Community reentry challenges after release from prison among people who inject drugs in St. Petersburg, Russia

• Published in: International journal of prisoner health Vol. 11; no. 3; pp. 183 - 192
• Main Authors: Cepeda, Javier A, Vetrova, Marina V, Lyubimova, Alexandra I, Levina, Olga S, Heimer, Robert, Niccolai, Linda M
• Format: Journal Article
• Language: English
• Published: England Emerald Group Publishing Limited 01-01-2015
• Subjects: Adult; Alcohol; Alcohol abuse; Alcohol use; Alcoholic beverages; Alcohols; Communities; Criminal intent; Criminology & forensic psychology; Disease prevention; Drug abuse; Drug overdose; Drug use; Employment; Ex-convicts; Female; Harm Reduction; Health & social care; Health education; HIV; Human immunodeficiency virus; Humans; Imprisonment; Injection; Intervention; Interviews; Male; Middle Aged; Motivation; Narcotics; Negative interactions; Opioids; Overdose; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Police; Police-Citizen interactions; Poverty; Prisoner health; Prisoners; Prisoners - psychology; Prisoners - statistics & numerical data; Prisons; Prisons - organization & administration; Public health; Qualitative Research; Reentry; Referral and Consultation - statistics & numerical data; Relapse; Release; Russia; Social Adjustment; Stability; Stimulants; Substance abuse; Substance abuse treatment; Substance Abuse, Intravenous - epidemiology; Substance Abuse, Intravenous - psychology; Young Adult; Russia; INW, Russia; Risk environment; Relapse; Opioid; Injection drugs; Overdose; Incarceration; Russia
• ISSN: 1744-9200; 1744-9219
• DOI: 10.1108/IJPH-03-2015-0007

Purpose
– 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.
Design/methodology/approach
– 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).
Findings
– 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.
Practical implications
– 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.
Originality/value
– 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.