Tomas Zabransky

Hepatitis C Virus Infection among Injecting Drug Users in the Czech Republic – Prevalence and Associated Factors

Aim: To determine the prevalence of, and factors associated with, hepatitis C virus (HCV) infection in the population of Czech injecting drug users (IDUs). Design: Multicentric cross-sectional study. Setting: A convenience sample of injecting drug users was recruited using the snowball sampling method. Participants: Sample of 760 IDUs from 9 different Czech regions. Measurement: We used one-drop instant blood tests to determine the anti-HCV antibodies status; a structured questionnaire was completed during the interview with the researcher. We calculated the ratio of positive findings and performed univariate analyses of correlations between predictors and independent variables. Finally, we created a logistic regression model that controlled for age, region of residence, reported sharing of injection paraphernalia, and length of injection drug use and for the interaction between length of injection use and imprisonmentin order to assess the predictive value of imprisonment in an individual’s history. Findings: 226 participants (29.74% of the tested sample) were found to be anti-HCV positive. After adjusting for the sensitivity of the test, the ‘true proportion’ was 34.97% (95% CI: 31.56–38.35). Many correlated independent variables were found in the univariate analyses. In our logistic regression model, we have found that imprisonment increases the odds of being anti-HCV positive by a factor of 4.3. Conclusion: Anti-HCV seroprevalence remains relatively low in the Czech IDUs population compared to similar populations in the developed countries. Regional differences exist in anti-HCV prevalence within the Czech Republic. The strong association of anti-HCV prevalence with imprisonment history when controlled for other potentially clinically important factors suggests the need for more effective preventive measures in Czech prisons.

On a search for useful indicators… or not?

Keywords: Decision-making; drug expenditures; drug situation: indicators; drug use: prevalence

“Friendly” marijuana markets in the Czech Republic and in the U. S. – drug policy outcomes and risks

A growing body of literature shows the importance of friendship within illicit markets in (recreational) drugs, including cannabis, mostly referred to as “social supply”. It is not clear to what extent this phenomenon is policy-responsive and what the risks related to it are. This analysis compares two localities with different drug policies (Florida, USA, as of 2009, and the Czech Republic, as of 2009) by examining the role of friendship and the risks of cannabis use related to it. Marijuana market patterns in the Czech Republic and North-Central Florida were analysed using mixed research methods. The quantitative data consisted of representative surveys (general population surveys with marijuana market modules). For the purpose of the qualitative study, 44 marijuana users and retailers were recruited in North-Central Florida and 66 in the Czech Republic via respondentdriven sampling. The inclusion criterion for the study was the use of marijuana in the last 12 months. Semi-structured interviews, which took 80 minutes on average, followed an interview guide focused on marijuana use, sharing, purchases, sales and growing, with extensive probes into the activities of the respondents’ “friends”, as they defined them. The quantitative data were analysed using frequency analysis and multinomial logit models. The qualitative data were analysed using inductive analysis. Compared to the Czech Republic, the acquisition of drugs through a “friend” was more prevalent in the U.S./Florida. The qualitative study showed that this “friendly” market pattern might encourage increased cannabis use and might increase the likelihood of driving under the influence of cannabis. The outcomes of the analysis suggest that punitive drug policies could provide incentives for shrinking the market into friendly/social networks and thus impose risks on users. It is therefore possible that a repressive drug policy contributes to harmful patterns of drug use, with illicit markets as significant transmission mechanisms.

“Just another drug” for marginalized users: The risks of using synthetic cathinones among NSP clients in the Czech Republic

ABSTRACT Background: In several EU countries, synthetic cathinone (SC) use has spread among injecting drug users (IDUs); it has been linked to risk of dependence and HIV/HCV transmission. Aims: To analyze the association between dependence and risky injecting practice with experimental and repeated SC use in the past 12 months among the clients of needle-syringe programs in the Czech Republic. Methods: IDUs in six locations in the Czech Republic were surveyed in 2013 and 2014 (n = 463). Single-predictor multinomial logit models were run to determine SC use upon the Severity of Dependence Scale (SDS) and risky injecting practice; the same predictors were included in the multivariate model with confounders. Findings: SDS score and risky injecting practice were significantly associated with repeated SC use in single-predictor models but not in the multivariate model; SC experimentation was linked to young and male respondents and those who lived in a larger city (>50,000); predictors of repeated SC use were homelessness (AOR = 3.2), co-occurring use of stimulants and opioids (AOR = 4.3), and use of cannabis (AOR = 2.4) in the past month. Conclusions: Repeated SC use was associated with poly-drug use and homelessness; given the rather inferior status of SCs among IDUs, their users face a risk of stigmatization and further marginalization.