Community reentry challenges after release from prison among people who inject drugs in St. Petersburg, Russia.
OBJECTIVE
Little is known about the context of the post-release risk environment among formerly incarcerated people who inject drugs (PWID) in Russia. The purpose of this paper is to explore these challenges as they relate to reentry, relapse to injection opioid use, and overdose.


METHODS
The authors conducted 25 in-depth semi-structured interviews among PWID living in St Petersburg, Russia who had been incarcerated within the past two years. Participants were recruited from street outreach (n=20) and a drug treatment center (n=5).


RESULTS
Emergent themes related to the post-release environment included financial instability, negative interactions with police, return to a drug using community, and reuniting with drug using peers. Many respondents relapsed to opioid use immediately after release. Those whose relapse occurred weeks or months after their release expressed more motivation to resist. Alcohol or stimulant use often preceded the opioid relapse episode. Among those who overdosed, alcohol use was often reported prior to overdosing on opioids.


CONCLUSIONS
Future post-release interventions in Russia should effectively link PWID to social, medical, and harm reduction services. Particular attention should be focussed on helping former inmates find employment and overdose prevention training prior to leaving prison that should also cover the heightened risk of concomitant alcohol use.


CONCLUSIONS
In addition to describing a syndemic involving the intersection of incarceration, injection drug use, poverty, and alcohol abuse, the findings can inform future interventions to address these interrelated public health challenges within the Russian setting.
Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA.
Javier A
JA
Cepeda
Marina V
MV
Vetrova
Alexandra I
AI
Lyubimova
Olga S
OS
Levina
Robert
R
Heimer
Linda M
LM
Niccolai
D000328:Adult; D005260:Female; D040261:Harm Reduction; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011330:Prisons / Q000458:organization & administration; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012426:Russia; D012917:Social Adjustment; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult
Incarceration; Injection drugs; Opioid; Overdose; Relapse; Risk environment; Russia