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

Abstract

ABSTRACTBackground: 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.