title: Boltushka: a homemade amphetamine-type stimulant and HIV risk in Odessa, Ukraine.
abstract: BACKGROUND
  Homemade amphetamine-type stimulants (ATSs) have been reported in Russia and Eastern Europe for decades. Recipes differ geographically and over time producing differing active ingredients. Vint and jeff (active ingredients methamphetamine and methcathinone, respectively) are two such homemade ATSs originally produced from over-the-counter cold medications and household chemicals.
  
  
  METHODS
  During a Rapid Policy Assessment and Responses (RPAR) project in Odessa, Ukraine, researchers found use of boltushka, a novel homemade ATS. Fourteen supplemental qualitative interviews were conducted, including ten interviews with boltushka injectors and four interviews with pharmacists. We report patterns of boltushka use among local injection drug users (IDUs) as well as the role of laws, regulations, and current pharmacy practices.
  
  
  RESULTS
  Legal restrictions on over-the-counter cold medicines in Ukraine led to products containing phenylpropanolamine (PPA), which oxidised with KMnO(4) (potassium permanganate), produces a weak ATS, cathinone, called boltushka. Boltushka's ingredients are easily available in pharmacies or on the black market. IDUs reported a mean age at first use of 16 years old (range 12-21). While published data are scant, anecdotal evidence reported here include amphetamine-like effects on energy and appetite, binging patterns of use, and some reports of shaking and other neurological damage consistent with earlier reports from exposure to KMnO(4). Users reported sharing syringes and other non-sterile injection practices. No users reported specific treatment or prevention programs for boltushka users.
  
  
  CONCLUSIONS
  Although Ukrainian government regulations have limited access to precursor chemicals, IDUs have continued to make and use boltushka. The actual extent and demographics of boltushka use are unknown. Besides risk of bloodborne disease, the health effects of injected homemade ATSs and their constituent chemicals are poorly documented. Interventions beyond available harm reduction efforts may be required. Education/treatment specific to boltushka users and screening for other physical harms are critical interventions.
authors.affiliation: The Fenway Institute, Fenway Community Health, Boston, MA, USA.
authors.forename: Repsina
authors.initials: R
authors.lastname: Chintalova-Dallas
authors.forename: Patricia
authors.initials: P
authors.lastname: Case
authors.forename: Nataliya
authors.initials: N
authors.lastname: Kitsenko
authors.forename: Zita
authors.initials: Z
authors.lastname: Lazzarini
mesh_terms: D000328:Adult; D000662:Amphetamines / Q000008:administration & dosage*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage*; D004339:Drug Compounding; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D010594:Pharmacies / Q000331:legislation & jurisprudence; D010665:Phenylpropanolamine / Q000008:administration & dosage / Q000737:chemistry; D011427:Propiophenones / Q000138:chemical synthesis / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology; D014455:Ukraine
chemical_list: D000662:Amphetamines; D000697:Central Nervous System Stimulants; D011427:Propiophenones; D010665:Phenylpropanolamine; C047806:monomethylpropion