename: Traci C
authors.initials: TC
authors.lastname: Green
authors.forename: Lauretta E
authors.initials: LE
authors.lastname: Grau
authors.forename: Ksenia N
authors.initials: KN
authors.lastname: Blinnikova
authors.forename: Mikhail
authors.initials: M
authors.lastname: Torban
authors.forename: Evgeny
authors.initials: E
authors.lastname: Krupitsky
authors.forename: Ruslan
authors.initials: R
authors.lastname: Ilyuk
authors.forename: Andrei
authors.initials: A
authors.lastname: Kozlov
authors.forename: Robert
authors.initials: R
authors.lastname: Heimer
mesh_terms: D000328:Adult; D001294:Attitude to Health; D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000592:standards; D003625:Data Collection; D062787:Drug Overdose / Q000401:mortality / Q000517:prevention & control; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D040261:Harm Reduction; D006801:Humans; D008297:Male; D009270:Naloxone / Q000600:supply & distribution / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000600:supply & distribution / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D012309:Risk-Taking; D012426:Russia / Q000453:epidemiology; D012931:Social Environment; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000401:mortality
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone
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