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Sarkar S, Hill DD, Rosenberg AF, Eaton EF, Kutsch O, Kobie JJ. Injection Drug Use Alters Plasma Regulation of the B Cell Response. Cells 2024; 13:1011. [PMID: 38920641 PMCID: PMC11202061 DOI: 10.3390/cells13121011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
The opioid epidemic continues to be a major public health issue that includes millions of people who inject drugs (PWID). PWID have increased incidence of serious infections, including HIV as well as metabolic and inflammatory sequelae. We sought to discern the extent of systemic alterations in humoral immunity associated with injection drug use, including alterations in the plasma proteome and its regulation of B cell responsiveness. Comprehensive plasma proteomics analysis of HIV negative/hepatitis C negative individuals with a history of recent injection heroin use was performed using mass spectrometry and ELISA. The effects of plasma from PWID and healthy controls on the in vitro proliferation and transcriptional profile of B cell responses to stimulation were determined by flow cytometry and RNA-Seq. The plasma proteome of PWID was distinct from healthy control individuals, with numerous immune-related analytes significantly altered in PWID, including complement (C3, C5, C9), immunoglobulin (IgD, IgM, kappa light chain), and other inflammatory mediators (CXCL4, LPS binding protein, C-reactive protein). The plasma of PWID suppressed the in vitro proliferation of B cells. Transcriptome analysis indicated that PWID plasma treatment increased B cell receptor and CD40 signaling and shifted B cell differentiation from plasma cell-like toward germinal center B cell-like transcriptional profiles. These results indicate that the systemic inflammatory milieu is substantially altered in PWID and may impact their B cell responses.
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Affiliation(s)
- Sanghita Sarkar
- Infectious Diseases Division, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Dave D. Hill
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Alexander F. Rosenberg
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Ellen F. Eaton
- Infectious Diseases Division, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Olaf Kutsch
- Infectious Diseases Division, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - James J. Kobie
- Infectious Diseases Division, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35249, USA
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Kitson C, Haines M, O’Byrne P. Understanding the Perspectives of Women Who Use Intravenous Drugs and are Experiencing Homelessness in an Urban Centre in Canada: An Analysis of Ethnographic Data. Glob Qual Nurs Res 2022; 9:23333936221080935. [PMID: 35340820 PMCID: PMC8941687 DOI: 10.1177/23333936221080935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Injection drug use has long been a topic of investigation, whether through a health or
criminal justice lens. Whilst these bodies of literature offer important perspectives,
missing from the extant literature is evidence, particularly involving women who use
drugs, and more specifically evidence about the health beliefs of these women. To address
this knowledge gap, we undertook an ethnographic study of homeless women in downtown
Ottawa who inject drugs. This included interviews, observations, and artifact analyses. In
this paper, we report on these ethnographic data to show the context and nature of the
subjective lives of women who use injection drugs and their beliefs and perspectives on
health. We use these data to make recommendations for nursing and healthcare practice
moving forward.
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Affiliation(s)
| | | | - Patrick O’Byrne
- University of Ottawa, Ottawa, ON, Canada
- Patrick O’Byrne, University of Ottawa, 451 Smyth
Road, Ottawa K1H 8M5, ON, Canada.
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Bacterial infections in people who inject psychoactive substances: An observational study in a French university hospital. Therapie 2021; 76:539-547. [PMID: 34183194 DOI: 10.1016/j.therap.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 11/22/2022]
Abstract
AIM OF THE STUDY To describe bacterial infections in injection drug users (IDUs) hospitalized at Montpellier University Hospital, France, and to identify factors that might influence the development of local or systemic infections. METHODS This cross-sectional observational monocentric study prospectively included bacterial infections in IDUs hospitalized at Montpellier University Hospital between 2012 and 2018. Types of infection (local or systemic) were described and compared to identify specific features (injection practices). RESULTS The study included 144 bacterial infections (56% of local infections and 44% of systemic infections) concerning 117 IDUs. The most common infection types were abscesses (50%), skin and soft tissue infections (33%), bacteremia/sepsis (20%), endocarditis (17%), and bone and joint infections (16%). Patients were mainly men (n=94; 80%), and the median age was 40 years [IQR25-75: 34-47]. Four deaths related to systemic infection were reported. The most frequent injected substances were cocaine, opioid maintenance treatments (OMT), and opioids. According to the multivariate analysis, factors associated with the occurrence of systemic infections were number of injection (OR 2.59 [1.07-6.27]; P=0.034) and injection of at least one opioid (OR 3.52 [1.28-9.72]; P=0.015). CONCLUSION Different types of bacterial infections, local or systemic, are observed in IDUs. Skin infections are quite common, but other infection types also are reported, with sometimes serious consequences. It is already known that injection practices are contributing factors in infection development, but the type of injected psychoactive substance(s) also may have an influence.
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Ellis K, Walters S, Friedman SR, Ouellet LJ, Ezell J, Rosentel K, Pho MT. Breaching Trust: A Qualitative Study of Healthcare Experiences of People Who Use Drugs in a Rural Setting. FRONTIERS IN SOCIOLOGY 2020; 5:593925. [PMID: 33869521 PMCID: PMC8022503 DOI: 10.3389/fsoc.2020.593925] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/16/2020] [Indexed: 05/05/2023]
Abstract
Background: Increased drug use has disproportionately impacted rural areas across the U.S. People who use drugs are at risk of overdose and other medical complications, including infectious diseases. Understanding barriers to healthcare access for this often stigmatized population is key to reducing morbidity and mortality, particularly in rural settings where resources may be limited. Methods: We conducted 20 semi-structured interviews with people who use drugs, including 17 who inject drugs, in rural southern Illinois between June 2018 and February 2019. Interviews were analyzed using a modified grounded theory approach where themes are coded and organized as they emerge from the data. Results: Participants reported breaches of trust by healthcare providers, often involving law enforcement and Emergency Medical Services, that dissuaded them from accessing medical care. Participants described experiences of mistreatment in emergency departments, with one account of forced catheterization. They further recounted disclosures of protected health information by healthcare providers, including communicating drug test results to law enforcement and sharing details of counseling sessions with community members without consent. Participants also described a hesitancy common among people who use drugs to call emergency medical services for an overdose due to fear of arrest. Conclusion: Breaches of trust by healthcare providers in rural communities discouraged people who use drugs from accessing medical care until absolutely necessary, if at all. These experiences may worsen healthcare outcomes and further stigmatize this marginalized community. Structural changes including reforming and clarifying law enforcement's role in Emergency Departments as well as instituting diversion policies during arrests may help rebuild trust in these communities. Other possible areas for intervention include stigma training and harm reduction education for emergency medicine providers, as well as developing and implementing referral systems between Emergency Departments and local harm reduction providers and medically assisted drug treatment programs.
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Affiliation(s)
- Kaitlin Ellis
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Suzan Walters
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Samuel R. Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Lawrence J. Ouellet
- COIP/Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, United States
| | - Jerel Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, United States
| | - Kris Rosentel
- Section of Infectious Disease, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States
| | - Mai T. Pho
- Section of Infectious Disease, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States
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DeMasi SC, Goyack LE, Shufflebarger EF, Hess EP, Skains RM, Thompson MA, Burleson SL, Gullett JP, Pigott DC. Clinical ultrasonography in patients who inject drugs (the CUPID protocol): an illustrated case series. J Am Coll Emerg Physicians Open 2020; 1:244-251. [PMID: 33000039 PMCID: PMC7493592 DOI: 10.1002/emp2.12028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/06/2022] Open
Abstract
In 2017, there were ≈47,600 opioid overdose-related deaths in the United States. US emergency department (ED) visits for suspected opioid overdose increased by 30% between July 2016 and September 2017.2 The current US opioid epidemic makes it critical for emergency physicians to be aware of common and uncommon infectious and non-infectious complications of injection drug use. Point-of-care ultrasound has become a widely available, non-invasive diagnostic tool in EDs across the United States and worldwide. The increasing population of injection drug use patients is at risk for serious morbidity and mortality from an array of disease states amenable to ultrasound-based diagnosis. We propose a protocol for clinical ultrasonography in patients who inject drugs (the CUPID protocol), a focused, 3-system point-of-care ultrasound approach emphasizing cardiovascular, thoracic, and musculoskeletal imaging. The protocol is a screening tool, designed to detect high risk infectious and noninfectious complications of injection drug use.
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Affiliation(s)
- Stephanie C. DeMasi
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Laura E. Goyack
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Erin F. Shufflebarger
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Erik P. Hess
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Rachel M. Skains
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Maxwell A. Thompson
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Samuel Luke Burleson
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - John P. Gullett
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - David C. Pigott
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabama
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Krsak M, Morrisette T, Miller M, Molina K, Huang M, Damioli L, Pisney L, Wong M, Poeschla E. Advantages of Outpatient Treatment with Long-Acting Lipoglycopeptides for Serious Gram-Positive Infections: A Review. Pharmacotherapy 2020; 40:469-478. [PMID: 32239771 DOI: 10.1002/phar.2389] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/21/2022]
Abstract
Treatment of serious gram-positive infections presents multiple challenges. Treatment often results in prolonged hospitalization for administration of intravenous antimicrobials and presents an inefficient use of hospital resources. Prolonged hospitalization is typically also unfavorable to patient preferences and potentially subjects patients to additional health care-associated complications. Current strategies of transition to outpatient settings-outpatient parenteral antimicrobial therapy and use of oral antibiotics-often do not adequately serve vulnerable populations for whom there is often no alternative to inpatient therapy. Specifically, people who use drugs, those who cannot reliably adhere to unsupervised treatment (poor mental or physical health), people with complicating life circumstances (e.g., homelessness, incarceration, rural location), and those with inadequate health insurance remain hospitalized for weeks longer than persons without such conditions. We suspected that long-acting lipoglycopeptides (laLGP), such as dalbavancin and oritavancin, may be useful in patient transitions to outpatient settings. Thus, we conducted a search of the peer-reviewed literature using the PubMed, Google Scholar, and MEDLINE databases. Based on accumulating literature, it appears that laLGPs offer a reliable alternative therapeutic strategy that addresses many of the personal and systemic barriers to the traditional transitioning approaches. Current evidence also suggests that these agents may be cost-effective from patient, payer, and hospital perspectives. Barriers to broader use of laLGPs include, among others, a relative lack of prospective data regarding efficacy in serious infections, a narrow United States Food and Drug Administration-approved indication restricted to only acute bacterial skin and skin structure infections, and lack of reimbursement infrastructure for inpatient settings.
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Affiliation(s)
- Martin Krsak
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Taylor Morrisette
- Department of Pharmacy-Infectious Diseases, University of Colorado Hospital, Aurora, Colorado.,Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | - Matthew Miller
- Department of Pharmacy-Infectious Diseases, University of Colorado Hospital, Aurora, Colorado
| | - Kyle Molina
- Department of Pharmacy-Infectious Diseases, University of Colorado Hospital, Aurora, Colorado.,Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | - Misha Huang
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura Damioli
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Larissa Pisney
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Megan Wong
- Department of Pharmacy-Orthopedics, University of Colorado Hospital, Aurora, Colorado
| | - Eric Poeschla
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Gonzalez PL, Rappo U, Akinapelli K, McGregor JS, Puttagunta S, Dunne MW. Treatment of acute bacterial skin and skin structure infection with single-dose dalbavancin in persons who inject drugs. Drugs Context 2018; 7:212559. [PMID: 30574170 PMCID: PMC6292452 DOI: 10.7573/dic.212559] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022] Open
Abstract
Background Persons who inject drugs (PWID) are at increased risk of acute bacterial skin and skin structure infections (ABSSSIs), a growing healthcare concern. Multiple medical, social, and economic issues, including adherence and comorbidities, complicate the medical care of the PWID population, adversely affecting patient outcomes. Methods We assessed demographics and outcomes for the PWID population in a double-blind trial of 698 patients randomized to dalbavancin 1500 mg as a single intravenous (IV) infusion or as a 2-dose regimen (1000 mg IV on day 1; 500 mg IV on day 8) for ABSSSI. The primary endpoint was ≥20% reduction in erythema at 48–72 hours in the intent-to-treat population; clinical status was also assessed at days 14 and 28. Results There were 212/698 (30.4%) patients with a history of injection drug use in this clinical trial. Dalbavancin efficacy was similar between the single- and 2-dose therapy groups in the PWID and non-PWID populations at all timepoints. Dalbavancin was well tolerated in the PWID population, with similar rates of adverse events as the non-PWID population. Conclusion Dalbavancin as a single-dose or 2-dose regimen had similar efficacy for the treatment of ABSSSI at all timepoints in the PWID and non-PWID populations. A single 30-minute IV infusion would eliminate the need for indwelling IV access. The convenience of a single dose supervised in a health setting may also optimize treatment adherence in the PWID population.
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Affiliation(s)
| | - Urania Rappo
- Clinical Development, Allergan plc, Madison, NJ, USA
| | | | | | - Sailaja Puttagunta
- Medical Affairs, Allergan plc, Madison, NJ, USA.,Current affiliation: Iterum Therapeutics, Old Saybrook, CT, USA
| | - Michael W Dunne
- Current affiliation: Iterum Therapeutics, Old Saybrook, CT, USA.,R&D, Allergan plc, Madison, NJ, USA
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Randhawa G, Azarbar A, Dong H, Milloy MJ, Kerr T, Hayashi K. Childhood Trauma and the Inability to Access Hospital Care Among People who Inject Drugs. J Trauma Stress 2018; 31:383-390. [PMID: 29924415 PMCID: PMC6026062 DOI: 10.1002/jts.22286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 01/20/2018] [Accepted: 01/31/2018] [Indexed: 12/12/2022]
Abstract
Childhood traumatic experiences can disrupt attachment, influence personality development, and precipitate chronic disease. Although the repercussions of these experiences may also pose a barrier to healthcare, few studies have examined the association between childhood trauma and access to healthcare. Therefore, we sought to investigate whether a history of childhood trauma is associated with self-reported inability to access hospital care among persons who inject drugs (PWID). Data were derived from two prospective cohorts of PWID in Vancouver, Canada. We used multivariable generalized estimating equations to examine associations between five types of childhood trauma and self-reported inability to access hospital care, both overall and specifically due to perceived mistreatment by hospital staff. In total, 300 participants (18.3%) reported having tried but being unable to access hospital care in the previous 6 months at some point during the study period; the primary reason was perceived mistreatment by hospital staff (32.1%). In multivariable analyses, childhood emotional abuse was independently associated with self-reported inability to access hospital care, adjusted odds ratio (AOR) = 1.51, 95% CI [1.03, 2.20]. Childhood physical neglect was also independently associated with inability to access care due to perceived mistreatment by hospital staff, AOR = 1.80, 95% CI [1.11, 2.93]. This suggests potentially damaging consequences of early trauma in adult PWID populations. Further, this study emphasizes the need for trauma-informed models of care as well as the need to improve therapeutic alliances with survivors of childhood trauma in the PWID population.
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Affiliation(s)
- Gurdeeshpal Randhawa
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Ataa Azarbar
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Huiru Dong
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - MJ Milloy
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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