Post-legalization shifts in cannabis use among young adults in Georgia-A nationally representative study.

Background And Aim: In 2018, the country of Georgia legalized cannabis for recreational use and decriminalized limited possession. This study aimed to assess whether cannabis use increased among young adults (ages 18-29 years) in Georgia after national policy changes and to evaluate whether perceived access became easier after legalization and current risk factors of young adult cannabis use.

Methods: We used data from the Georgian nationally representative survey administered in 2015 (n = 1308) and 2022 (n = 758), before and after decriminalization.

Are cannabis use problems comparable across individuals using for recreational and medical purposes? An international cross-sectional study of individuals who use self-grown cannabis.

Background: Little is known about cannabis use problems among individuals who use cannabis for medical purposes and whether rates and determinants of cannabis use problems in medical users differ to those observed among individuals using for recreational reasons. This study examines whether Severity of Dependence Scale (SDS) scores differ across individuals who use self-grown cannabis for the following reasons: "recreational only", "medical and recreational" and "medical only". Furthermore, the study tests whether cannabis use frequency, cannabis strain, and type of cannabis influences the strength of the association between purpose of use and cannabis use problems.

Costs of syringe vending machines in Tbilisi, Georgia.

Background: Syringe vending machines (SVM) can improve access to sterile injecting equipment, but they have not been widely implemented or evaluated. We evaluate the cost of SVM installed between July 2019-December 2020 in Tbilisi, Georgia.

Methods: The SVM were stocked with several kit types, including injecting equipment for opioid or stimulant users, naloxone, male and female condoms, and pregnancy tests.

Implementation and evaluation of a syringe vending machine trial in Tbilisi, Georgia.

Background: Syringe vending machines (SVM) have proven to be an effective vehicle for providing an uninterrupted supply of sterile equipment to PWID, but they have not been implemented or disseminated broadly. The aim of this study was to implement and evaluate outcomes of introducing SVM in Tbilisi, Georgia.

Methods: We installed SVM at five HIV prevention sites in 10 locations in Tbilisi, Georgia and studied implementation over 20 months.

The impact of the COVID-19 pandemic on illicit drug supply, drug-related behaviour of people who use drugs and provision of drug related services in Georgia: results of a mixed methods prospective cohort study.

Background: This study examines the effects of COVID-19 related restrictions on the supply of illicit drugs, drug-use behaviour among people who use drugs (PWUD) regularly (at least weekly), and drug-related service provision in Tbilisi, Georgia.

Methodology: In this mixed methods study, a cohort of 50 Georgian PWUD recruited through a snow-ball sampling participated in a bi-weekly online survey in April-September, 2020. They also took part in the qualitative telephone interviews at 12- and 24-week follow-up time points.

Smart Syringe Vending Machines: Research Capabilities and Implications for Research Data Collection.

Objective: Syringe vending machines (SVMs) are intended to supplement the standard syringe exchange programs to access hard-to-reach groups and to cover unserved geographical areas. This report describes how we adapted SVMs to deliver interventions and collect research data as part of a study of smart SVMs (SSVMs) in Tbilisi, Georgia.

Method: To create SSVMs, we upgraded commercial vending machines and developed a computer program to track and record interactions and to display messages related to study procedures.

Hidden populations: risk behaviours in drug-using populations in the Republic of Georgia through subsequent peer-driven interventions.

Background: Georgia has a significant risk of ongoing HIV and HCV outbreak. Within this context, harm reduction aims to reduce risk associated with drug use through community activities, such as peer recruitment and involvement. The aim of this study was to identify significant differences between known and hidden populations, and attest to the ongoing utility of peer-driven intervention across multiple years in recruiting high-risk, vulnerable populations through peer networks.

Interim effect evaluation of the hepatitis C elimination programme in Georgia: a modelling study.

Background: Georgia has a high prevalence of hepatitis C, with 5·4% of adults chronically infected. On April 28, 2015, Georgia launched a national programme to eliminate hepatitis C by 2020 (90% reduction in prevalence) through scaled-up treatment and prevention interventions. We evaluated the interim effect of the programme and feasibility of achieving the elimination goal.

Perceived acceptability of and willingness to use syringe vending machines: results of a cross-sectional survey of out-of-service people who inject drugs in Tbilisi, Georgia.

Background: The growing HIV epidemic in Eastern Europe and Central Asia has been driven by high rates of injection drug use. The Republic of Georgia has among the highest injection drug use rates globally, with a prevalence of 2.24%.

Nightlife and Drug Use in Tbilisi, Georgia: Results of an Exploratory Qualitative Study.

Tbilisi is fast becoming a regional hub for electronic dance music. This study describes the use of illicit psychoactive drugs by frequent nightclub visitors in a club setting. We conducted 16 qualitative in-depth interviews with young nightclubbers with a history of drug use in Tbilisi.

Comprehensive Women-Centered Treatment for Psychoactive Substance Use in the Republic of Georgia: Outcomes of a Randomized Clinical Trial.

This study aimed to assess the impact of a culturally sensitive, comprehensive women-centered intervention on psychoactive substance use among women in the Republic of Georgia. Study participants included 128 women who had injected psychoactive substance(s) in the past 30 days and had enrolled in a randomized controlled trial that compared Reinforcement Based Treatment and the Women's CoOp (RBT+WC) to usual care (UC). RBT+WC provided a structured 12-session intervention designed to reduce HIV/HCV risk and psychoactive substance and alcohol use, and to improve mental and physical health; whereas UC provided information booklets on the same topics and case management for 12 sessions.

Republic of Georgia estimates for prevalence of drug use: Randomized response techniques suggest under-estimation.

Background: Validity of responses in surveys is an important research concern, especially in emerging market economies where surveys in the general population are a novelty, and the level of social control is traditionally higher. The Randomized Response Technique (RRT) can be used as a check on response validity when the study aim is to estimate population prevalence of drug experiences and other socially sensitive and/or illegal behaviors.

Aim: To apply RRT and to study potential under-reporting of drug use in a nation-scale, population-based general population survey of alcohol and other drug use.

Exploring the New Phenomena of Home-Made Extraction and Injection of Ephedra Plant Product in Georgia.

Background: Since the end of 2015, reports by service providers have indicated a new trend in kitchen (homemade) production of an injection drug prepared from an ephedrine-containing conifer bush that is indigenous to the region.

Objective: The aim of this report is to describe an emerging new homemade psychoactive drug synthesized from the ephedra plant, and the drug consumption methods associated with its' use in the Eurasia.

Methods: Focus groups conducted with 16 people, self-identified as injection drug users (IDU's) who reported at least one incidence of ephedra preparation injection during the previous 30-days.

Drug preparation, injection, and sharing practices in Tajikistan: a qualitative study in Kulob and Khorog.

Background: Sharing injection equipment remains an important rout of transmission of HIV and HCV infections in the region of Eastern Europe and Central Asia. Tajikistan is one of the most affected countries with high rates of injection drug use and related epidemics.The aim of this qualitative study was to describe drug use practices and related behaviors in two Tajik cities - Kulob and Khorog.

Policing, massive street drug testing and poly-substance use chaos in Georgia - a policy case study.

Background: Since early 2000, intensive policing, wide scale street drug testing, and actions aimed at limiting the availability of specific drugs have been implemented in Georgia. Supporters of this approach argue that fear of drug testing and resulting punishment compels drug users to stop using and prevents youth from initiating drug use. It has been also stated that reduction in the availability of specific drugs should be seen as an indication of the overall success of counter-drug efforts.

Feasibility and initial efficacy of a culturally sensitive women-centered substance use intervention in Georgia: Sex risk outcomes.

Background: This paper reports on the feasibility and initial efficacy of a culturally sensitive, comprehensive women-centered substance use intervention for women who inject drugs in Georgia in terms of the primary and secondary sex risk outcomes. The hypothesis under examination was that, relative to case management participants, participants in a culturally sensitive, comprehensive women-specific and -centered intervention would, on average, show significant decreases in past-30-day frequency of unprotected sex, unprotected sex at the last sexual encounter, and increases in condom use and safer sex actions.

Methods: The study was a two-arm randomized trial, in which 173 potentially eligible women were screened, and those 128 women determined to be eligible were assigned at random to either Reinforcement-based Treatment plus Women's Co-Op (RBT + WC) or case management (CM).

Factors that influence the characteristics of needles and syringes used by people who inject drugs in Tajikistan.

Background: "Low dead space" syringes with permanently attached needles retain less fluid, blood, and HIV after use than standard "high dead space" syringes. This reduces the probability of HIV transmission if they are shared by people who inject drugs (PWID). The World Health Organization recently recommended that needle and syringe programs (NSP) offer clients low dead space syringes.

Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions.

The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women's risk behavior, their roles in sexual relationships, and gender power dynamics and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs.

Women who inject drugs in the republic of georgia: in their own words.

This study describes the initiation and maintenance of illicit drug use, risky behaviors, and the substance use treatment experiences of women in Georgia. Qualitative interviews with 55 drug-using women (mean age 36 years; SD = 9.52), were conducted during April-September 2011.

Comprehensive Women-centered Treatment for Substance Use Disorders in Georgia: Current Status and Future Directions.

The present paper examines the current status of women-centered substance use disorder treatment in Georgia. Four major issues are identified that adversely impact the delivery of effective services for women with substance use disorders: Policy Issues; Sociocultural Issues; Programmatic/Structural Issues; and Personal/Interpersonal Issues. These four issues are seen to form a complex, dynamic system that serves to maintain the current ineffective service delivery system and suppresses movement toward an effective service delivery for this highly marginalized and at-risk population.

Process and product in cross-cultural treatment research: development of a culturally sensitive women-centered substance use intervention in georgia.

Women who inject drugs (WID) are highly marginalized and stigmatized and experience ongoing discrimination in Georgia. Few opportunities exist for WID to receive publicly funded treatment for substance use disorders. The IMEDI (Investigating Methods for Enhancing Development in Individuals) project was developed in response to the need for women-specific and women-centered treatment services.

Hepatitis C among people who inject drugs in Tbilisi, Georgia: an urgent need for prevention and treatment.

Background: Drug use and hepatitis C virus (HCV) are both major public health issues in Georgia. However, the access to HCV prevention and care is still very limited in the country. This study was conducted to examine the HCV epidemic among people who inject drugs (PWID) in Tbilisi and to assess the treatment needs of this most-at-risk population.

Access to treatment for substance-using women in the Republic of Georgia: socio-cultural and structural barriers.

Background: In the Republic of Georgia, women comprise under 2% of patients in substance use treatment and to date there has been no empirical research to investigate what factors may facilitate or hinder their help-seeking behaviour or access to treatment services.

Methods: This study included secondary analysis of in-depth interviews with 55 substance-using women and 34 providers of health-related services.

Results: The roles and norms of women in Georgian society were identified as major factors influencing their help-seeking behaviour.

Twice stigmatized: provider's perspectives on drug-using women in the Republic of Georgia.

This study examined attitudes and perspectives of 34 health service providers through in-depth interviews in the Republic of Georgia who encountered an injection drug-using woman at least once in the past two months. Most participants' concept of drug dependence treatment was detoxification, as medication-assisted therapy was considered part of harm reduction, although it was thought to have relatively better treatment outcomes compared to detoxification. Respondents reported that drug dependence in women is much more severe than in men.