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Implementing an Updated “Break the Cycle” Intervention to Reduce Initiating Persons into Injecting Drug Use in an Eastern European and a US “opioid epidemic” Setting

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Abstract

We tested the hypothesis that an updated “Break the Cycle” (BtC) intervention, based in social cognitive theory and motivational interviewing, would reduce the likelihood that current persons who inject drugs (PWID) would assist persons who do not inject drugs (non-PWID) with first injections in Tallinn, Estonia and Staten Island, New York City. 402 PWID were recruited, a baseline interview covering demographics, drug use, and assisting non-PWID with first drug injections was administered, followed by BtC intervention. 296 follow-up interviews were conducted 6 months post-intervention. Percentages assisting with first injections declined from 4.7 to 1.3% (73% reduction) in Tallinn (p < 0.02), and from 15 to 6% (60% reduction) in Staten Island (p < 0.05). Persons assisted with first injections declined from 11 to 3 in Tallinn (p = 0.02) and from 32 to 13 in Staten Island. (p = 0.024). Further implementation research on BtC interventions is urgently needed where injecting drug use is driving HIV/HCV epidemics and areas experiencing opioid epidemics.

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Funding

This work was supported through Grant 5-DP1-DA039542 from the US National Institute on Drug Abuse and Grant # IUT34-17 from the Estonian Ministry of Education and Research. The funding agency had no role in the design, conduct, data analysis or report preparation for the study.

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Authors and Affiliations

  1. Social and Behavioral Sciences, College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA

    Don Des Jarlais, David M. Barnes, Kamyar Arasteh & Hayley Berg

  2. Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia

    Anneli Uuskula, Ave Talu, Mait Raag & Greete Org

  3. CHASI: Community Health Action of Staten Island, New York, USA

    Donna Demarest

  4. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA

    Jonathan Feelemyer

  5. HIV Center for Clinical and Behavioral Studies at The New York State Psychiatric Institute and Columbia University, New York, USA

    Susan Tross

Authors
  1. Don Des Jarlais
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  2. Anneli Uuskula
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  3. Ave Talu
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  4. David M. Barnes
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  11. Susan Tross
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Correspondence to Don Des Jarlais.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Des Jarlais, D., Uuskula, A., Talu, A. et al. Implementing an Updated “Break the Cycle” Intervention to Reduce Initiating Persons into Injecting Drug Use in an Eastern European and a US “opioid epidemic” Setting. AIDS Behav 23, 2304–2314 (2019). https://doi.org/10.1007/s10461-019-02467-y

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