Transcript Boltushka in Odessa

Boltushka: Use of Homemade
Amphetamine in Odessa, Ukraine
Repsina Chintalova-Dallas [1]
Dmitry Lutzenko [2]
Zita Lazzarini [1]
Patricia Case [3]
[1] University of Connecticut Health Center, USA;
[2] Charity Fund “The Way Home” Odessa, Ukraine;
[3] Fenway Community Health Center, USA
NIDA/NIH Grant # 5 R01 DA17002-02
Odessa, Ukraine
• Odessa is the third largest city in the
Ukraine (Pop. 1.1 million);
• One of the first rapidly escalating HIV
epidemics in Ukraine and Eastern
Europe, most cases attributed to injection
drug use;
• 7,822 officially registered drug users in
Odessa;
• Estimated real number ranges from four
to five times higher (31,288 - 39,110) [1]
Source: S. Matic, J. V. Lazarus, M.C. Donoghoe “HIV/AIDS
in Europe: Moving from death sentence to chronic disease
management”, WHO/Europe 2006
Homemade Amphetamines have a
long history in Eastern Europe

1980’s: Efforts to control Roma villages distributing opium
resulted in police raids in Ukraine starting in late 1980s. This
increased the price of opium and caused the shift to cheaper
amphetamines

1980’s: Users began making “Vint” – a homemade preparation
containing methamphetamine and obtained via ephedrine
reduction

1990’s: Users began making Boltushka using a less complicated
process. Boltushka is homemade preparation containing
methcathinone. Pseudoephedrine-containing cold medications
oxidized with KMnO4 produce Boltushka.

1990’s: In the effort to control homemade amphetamines,
ephedrine was regulated. Now drug users use cold medications
containing PPA and the same oxidation process to produce
cathinone, a weak amphetamine. The drug is still called
Boltushka or “mix”.
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Rapid Policy Assessment and
Response (RPAR)
Collect laws and
epidemiological
& criminal
justice
Action
Plan
3 focus Groups
Analysis
statistics
Organize CAB*
CAB 1 CAB 2
Key Informants
•24 in “system”
•14 IDUs
CAB 3
CAB 4
Community
action &
change
Report
CAB 5 CAB 6 CAB 7
*CAB includes participants from law enforcement (police, judiciary, prisons), public and private drug4
treatment providers, health care (physicians, nurses) and social welfare agencies (Family Support office).
Boltushka Research
Methods:

Ten interviews with young IDUs (who have used
boltushka once in the last three months and were
between the ages of 18 to 25);

Four interviews with pharmacists;

Informal interviews with volunteers at NEP, doctors
at Charity Fund “The Way Home” and social
workers.
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Demographics of Boltushka users
N
%
Male
7
70%
Female
3
30%
21.3 year
19 – 25 year
Median age in
year (range)
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Demographics of Boltushka users
“Boltushka has become increasingly
popular among the very young and
very poor of the city of Odessa in the
late 1990s and 2000s” [1]
[1] Ukraine/Odessa/Interviews 1,3,4,5,7,8 with IDUs/RPAR Project/January 2006
(UKR/IDU/1,3,4,5,7,8)
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Making boltushka

10 tablets of cold medicine
(Teffedrin, Koldack, Effect)

10 cc of warm water

1 cc of household vinegar

3 – 5 g of KMnO4 (potassium
permanganate)

Shake or mix until the
substance “smells of cherries”

Sometimes aspirin is used
instead of vinegar (or both
ingredients used in half doses)
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Availability of Boltushka ingredients in
Odessa

Ephedrine-containing medicines are only sold with the
prescription;

PPA containing medicines are sold over-the-counter;

KMnO4 is only sold openly in one pharmacy in Odessa,
but is widely available at black market;

Several pharmacies around the city are “doing business
with drug users”;

Needles and syringes are widely available and are
inexpensive.
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Boltushka and its use

Cost per dose - <US$1.00;

Prepared for personal use only;

Mainly used by the very young and poor;

Boltushka is a group drug (usually groups of 3-7
people);

Usually injected 5-6 times a day (some reported up
to 10 times a day);

Some IDUs reported to injecting for 2-3 days going
without food and sleep;

Only injected intravenously (most commonly in
arms and legs);
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Boltushka and its use

“needles and syringes are the last thing to worry
about; you need to find money for pills – that’s
what’s important. In most cases after having gone a
long way to buy the pills and hurrying back home to
make boltushka you don’t even remember to think
about syringes. There’s at least one person in the
group who will have the syringe if you don’t have
yours”[1].
[1] Ukraine/Odessa/Interview 4 with IDU/RPAR Project/January 2006 (UKR/IDU/4)
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Risk of bloodborne disease

Common practice of sharing the equipment;
• Currently only 2 IDUs use NEP as needles and syringes are
available and inexpensive or they can borrow from other
people in the group;

9 IDUs confirmed the practice of front-loading;

6 IDUs reported having engaged in an unprotected sex
following the injection;

At least one respondent stated that boltushka is popular
among young and uneducated female commercial sex
workers “to make their work easy”;

IDUs (aged 11-14) pick up needles and syringes on streets
and use them.
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Police and boltushka users

Police stop boltushka users mainly outside pharmacies, but
“usually they let us go the same day because police know
they are wasting their time on us as most boltushka users are
poor and have no money for bribes”[1].

IDUs reported police use physical abuse against them (most
commonly against male IDUs);

Pharmacists will help IDUs conceal cold medication from
police by switching boxes with other medications.
[1] Ukraine/Odessa/Interview 1 with IDU/RPAR Project/January 2006 (UKR/IDU/1)
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Reported health effects of Boltushka use

Early effects (approximately after 1 month of use):
– IDUs report “shaking wildly”;
– Grinding teeth;
– Abscess and skin burns when injected under the skin

After continued long use:
– Partial loss of cognitive function;
– Brain damage;
– Parkinsonian symptoms;

Delayed mental and physical development in children age 1114 who use boltushka
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Reported behavioral effects of boltushka use

High level of activity and energy;

Talkativeness;

Reported loss of appetite for 2-3 days.
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Interventions for Boltushka users

Boltushka users are at probable risk of Hepatitis C and HIV
infection because of shared equipment and poor hygiene
practices;

Apparent need for drug treatment resources directly
addressing the needs of boltushka users;

Education/treatment specific to boltushka users;

Screening for other physical harms to document the drug’s
other effects
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