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Bluthenthal RN, Humphrey JL, Strack CN, Wenger LD, LaKosky P, Patel SV, Kral AH, Lambdin B. Racialized environments and syringe services program implementation: County-level factors. Drug Alcohol Depend 2024; 263:112430. [PMID: 39216198 PMCID: PMC11409812 DOI: 10.1016/j.drugalcdep.2024.112430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 08/10/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Racialized health inequities in substance use-related harms might emerge from differential access to syringe service programs (SSPs). To explore this, we examined the association between county-level racialized environments, other factors, and (1) SSP presence, and (2) per capita syringe and (3) naloxone distribution. METHODS 2021 US National Survey of SSP data (n=295/412;72 % response rate) was used to identify SSP presence and the sum of syringes and naloxone doses distributed in 2020 by county. Study measures included racial residential segregation (RRS; i.e., divergence and dissimilarity indexes for Black:Non-Hispanic White & Hispanic:Non-Hispanic White) and covariates (i.e., demographic proportions, urban/suburban/rural classifications, 2020 US presidential Republican vote share, and overdose mortality from 2019). We used logit Generalized Estimating Equations to determine factors associated with county-level SSP presence, and zero inflated negative binomial regression models to determine factors associated with per capita syringe and naloxone distribution. RESULTS SSPs were reported in 9 % (283/3106) of US counties. SSP presence was associated with higher divergence and dissimilarity indexes, urban and suburban counties, higher opioid overdose mortality, and lower 2020 Republican presidential vote share. Per capita syringes distributed was associated with lower RRS (divergence and Hispanic:White dissimilarity), lower racially minoritized population proportions and rural counties, while per capita naloxone distribution was associated with lower Hispanic and "other" population proportions, and rural counties. CONCLUSIONS Racialized environments are associated with SSP presence but not the scope of those programs. Preventing HIV and HCV outbreaks, and overdose deaths requires addressing community level factors that influence SSP implementation and accessibility.
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Affiliation(s)
- Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | | | | | | | - Paul LaKosky
- North American Syringe Exchange Network, Tacoma, WA, USA
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Anderson ES, Frazee BW. The Intersection of Substance Use Disorders and Infectious Diseases in the Emergency Department. Emerg Med Clin North Am 2024; 42:391-413. [PMID: 38641396 DOI: 10.1016/j.emc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Substance use disorders (SUDs) intersect clinically with many infectious diseases, leading to significant morbidity and mortality if either condition is inadequately treated. In this article, we will describe commonly seen SUDs in the emergency department (ED) as well as their associated infectious diseases, discuss social drivers of patient outcomes, and introduce novel ED-based interventions for co-occurring conditions. Clinicians should come away from this article with prescriptions for both antimicrobial medications and pharmacotherapy for SUDs, as well as an appreciation for social barriers, to care for these patients.
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Affiliation(s)
- Erik S Anderson
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA; Division of Addiction Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Bradley W Frazee
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
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Morgan B, Lancaster R, Boyagoda B, Ananda R, Attwood LO, Jacka D, Woolley I. The burden of skin and soft tissue, bone and joint infections in an Australian cohort of people who inject drugs. BMC Infect Dis 2024; 24:299. [PMID: 38454356 PMCID: PMC10918955 DOI: 10.1186/s12879-024-09143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION There are currently limited data regarding the clinical and economic significance of skin and soft tissue infections (SSTI) and bone and joint infections in Australian people who inject drugs (PWID). METHODS Retrospective cohort study in adult PWID admitted to Monash Health, a large heath care network with six hospitals in Victoria, Australia. Inpatients were identified using administrative datasets and International Classification of Disease (ICD-10) coding for specific infection-related conditions. Cost analysis was based on mean ward, intensive care and hospital-in-the-home (HITH) lengths of stay. Spinal infections and endocarditis were excluded as part of previous studies. RESULTS A total of 185 PWID (61 female, 124 male, median age 37) meeting the study criteria were admitted to Monash Health between January 2010 and January 2021. Admitting diagnoses included 78 skin abscesses, 80 cellulitis, 17 septic arthritis, 4 osteomyelitis, 3 thrombophlebitis and 1 each of necrotising fasciitis, vasculitis and myositis. Pain (87.5%) and swelling (75.1%) were the most common presenting complaints. Opioids (67.4%) and methamphetamine (37.5%) were the most common primary drugs injected. Almost half (46.5%) of patients had concurrent active hepatitis C (HCV) infection on admission. Hepatitis B (HBV) and Human Immunodeficiency Virus (HIV) were uncommon. The most significant causative organism was methicillin-susceptible Staphylococcus aureus (24.9%). In 40.0% (74/185) no organism was identified. Patients required a median acute hospital stay of 5 days (2-51 days). There were 15 patients admitted to the intensive care unit (ICU) with median duration 2 days. PICC line insertion for antibiotics was required in 16.8% of patients, while 51.4% required surgical intervention. Median duration of both oral and IV antibiotic therapy was 11 days. Almost half (48.6%) of patients were enrolled in an opioid maintenance program on discharge. Average estimated expenditure was AUD $16, 528 per admission. CONCLUSION Skin and soft tissue and joint infections are a major cause of morbidity for PWID. Admission to hospital provides opportunistic involvement of addiction specialty services.
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Affiliation(s)
- B Morgan
- Department of Medicine, Monash Health, Clayton, Australia.
| | - R Lancaster
- Addiction Medicine Unit, Monash Health, Clayton, Australia
| | - B Boyagoda
- Central Clinical School, Monash University, Clayton, Australia
| | - R Ananda
- Department of Medicine, Monash Health, Clayton, Australia
| | - L O Attwood
- Central Clinical School, Monash University, Clayton, Australia
- Department of Infectious Diseases, Alfred Health, Clayton, Australia
- Monash Infectious Diseases, Monash Health, Clayton, Australia
| | - D Jacka
- Addiction Medicine Unit, Monash Health, Clayton, Australia
| | - I Woolley
- Central Clinical School, Monash University, Clayton, Australia.
- Department of Infectious Diseases, Alfred Health, Clayton, Australia.
- Monash Infectious Diseases, Monash Health, Clayton, Australia.
- School of Clinical Sciences, Monash University, Clayton, Australia.
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Brothers TD, Lewer D, Jones N, Colledge-Frisby S, Bonn M, Wheeler A, Grebely J, Farrell M, Hickman M, Hayward A, Degenhardt L. Effect of incarceration and opioid agonist treatment transitions on risk of hospitalisation with injection drug use-associated bacterial infections: A self-controlled case series in New South Wales, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104218. [PMID: 37813083 DOI: 10.1016/j.drugpo.2023.104218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Transitional times in opioid use, such as release from prison and discontinuation of opioid agonist treatment (OAT), are associated with health harms due to changing drug consumption practices and limited access to health and social supports. Using a self-controlled (within-person) study design, we aimed to understand if these transitions increase risks of injection drug use-associated bacterial infections. METHODS We performed a self-controlled case series among a cohort of people with opioid use disorder (who had all previously accessed OAT) in New South Wales, Australia, 2001-2018. The outcome was hospitalisation with injecting-related bacterial infections. We divided participants' observed days into time windows related to incarceration and OAT receipt. We compared hospitalization rates during focal (exposure) windows and referent (control) windows (i.e., 5-52 weeks continuously not incarcerated or continuously receiving OAT). We estimated adjusted incidence rate ratios (aIRR) using conditional logistic regression, adjusted for time-varying confounders. RESULTS There were 7590 participants who experienced hospitalisation with injecting-related bacterial infections (35% female; median age 38 years; 78% hospitalised with skin and soft-tissue infections). Risk for injecting-related bacterial infections was elevated for two weeks following release from prison (aIRR 1.45; 95%CI 1.22-1.72). Risk was increased during two weeks before (aIRR 1.89; 95%CI 1.59-2.25) and after (aIRR 1.91; 95%CI 1.54-2.36) discontinuation of OAT, and during two weeks before (aIRR 3.63; 95%CI 3.13-4.22) and after (aIRR 2.52; 95%CI 2.09-3.04) OAT initiation. CONCLUSION Risk of injecting-related bacterial infections varies greatly within-individuals over time. Risk is raised immediately after prison release, and around initiation and discontinuation of OAT. Social contextual factors likely contribute to excess risks at transitions in incarceration and OAT exposure.
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Affiliation(s)
- Thomas D Brothers
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia; UCL Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, United Kingdom; Division of General Internal Medicine, Department of Medicine, Dalhousie University, Canada.
| | - Dan Lewer
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia; UCL Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, United Kingdom; Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Nicola Jones
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia
| | | | - Matthew Bonn
- Canadian Association of People who Use Drugs (CAPUD), Canada
| | - Alice Wheeler
- Kirby Institute, University of New South Wales, Australia
| | - Jason Grebely
- Kirby Institute, University of New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, United Kingdom
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia
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Kesten J, Hussey D, Lord C, Roberts L, Bayliss J, Erswell H, Preston A, Telfer M, Scott J, Harris M, Mellon D, Hickman M, MacArthur G, Fisher H. Development, acceptability and feasibility of a personalised, behavioural intervention to prevent bacterial skin and soft tissue infections among people who inject drugs: a mixed-methods Person-Based Approach study. Harm Reduct J 2023; 20:114. [PMID: 37608267 PMCID: PMC10463350 DOI: 10.1186/s12954-023-00823-9] [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: 12/02/2022] [Accepted: 07/10/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Skin and soft tissue infections (SSTI) among people who inject drugs (PWID) are a public health concern. This study aimed to co-produce and assess the acceptability and feasibility of a behavioural intervention to prevent SSTI. METHODS The Person-Based Approach (PBA) was followed which involves: (i) collating and analysing evidence; (ii) developing guiding principles; (iii) a behavioural analysis; (iv) logic model development; and (v) designing and refining intervention materials. Co-production activities with target group representatives and key collaborators obtained feedback on the intervention which was used to refine its design and content. The intervention, harm reduction advice cards to support conversation between service provider and PWID and resources to support safer injecting practice, was piloted with 13 PWID by four service providers in Bristol and evaluated using a mixed-methods approach. Semi-structured interviews were conducted with 11 PWID and four service providers. Questionnaires completed by all PWID recorded demographic characteristics, SSTI, drug use and treatment history. Interviews were analysed thematically and questionnaires were analysed descriptively. RESULTS Published literature highlighted structural barriers to safer injecting practices, such as access to hygienic injecting environments and injecting practices associated with SSTI included: limited handwashing/injection-site swabbing and use of too much acidifier to dissolve drugs. Co-production activities and the literature indicated vein care and minimisation of pain as PWID priorities. The importance of service provider-client relationships and non-stigmatising delivery was highlighted through the co-production work. Providing practical resources was identified as important to address environmental constraints to safer injecting practices. Most participants receiving the intervention were White British, male, had a history of SSTI and on average were 43.6 years old and had injected for 22.7 years. The intervention was well-received by PWID and service providers. Intervention content and materials given out to support harm reduction were viewed positively. The intervention appeared to support reflections on and intentions to change injecting behaviours, though barriers to safer injecting practice remained prominent. CONCLUSIONS The PBA ensured the intervention aligned to the priorities of PWID. It was viewed as acceptable and mostly feasible to PWID and service providers and has transferability promise. Further implementation alongside broader harm reduction interventions is needed.
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Affiliation(s)
- Joanna Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- The National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | | | | | | | - James Bayliss
- Bristol, North Somerset, South Gloucestershire Integrated Care System, Bristol, UK
| | - Helen Erswell
- UK Health Security Agency (UKHSA), South West Region, Bristol, UK
| | | | | | - Jenny Scott
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Dominic Mellon
- UK Health Security Agency (UKHSA), South West Region, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Georgie MacArthur
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Harriet Fisher
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Stevenson N, Suttie S, Fernandes E, Rae N. Acute infections in people who inject drugs. BMJ 2022; 379:e072635. [PMID: 36207027 DOI: 10.1136/bmj-2022-072635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Stuart Suttie
- Department of Vascular Surgery, Ninewells Hospital, Dundee
| | - Eduardo Fernandes
- Department of Surgery, University of Illinois Health Science System, Chicago, Illinois, USA
| | - Nikolas Rae
- Infection Unit, Ninewells Hospital, Dundee DD1 9SY, UK
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Colledge-Frisby S, Jones N, Larney S, Peacock A, Lewer D, Brothers TD, Hickman M, Farrell M, Degenhardt L. The impact of opioid agonist treatment on hospitalisations for injecting-related diseases among an opioid dependent population: A retrospective data linkage study. Drug Alcohol Depend 2022; 236:109494. [PMID: 35605532 DOI: 10.1016/j.drugalcdep.2022.109494] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Injecting-related bacterial and fungal infections cause substantial illness and disability among people who use illicit drugs. Opioid agonist treatment (OAT) reduces injecting frequency and the transmission of blood borne viruses. We estimated the impact of OAT on hospitalisations for non-viral infections and examine trends in incidence over time. METHODS We conducted a retrospective cohort study using linked administrative data. The cohort included 47 163 individuals starting OAT between August 2001 and December 2017 in New South Wales, Australia, with 454 951 person-years of follow-up. The primary outcome was hospitalisation for an injecting-related disease. The primary exposure was OAT status (out of OAT, first four weeks of OAT, and OAT retention [i.e., more than four weeks in treatment]). Covariates included demographic characteristics, year of hospitalisation, and recent clinical treatment. RESULTS 9122 participants (19.3%) had at least one hospitalisation for any injecting-related disease. Compared to time out of treatment, retention on OAT was associated with a reduced rate of injecting-related diseases (adjusted rate ratio[ARR]=0.92; 95%CI 0.87-0.97). The first four weeks of treatment was associated with an increased rate (ARR 1.53, 95%CI 1.38-1.70), which we believe is explained by referral pathways between hospital and community OAT services. The age-adjusted incidence rates of hospitalisations for any injecting-related disease increased from 34.8 (95% CI =30.2-40.0) per 1000 person-years in 2001 to 54.9 (95%CI=51.3-58.8) in 2017. INTERPRETATION Stable OAT is associated with reduced hospitalisations for injecting-related bacterial infections; however, OAT appears insufficient to prevent these harms as the rate of these infections is increasing in Australia.
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Affiliation(s)
- Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; Burnet Institute, Melbourne, Australia.
| | - Nicola Jones
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Sarah Larney
- CHUM Research Centre, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; School of Psychology, University of Tasmania, Hobart, Australia
| | - Dan Lewer
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Thomas D Brothers
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia; UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Barocas JA, Eftekhari Yazdi G, Savinkina A, Nolen S, Savitzky C, Samet JH, Englander H, Linas BP. Long-term Infective Endocarditis Mortality Associated With Injection Opioid Use in the United States: A Modeling Study. Clin Infect Dis 2021; 73:e3661-e3669. [PMID: 32901815 PMCID: PMC8662770 DOI: 10.1093/cid/ciaa1346] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The expansion of the US opioid epidemic has led to significant increases in infections, such as infective endocarditis (IE), which is tied to injection behaviors. We aimed to estimate the population-level IE mortality rate among people who inject opioids and compare the risk of IE death against the risks of death from other causes. METHODS We developed a microsimulation model of the natural history of injection opioid use. We defined injection behavior profiles by both injection frequency and injection techniques. We accounted for competing risks of death and populated the model with primary and published data. We modeled cohorts of 1 million individuals with different injection behavior profiles until age 60 years. We combined model-generated estimates with published data to project the total expected number of IE deaths in the United States by 2030. RESULTS The probabilities of death from IE by age 60 years for 20-, 30-, and 40-year-old men with high-frequency use with higher infection risk techniques compared to lower risk techniques for IE were 53.8% versus 3.7%, 51.4% versus 3.1%, and 44.5% versus 2.2%, respectively. The predicted population-level attributable fraction of 10-year mortality from IE among all risk groups was 20%. We estimated that approximately 257 800 people are expected to die from IE by 2030. CONCLUSIONS The expected burden of IE among people who inject opioids in the United States is large. Adopting a harm reduction approach, including through expansion of syringe service programs, to address injection behaviors could have a major impact on decreasing the mortality rate associated with the opioid epidemic.
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Affiliation(s)
- Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Alexandra Savinkina
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Shayla Nolen
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Caroline Savitzky
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Honora Englander
- Division of Hospital Medicine, Oregon Health Sciences University, Portland, Oregon, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
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Association of skin infections with sharing of injection drug preparation equipment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103198. [PMID: 33744668 PMCID: PMC8373634 DOI: 10.1016/j.drugpo.2021.103198] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sharing needles and injection drug preparation equipment (IDPE) among people who inject drugs (PWID) are well-established risk factors for viral transmission. Shared needles and IDPE may serve as bacterial niduses for skin and soft tissue infections (SSTI). Given the rising rates of SSTI in PWID, we investigated the association of needle and IDPE sharing on incidence of SSTI in a cohort of PWID. METHODS Inpatient PWID (N = 252) were recruited to a randomized controlled trial of an intervention aimed at reducing infections. The primary outcome was self-reported incidence of SSTI one-year post-hospitalization. In this secondary analysis, we assessed two variables: 1) sharing of IDPE alone, 2) sharing needles with or without IDPE, and compared these groups separately to persons who reported no sharing of needles or IDPE via a mixed-effects negative binomial regression model to estimate the effect of baseline sharing behavior on SSTI during follow-up via incidence rate ratios (IRR). RESULTS Participant characteristics: 38 years [mean], 58% male, 60% White, 90% primarily injected opioids, 1.58 (± 2.35) mean SSTI in the year prior to baseline. In terms of sharing behavior, 29% didn't share needles or IDPE, 13% shared IDPE only, and 58% shared needles with or without IDPE three months prior to baseline. After adjusting for co-variables, PWID who shared IDPE alone had a 2.2 fold higher IRR of SSTI (95%CI 1.27; 3.85, p = 0.005) and PWID who shared needles with or without IDPE had a 3.31 fold higher IRR of SSTI (95%CI 2.04; 5.37, p < 0.001), compared to those who did not share any equipment. The number of SSTI at baseline was associated with an IRR of 1.20 of SSTI during follow-up (95%CI 1.09; 1.32, p < 0.001). CONCLUSIONS In this cohort of hospitalized PWID, we found a significant association between baseline sharing of IDPE alone and of sharing of needles with or without IDPE with one-year incidence of SSTI.
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Dunleavy K, Hutchinson SJ, Palmateer N, Goldberg D, Taylor A, Munro A, Shepherd SJ, Gunson RN, Given S, Campbell J, McAuley A. The uptake of foil from needle and syringe provision services and its role in smoking or snorting heroin among people who inject drugs in Scotland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103369. [PMID: 34340168 DOI: 10.1016/j.drugpo.2021.103369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/01/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the UK, legislation was implemented in 2014 allowing needle and syringe provision (NSP) services to offer foil to people who inject drugs (PWID) to encourage smoking rather than injecting. This paper aims to examine the association between foil uptake and smoking or snorting heroin among PWID. This is the first large scale national study to examine foil uptake and smoking or snorting heroin among PWID post legislative change. METHOD Data from 1453 PWID interviewed via Scotland's Needle Exchange Surveillance Initiative in 2017-2018 were analysed using multivariate logistic regression. RESULTS Overall, 36% of PWID had obtained foil from NSP services in the past six months. The odds of smoking or snorting heroin were higher among those who had obtained foil (Adjusted Odds Ratio (AOR) 3.79 (95% CI 2.98-4.82) p<0.001) compared to those who had not. Smoking or snorting heroin was associated with lower odds of injecting four or more times daily (AOR 0.60 (95% CI 0.40-0.90) p = 0.012) and injecting into the groin or neck (AOR 0.57 (95% CI 0.46-0.71) p<0.001) but increased odds of having had a skin and soft tissue infection (SSTI) (AOR 1.49 (95% CI 1.17-1.89) p = 0.001) and having experienced an overdose (AOR 1.58 (95% CI 1.18-2.10) p = 0.002) both in the past year. CONCLUSION The promotion of smoking drugs via foil provision from NSP services may contribute to the package of harm reduction measures for PWID alongside the provision of injecting equipment. We found that those in receipt of foil were more likely to smoke or snort heroin, and that smoking or snorting heroin was associated with a lower likelihood of some risky injecting behaviours, namely frequent injecting and injecting into the groin or neck. But it remains uncertain if the provision of foil can lead to a reduction in health harms, such as SSTI and overdose. Future research is needed to understand PWID motivations for smoking drugs, obtaining foil from NSP services, and its uses particularly among polydrug users.
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Affiliation(s)
- Karen Dunleavy
- School of Education and Social Sciences, University of the West of Scotland, Paisley, PA1 2BE, Scotland.
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; Public Health Scotland, NHS National Services Scotland, Glasgow, Scotland
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; Public Health Scotland, NHS National Services Scotland, Glasgow, Scotland
| | - David Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; Public Health Scotland, NHS National Services Scotland, Glasgow, Scotland
| | - Avril Taylor
- School of Education and Social Sciences, University of the West of Scotland, Paisley, PA1 2BE, Scotland
| | - Alison Munro
- School of Health Sciences, University of Dundee, Dundee, Scotland
| | | | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow, Scotland
| | - Sophie Given
- Scottish Drugs Forum, 139 Morrison Street, Edinburgh, Scotland
| | | | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; Public Health Scotland, NHS National Services Scotland, Glasgow, Scotland
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Saldana CS, Vyas DA, Wurcel AG. Soft Tissue, Bone, and Joint Infections in People Who Inject Drugs. Infect Dis Clin North Am 2021; 34:495-509. [PMID: 32782098 DOI: 10.1016/j.idc.2020.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Infections are a common complication among people who inject drugs (PWID). Skin and soft tissue infections (SSTI) as well as bone and joint infections comprise a significant source of morbidity and mortality among this population. The appropriate recognition and management of these infections are critical for providers, as is familiarity with harm-reduction strategies. This review provides an overview of the presentation and management of SSTI and bone and joint infections among PWID, as well as key prevention measures that providers can take.
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Affiliation(s)
- Carlos S Saldana
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Darshali A Vyas
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Alysse G Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
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12
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Tsybina P, Kassir S, Clark M, Skinner S. Hospital admissions and mortality due to complications of injection drug use in two hospitals in Regina, Canada: retrospective chart review. Harm Reduct J 2021; 18:44. [PMID: 33882950 PMCID: PMC8061207 DOI: 10.1186/s12954-021-00492-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infectious complications of injection drug use (IDU) often require lengthy inpatient treatment. Our objective was to identify the number of admissions related to IDU in Regina, Canada, as well as describe patient demographics and comorbidities, yearly mortality, readmission rate, and cumulative cost of these hospitalizations between January 1 and December 31, 2018. Additionally, we sought to identify factors that increased risk of death or readmission. METHODS This study is a retrospective chart review conducted at the two hospitals in Regina. Eligible study cases were identified by querying the discharge database for predetermined International Classification of Diseases code combinations. Electronic medical records were reviewed to assess whether each admission met inclusion criteria, and hospitalization and patient data were subsequently extracted for all included admissions. Mortality data were gleaned from hospital and Ministry of Health databases. Data were analyzed using Excel and IBM SPSS Statistics to identify common comorbidities, admission diagnoses, and costs, as well as to compare patients with a single admission during the study period to those with multiple admissions. Logistic regression analysis was used to identify the relationship between individual variables and in- and out-of-hospital annual mortality. RESULTS One hundred and forty-nine admissions were included, with 102 unique patients identified. Common comorbidities included hepatitis C (47%), human immunodeficiency virus (HIV) (25%), and comorbid psychiatric disorders (19%). In 23% of all admissions, patients left hospital prior to treatment completion, and 27% of patients experienced multiple admissions. Female patients and those with chronic pain were more likely to be readmitted (p = 0.024 and p = 0.029, respectively). Patients admitted with infective endocarditis were more likely to die during hospitalization (p = 0.0001). The overall mortality was 15% in our cohort. The estimated cumulative cost of inpatient treatment of complications of IDU in Regina was $3.7 million CAD in 2018. CONCLUSION Patients with history of IDU and hospital admission experience high mortality rates in Regina, a city with paucity of inpatient supports for persons who use injection drugs. Needle syringe programs, opioid agonist therapy, and safe consumption sites have been shown to improve outcomes as well as reduce healthcare costs for this patient population. We will use our findings to advocate for increased access to these harm reduction strategies in Regina, particularly for inpatients.
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Affiliation(s)
- Polina Tsybina
- College of Medicine, Regina General Hospital, University of Saskatchewan, 1440 14th Avenue, Regina, SK, S4P 0W5, Canada.
| | - Sandy Kassir
- Research Department, Saskatchewan Health Authority, Regina, Canada
| | - Megan Clark
- Department of Family Medicine, University of Saskatchewan, Regina, Canada
| | - Stuart Skinner
- Department of Medicine, University of Saskatchewan, Regina, Canada
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13
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Huyck MA, Messmer S, Mayer SM, Yingling C. Intrawound injection of heroin as a drug delivery route among a cohort of people who inject drugs. Health Sci Rep 2021; 4:e231. [PMID: 33490636 PMCID: PMC7813019 DOI: 10.1002/hsr2.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael Anthony Huyck
- Department of Health Systems ScienceCollege of Nursing, University of Illinois at ChicagoChicagoIllinois
| | - Sarah Messmer
- College of Medicine and Department of Infectious DiseaseUniversity of Illinois at ChicagoChicagoIllinois
| | - Stockton McQuade Mayer
- College of Medicine and Department of PediatricsUniversity of Illinois at ChicagoChicagoIllinois
| | - Charles Yingling
- College of Nursing and Department of Health Systems ScienceUniversity of Illinois at ChicagoChicagoIllinois
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14
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Yoshida Y, Takashima R, Yano R. Is skin disinfection before subcutaneous injection necessary? The reasoning of Certified Nurses in Infection Control in Japan. PLoS One 2021; 16:e0245202. [PMID: 33418557 PMCID: PMC7794031 DOI: 10.1371/journal.pone.0245202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022] Open
Abstract
Nurses continue to disinfect the skin before administering subcutaneous injections as a standard process in clinical settings; despite evidence that disinfection is not necessary. To implement evidence-based practice, it is critical to explore why this gap between "evidence" and "practice" exists. This study aimed to describe the reasons offered by Certified Nurses in Infection Control (CNIC) in Japan for performing skin disinfection before subcutaneous injection. Adopting an inductive qualitative design, interviews were conducted with 10 CNIC in 2013. According to the participants, skin disinfection before subcutaneous injection: (a) was common practice; (b) may have been beneficial if it was omitted; (c) adhered to hospital norms; (d) prevented persistent suspicion of infection; (e) had no detrimental effect; (f) was an ingrained custom; and (g) involved a tacit approval for not disinfecting in home care settings. The themes (c) and (g) were cited as the main reasons affecting decision-making. The CNIC administered injections following skin disinfection in hospitals in accordance with hospital norms. On the contrary, outside the hospital, they administered subcutaneous injections without skin disinfection. All themes except (b) and (g) reflect the barriers and resistance to omitting skin disinfection, while (g) shows that it is already partly implemented in home care settings. It is necessary to create a guideline for skin disinfection before subcutaneous injection that considers the quality of life of patients at home, their physical conditions, and the surrounding environment at the time of injection, in addition to the guidelines applicable in hospitals.
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Affiliation(s)
- Yuko Yoshida
- Department of Fundamental Nursing, Hokkaido University Faculty of Health Sciences, Sapporo, Hokkaido, Japan
| | - Risa Takashima
- Department of Functioning and Disability, Hokkaido University Faculty of Health Sciences, Sapporo, Hokkaido, Japan
| | - Rika Yano
- Department of Fundamental Nursing, Hokkaido University Faculty of Health Sciences, Sapporo, Hokkaido, Japan
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15
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Kimmel SD, Gaeta JM, Hadland SE, Hallett E, Marshall BDL. Principles of Harm Reduction for Young People Who Use Drugs. Pediatrics 2021; 147:S240-S248. [PMID: 33386326 PMCID: PMC7907587 DOI: 10.1542/peds.2020-023523g] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
In summarizing the proceedings of a longitudinal meeting of experts on substance use disorders among adolescents and young adults, we review 2 principles of care related to harm reduction for young adults with substance use disorders. The first is that harm reduction services are critical to keeping young adults alive and healthy and can offer opportunities for future engagement in treatment. Such services therefore should be offered at every opportunity, regardless of an individual's interest or ability to minimize use of substances. The second is that all evidence-based harm reduction strategies available to older adults should be available to young adults and that whenever possible, harm reduction programs should be tailored to young adults and be developmentally appropriate.
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Affiliation(s)
- Simeon D Kimmel
- Clinical Addition Research and Education Unit,
- Sections of General Internal Medicine and
- Infectious Diseases, Department of Medicine, Boston University School of Medicine and
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
| | - Jessie M Gaeta
- Sections of General Internal Medicine and
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Scott E Hadland
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University and Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts; and
| | - Eliza Hallett
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, Boston University and Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts; and
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
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16
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Abstract
Persons who inject drugs are at high risk for skin and soft tissue infections. Infections range from simple abscesses and uncomplicated cellulitis to life-threatening and limb-threatening infections. These infections are predominantly caused by gram-positive organisms with Staphylococcus aureus, Streptococcus pyogenes, and other streptococcal species being most common. Although antimicrobial therapy has an important role in treatment of these infections, surgical incision, drainage, and debridement of devitalized tissue are primary. Strategies that decrease the frequency of injection drug use, needle sharing, use of contaminated equipment, and other risk behaviors may be effective in preventing these infections in persons who inject drugs.
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Affiliation(s)
- Henry F Chambers
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, Building 30, Room 3400, San Francisco, CA 94110, USA.
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17
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Peckham AM, Young EH. Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review. Open Forum Infect Dis 2020; 7:ofaa503. [PMID: 33241069 PMCID: PMC7676504 DOI: 10.1093/ofid/ofaa503] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Abstract
Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include (1) teaching and distribution of materials related to safer injection practice such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and postexposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.
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Affiliation(s)
- Alyssa M Peckham
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erika H Young
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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18
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Torres-Leguizamon M, Reynaud EG, Néfau T, Duplessy C. HaRePo (harm reduction by post): an innovative and effective harm reduction programme for people who use drugs using email, telephone, and post service. Harm Reduct J 2020; 17:59. [PMID: 32831094 PMCID: PMC7444046 DOI: 10.1186/s12954-020-00403-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/11/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Despite multiple harm reduction (HR) programmes worldwide, there are still an important number of people who use drugs (PWUD) who do not access those services. Their difficulties to obtain HR tools are due to their inability to reach such services (remoteness and/or limited customer service hours), costs, quantitative restrictions, fear of judgement, lack of confidentiality in pharmacy, and unfamiliarity with HR programmes. We tested an innovative approach using the power of remote online communication and the national postal distribution network to improve HR tool access and counselling. METHODS Based on these observations, SAFE association created HaRePo in 2011, a free and confidential programme designed for people who have difficulties accessing HR tools and counselling. PWUD can access the programme by phone and/or email. An HR professional delivers HR counselling and HR tools and connects PWUD to other HR services, medical, and social workers. HR tools are prepared and sent according to the person's needs through the French postal service to consumers across Metropolitan France and overseas territories. RESULTS Since 2011, 1920 PWUD have benefited from HaRePo: 10,450 parcels were sent accounting for more than 1.7 million syringes and 6 million HR-related items. HaRePo receives positive feedback from PWUD who have improved their practices through remote but trusted communication. The percentage of people that, after joining the programme, never reuse and/or share HR tools have significantly increased. On average, 71.5% of beneficiaries never reuse syringes and 81% do not reuse needles. And they are 98.5% consumers who never share syringes and 99% needles any longer. Between 44 and 80% HaRePo beneficiaries have reported that their drug-related practices (injection, inhalation, and snorting) are now safer. Finally, between 39 and 53% HaRePo consumers declared that their overall physical state has improved (e.g. venous condition, the appearance of point of injection, swelling of arms, legs, and hands). CONCLUSION HaRePo is an innovative HR programme efficient for hard-to-reach PWUD. It shows evidence of a positive feedback loop for PWUD in improving their practices. Finally, HaRePo represents a clear benefit for health authorities in France, who decided to expand the programme in 2016.
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Affiliation(s)
| | - Emmanuel G Reynaud
- School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Thomas Néfau
- SAFE, 11 avenue de la Porte de la Plaine, 75015, Paris, France
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19
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Lewer D, Hope VD, Harris M, Kelleher M, Jewell A, Pritchard M, Strang J, Morley KI. Incidence and treatment costs of severe bacterial infections among people who inject heroin: A cohort study in South London, England. Drug Alcohol Depend 2020; 212:108057. [PMID: 32422537 PMCID: PMC7301433 DOI: 10.1016/j.drugalcdep.2020.108057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND People who inject drugs often get bacterial infections. Few longitudinal studies have reported the incidence and treatment costs of these infections. METHODS For a cohort of 2335 people who inject heroin entering treatment for drug dependence between 2006 and 2017 in London, England, we reported the rates of hospitalisation or death with primary causes of cutaneous abscess, cellulitis, phlebitis, septicaemia, osteomyelitis, septic arthritis, endocarditis, or necrotising fasciitis. We compared these rates to the general population. We also used NHS reference costs to calculate the cost of admissions. RESULTS During a median of 8.0 years of follow-up, 24 % of patients (570/2335) had a severe bacterial infection, most commonly presenting with cutaneous abscesses or cellulitis. Bacterial infections accounted for 13 % of all hospital admissions. The rate was 73 per 1000 person-years (95 % CI 69-77); 50 times the general population, and the rate remained high throughout follow-up. The rate of severe bacterial infections for women was 1.50 (95 % CI 1.32-1.69) times the rate for men. The mean cost per admission was £4980, and we estimate that the annual cost of hospital treatment for people who inject heroin in London is £4.5 million. CONCLUSIONS People who inject heroin have extreme and long-term risk of severe bacterial infections.
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Affiliation(s)
- Dan Lewer
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK.
| | - Vivian D Hope
- Public Health Institute, Liverpool John Moores University, 3rd Floor, Exchange Station, Tithebarn Street, Liverpool L2 2QP, UK
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Michael Kelleher
- South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK
| | - Amelia Jewell
- South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK
| | - Katherine I Morley
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Camberwell, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Monks Orchard Road Beckenham, London BR3 3BX, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, Level 3, 207 Bouverie Street, The University of Melbourne Victoria 3010 Australia; RAND Europe, Westbrook Centre, Milton Road, Cambridge CB4 1YG, UK
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20
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Huyck M, Mayer S, Messmer S, Yingling C. Community Wound Care Program Within a Syringe Exchange Program: Chicago, 2018-2019. Am J Public Health 2020; 110:1211-1213. [PMID: 32552028 DOI: 10.2105/ajph.2020.305681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
People who inject drugs (PWID) are at increased risk for developing wounds in addition to skin and soft tissue infections. The University of Illinois at Chicago College of Nursing, College of Medicine, and School of Public Health collaborated to establish a medical clinic serving PWID attending a Chicago syringe exchange program. A wound care program was implemented to improve clinicians' competence. During October 2018 to August 2019, 24% of all encounters were related to wound complaints.
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Affiliation(s)
- Michael Huyck
- The authors are with the University of Illinois at Chicago. Michael Huyck is with the Department of Health Systems Science, College of Nursing; Stockton Mayer is with the College of Medicine and Department of Infectious Disease; Sarah Messmer is with the College of Medicine and Department of Pediatrics; and Charles Yingling is with the College of Nursing and Department of Health Systems Science
| | - Stockton Mayer
- The authors are with the University of Illinois at Chicago. Michael Huyck is with the Department of Health Systems Science, College of Nursing; Stockton Mayer is with the College of Medicine and Department of Infectious Disease; Sarah Messmer is with the College of Medicine and Department of Pediatrics; and Charles Yingling is with the College of Nursing and Department of Health Systems Science
| | - Sarah Messmer
- The authors are with the University of Illinois at Chicago. Michael Huyck is with the Department of Health Systems Science, College of Nursing; Stockton Mayer is with the College of Medicine and Department of Infectious Disease; Sarah Messmer is with the College of Medicine and Department of Pediatrics; and Charles Yingling is with the College of Nursing and Department of Health Systems Science
| | - Charles Yingling
- The authors are with the University of Illinois at Chicago. Michael Huyck is with the Department of Health Systems Science, College of Nursing; Stockton Mayer is with the College of Medicine and Department of Infectious Disease; Sarah Messmer is with the College of Medicine and Department of Pediatrics; and Charles Yingling is with the College of Nursing and Department of Health Systems Science
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21
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Zaw C, Mehra D. The efficacy of syringe services programs in reducing skin and soft tissue infection-associated healthcare costs and multidrug-resistant bacteria. Am J Infect Control 2020; 48:467-468. [PMID: 31959540 DOI: 10.1016/j.ajic.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/06/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Catherine Zaw
- University of Miami, Miller School of Medicine, Miami, FL
| | - Divy Mehra
- Nova Southeastern University KP College of Osteopathic Medicine, Fort Lauderdale, FL.
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22
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Monteiro J, Phillips KT, Herman DS, Stewart C, Keosaian J, Anderson BJ, Stein MD. Self-treatment of skin infections by people who inject drugs. Drug Alcohol Depend 2020; 206:107695. [PMID: 31786397 DOI: 10.1016/j.drugalcdep.2019.107695] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Persons who inject drugs (PWID) experience high rates of skin and soft tissue infections (SSTI) and often access emergency or inpatient treatment. However, many PWID do not seek care and self-treat some or all of their infections. The goal of the current study was to examine predictors of self-treatment of SSTI in a sample of hospitalized PWID, and describe methods of and reasons for self-treatment. METHODS PWID (N = 252) were recruited from inpatient medical units at an urban safety-net hospital to join a behavioral intervention trial. The baseline interview focused on past-year SSTI incidence and related treatment, including reasons for not accessing medical care and methods of self-treatment. RESULTS Of study participants, 162 (64%) reported having at least one SSTI in the past year. This subset was 59.9% White/Caucasian with a mean age of 38.0 (SD + 10.5). One-third of these participants (32.3%) reported ever self-treating SSTI in the past year. In a logistic regression model, number of past-year infections (OR = 1.81, p < .001) and positive outlook (OR = 2.46, p < .001) were associated with self-treatment of SSTI. Common methods of self-treatment included mechanically draining sores, applying heat/warm compress, and cleaning affected areas. Continued drug use and belief that infections were not serious and could be self-treated were two main reasons for not seeking professional medical care. CONCLUSIONS Interventions targeting SSTI among PWID should include education on when to seek medical care and the risks of serious infection, and could be implemented at local clinics or harm reduction programs to increase access.
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Affiliation(s)
- Jordanna Monteiro
- Boston University School of Public Health and Boston Medical Center, 715 Albany Street, 2nd Floor, Boston, MA 02118, USA.
| | - Kristina T Phillips
- Center for Integrated Health Care Research (CIHR), Kaiser Permanente 501 Alakawa Street, Suite 201, Honolulu, Hawaii 96817 USA.
| | - Debra S Herman
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906 USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Catherine Stewart
- Boston University School of Public Health and Boston Medical Center, 715 Albany Street, 2nd Floor, Boston, MA 02118, USA.
| | - Julia Keosaian
- Boston University School of Public Health and Boston Medical Center, 715 Albany Street, 2nd Floor, Boston, MA 02118, USA.
| | | | - Michael D Stein
- Boston University School of Public Health and Boston Medical Center, 715 Albany Street, 2nd Floor, Boston, MA 02118, USA; Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906 USA.
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Moradi-Joo M, Ghiasvand H, Noroozi M, Armoon B, Noroozi A, Karimy M, Rostami A, Mirzaee MS, Hemmat M. Prevalence of skin and soft tissue infections and its related high-risk behaviors among people who inject drugs: A systematic review and meta-analysis. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1572805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Mohammad Moradi-Joo
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Alireza Noroozi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Psychiatrists, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR, Iran
| | - Mohammad Saeed Mirzaee
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Morteza Hemmat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
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24
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Dunleavy K, Hope V, Roy K, Taylor A. The experiences of people who inject drugs of skin and soft tissue infections and harm reduction: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 65:65-72. [PMID: 30665085 DOI: 10.1016/j.drugpo.2018.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bacterial skin and soft tissue infections (SSTI) among people who inject drugs (PWID) are considered a public health concern. There is a lack of qualitative research examining the lived experience of PWID who have had SSTI. This paper explores PWID views and experiences of their SSTI, their perceptions on the causes of their SSTI and their harm reduction (HR) behaviours. The implications for HR service delivery and practice will be discussed. METHODS Between October 2015-January 2016, 22 in-depth interviews were conducted with PWID who had experienced a SSTI within the past year. Interviewees were recruited from an injecting equipment provision service and a drug treatment service in Glasgow and Edinburgh respectively. The interview transcripts were transcribed verbatim and underwent thematic analysis. RESULTS We found that the experience of SSTI can cause strong negative feelings, including panic and stigma and that there was limited knowledge of SSTI prior to first hand experience. The awareness of the unacceptable social and physical consequences of SSTI fostered a sense of personal responsibility and agency which led to the introduction or improved HR uptake. However, when PWID were struggling to inject or when their physical and political environments were compromised there was an increased risk for SSTI and reduced effectiveness of HR. CONCLUSION Compared to HCV and HIV, SSTI as an injecting related harm has received less policy attention. Policy makers need to address SSTI HR within enabling environments, such as 'safer environment interventions'. It is recommended that peer based support, improved NSP provision and medically supervised injecting facilities are needed to deliver SSTI HR.
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Affiliation(s)
- Karen Dunleavy
- School of Media, Culture and Society, University of the West of Scotland, Paisley, PA1 2BE, Scotland, United Kingdom.
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, England, United Kingdom
| | - Kirsty Roy
- Health Protection Scotland, NHS National Services Scotland, Glasgow, Scotland, United Kingdom
| | - Avril Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley, PA1 2BE, Scotland, United Kingdom
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