title: Effective use of naloxone among people who inject drugs in Kyrgyzstan and Tajikistan using pharmacy- and community-based distribution approaches.
abstract: BACKGROUND
  Opioid overdose (OD) is a major cause of mortality among people who inject drugs (PWID) in Central Asia, and distribution of naloxone, an opioid antagonist, can effectively prevent these deaths. However, little is known about the use and wastage of distributed naloxone ampoules. Having reliable data on wastage rates is critical for accurately calculating the health impact of naloxone distribution projects targeting PWID.
  
  
  METHODS
  In 2011, Population Services International (PSI) launched two pilot naloxone distribution programs in Kyrgyzstan (pharmacy-based approach) and Tajikistan (community-based approach). PWID were trained on OD prevention and naloxone use. Upon returning for more ampoules, the PWID completed a brief survey on their OD experience and naloxone use. 158 respondents in Kyrgyzstan and 59 in Tajikistan completed the questionnaire. Usage and wastage rates were calculated based on responses. A four-year model wastage rate that takes into account the shelf life of naloxone for both countries was then calculated.
  
  
  RESULTS
  51.3% of respondents in Kyrgyzstan and 91.5% in Tajikistan reported having ever experienced an OD. 82.9% of respondents in Kyrgyzstan and all respondents in Tajikistan had ever witnessed an OD. Out of these PWID who experienced or witnessed OD, 81.5% in Kyrgyzstan and 59.3% in Tajikistan reported having been injected with naloxone, and 83.2% in Kyrgyzstan and 50.9% in Tajikistan reported injecting another individual with naloxone. Of ampoules received, 46.5% in Kyrgyzstan and 78.1% in Tajikistan were used. In both countries, 3.1% of these ampoules were wasted. The four-year model wastage rates for Kyrgyzstan and Tajikistan were found to be 13.8% and 3.9% respectively.
  
  
  CONCLUSIONS
  Findings indicate that a high proportion of naloxone distributed to PWID is used in actual OD incidents, with low wastage rates in both countries. Expanding these distribution models can potentially create more positive health outcomes for PWID in Central Asia.
authors.affiliation: Population Services International, Central Asian Republics, Almaty, Kazakhstan. Electronic address: Maxim.Kan@PSI.kz.
authors.forename: Maxim
authors.initials: M
authors.lastname: Kan
authors.affiliation: Population Services International, Central Asian Republics, Almaty, Kazakhstan. Electronic address: Julia.Gall@PSI.kz.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Gall
authors.affiliation: The Central Asia Program, The Elliott School of International Affairs, The Institute for European, Russian, and Eurasian Studies, The George Washington University, Washington, DC, USA; Global Health Research Center of Central Asia, Columbia University, New York, NY, USA. Electronic address: alisher_latypov@fulbrightmail.org.
authors.forename: Alisher
authors.initials: A
authors.lastname: Latypov
authors.affiliation: Population Services International, Laos Office, Vientiane, Laos. Electronic address: robgray@psilaos.org.
authors.forename: Robert
authors.initials: R
authors.lastname: Gray
authors.affiliation: Population Services International, Central Asian Republics, Almaty, Kazakhstan.
authors.forename: Marat
authors.initials: M
authors.lastname: Bakpayev
authors.affiliation: Population Services International, Kyrgyzstan Office, Bishkek, Kyrgyzstan. Electronic address: alisheva@psi.kg.
authors.forename: Djamila
authors.initials: D
authors.lastname: Alisheva
authors.affiliation: Population Services International, Tajikistan Office, Dushanbe, Tajikistan. Electronic address: khursheda@psi.tajnet.tj.
authors.forename: Khursheda
authors.initials: K
authors.lastname: Rakhmatova
authors.affiliation: Osh Interregional Narcological Center, Osh, Kyrgyzstan. Electronic address: s_aigul08@mail.ru.
authors.forename: Aigul S
authors.initials: AS
authors.lastname: Sadieva
mesh_terms: D000328:Adult; D003156:Community Mental Health Services; D003157:Community Pharmacy Services; D062787:Drug Overdose / Q000453:epidemiology; D005260:Female; D006801:Humans; D007707:Kyrgyzstan / Q000453:epidemiology; D008297:Male; D008506:Medical Waste / Q000706:statistics & numerical data; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use; D015819:Substance Abuse, Intravenous / Q000188:drug therapy*; D013620:Tajikistan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D008506:Medical Waste; D009292:Narcotic Antagonists; D009270:Naloxone
keywords: Kyrgyzstan; Naloxone; Overdose; People who inject drugs; Tajikistan; Wastage