A qualitative study of diphenhydramine injection in Kyrgyz prisons and implications for harm reduction
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RESEARCH
A qualitative study of diphenhydramine injection in Kyrgyz prisons and implications for harm reduction Jaimie P. Meyer1* , Gabriel J. Culbert2, Lyuba Azbel1, Chethan Bachireddy3, Ainura Kurmanalieva4, Tim Rhodes5 and Frederick L. Altice1
Abstract Background: To reduce opioid dependence and HIV transmission, Kyrgyzstan has introduced methadone maintenance therapy and needle/syringe programs into prisons. Illicit injection of diphenhydramine, an antihistamine branded as Dimedrol®, has been anecdotally reported as a potential challenge to harm reduction efforts in prisons but has not been studied systematically. Methods: We conducted qualitative interviews in Kyrgyz or Russian with prisoners (n = 49), former prisoners (n = 19), and stakeholders (n = 18), including prison administrators and prisoner advocates near Bishkek, Kyrgyzstan from October 2016 to September 2018. Interviews explored social–contextual factors influencing methadone utilization in prisons. Transcripts were coded by five researchers using content analysis. Dimedrol injection emerged as an important topic, prompting a dedicated analysis. Results: After drinking methadone, some people in prison inject crushed Dimedrol tablets, a non-prescription antihistamine that is banned but obtainable in prison, to achieve a state of euphoria. From the perspectives of the study participants, Dimedrol injection was associated with devastating physical and mental health consequences, including psychosis and skin infections. Moreover, the visible wounds of Dimedrol injecting contributed to the perception of methadone as a harmful drug and supporting preference for heroin over methadone. Conclusion: Dimedrol injecting is a potentially serious threat to harm reduction and HIV prevention efforts in Kyrgyzstan and elsewhere in the Eastern European and Central Asian region and requires further investigation. Keywords: Antihistamines, Eastern Europe and Central Asia (EECA), HIV, Injection drug use, Methadone, Prisons Background [He] also died last year. I got his passport done for him. He has a mother and two brothers who sent money through me. I asked him, “What keeps you here?” I said to him, “Come on, I’ll take you to detox and you’ll spend ten days there and you’ll have a
*Correspondence: [email protected] 1 Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510, USA Full list of author information is available at the end of the article
ticket, and I’ll take you straight to [a rehabilitation center]…What keeps you here is Dimedrol only, nothing else. You’ve exchanged your relatives for Dimedrol!” He didn’t go and he ended up dying in a manhole. He shot up in the groin. Everything rotted there. And we called the police officers. They took him out of the manhole already semi-decomposed. [Marina] HIV incidence is declining globally, with many countries poised to achieve UNAIDS goals of zero new HIV infections by 2030 [1]. Yet, HIV incidence is increasing
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