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Jones JD, Chaple M, Rozen S, DelaCuesta C, Sosa ES, Bryant K. Empirical assessment of wounds among people who use substances. Drug Alcohol Depend 2024; 262:111375. [PMID: 38971028 DOI: 10.1016/j.drugalcdep.2024.111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Wounds are a significant source of morbidity among people who use substances (PWUS). This project sought to identify the incidence and severity of wounds among PWUS in the South Bronx, a region of New York City with one of the highest morbidities of substance use disorder. METHODS This study recruited PWUS within the past 30 days. Research staff were trained to document the presence and severity of wounds. The primary outcome measure was the incidence of wounds. Acceptability of on-the-street wound care was assessed by the number of participants encountered. The association between participant characteristics and wounds was also evaluated. RESULTS In total, 586 PWUS were assessed (19.4 % female: 69 % Hispanic; 23 % Black; 5 % White). Heroin (65.7 %) and psychostimulants (58.3 %) were the most commonly used drugs. Approximately 23 % of outreach recipients disclosed a wound. Among those with a wound, 60.9 % reported one wound, 27.8 % had two wounds, and 11.3 % had three or more wounds. Small wounds (approximately the size of a cherry) were the most common (78.6 %). Recent use of stimulants or heroin, along with intravenous use of any substance were significantly associated with having a wound. CONCLUSIONS This study found that drug-related wounds were common among PWUS. Toxicology data from other sources indicate that xylazine was present in the NYC market at the time, though its prevalence among the current sample is difficult to determine. The occurrence and severity of substance-related wounds in NYC should continue to be monitored as a function of changes in the xylazine adulteration.
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Affiliation(s)
- Jermaine D Jones
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Michael Chaple
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Stephanie Rozen
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States
| | - Courtney DelaCuesta
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Emely Santiago Sosa
- Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Kellie Bryant
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States
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Calderón-Villarreal A, Abramovitz D, Avelar Portillo LJ, Goldenberg S, Flanigan S, Quintana PJE, Harvey-Vera A, Vera CF, Rangel G, Strathdee SA, Kayser GL. Water, sanitation and hygiene insecurity predict abscess incidence among people who inject drugs in a binational US-Mexico metropolitan area: A longitudinal cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104485. [PMID: 38901113 DOI: 10.1016/j.drugpo.2024.104485] [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: 02/13/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION People who inject drugs (PWID) are at high risk of developing injection-related infections, including abscesses. Access to water, sanitation, and hygiene (WASH) are key human rights and services; yet these services have been underexplored as predictors of abscesses among PWID. METHODS Longitudinal analysis was employed among a cohort of PWID to determine if WASH insecurity (lack of access) was associated with abscess incidence in the Tijuana, Mexico and San Diego, United States metropolitan area during 24-months of follow-up survey data from 2020 to 2023. We calculated abscess prevalence at baseline and tracked the incidence of new abscesses among individuals without an abscess during the previous visit. Time dependent Cox regression modeling was employed with variance clustered by participant to characterize the relationship between WASH insecurity and abscess incidence. RESULTS At baseline, hand hygiene insecurity, bathing insecurity in the previous six months and open defecation in the last week, were reported by 60 %, 54 % and 38 % of participants, respectively; 21 % reported an abscess in the last six months. The incidence of abscesses was 24.4 (95 %CI: 21.1-27.6) per 100 person-years. After adjusting for covariates, the hazard of developing an abscess remained significantly elevated among individuals using non-improved (with risk of contamination) water sources (e.g., surface water) for preparing drugs (adjusted HR [adjHR]: 1.49 [95 %CI: 1.01-2.21], experiencing bathing insecurity (adjHR: 1.59 [95 %CI: 1.12-2.24]) and open defecation (adjHR: 1.65 [95 %CI: 1.16-2.35]). CONCLUSIONS PWID in the Tijuana-San Diego metropolitan area reported facing high rates of insecurity accessing WASH services. Abscess incidence was higher (four to nine times) than observed rate among PWID cohorts in other settings. Access to continuously available toilet facilities, bathing infrastructure, and safe water sources for preparing drugs for injection could prevent abscesses among PWID. Accessible WASH infrastructure should be ensured among PWID communities and promoted as a key component of harm reduction infrastructure.
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Affiliation(s)
- Alhelí Calderón-Villarreal
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego (UCSD), San Diego, CA, USA; School of Public Health, San Diego State University (SDSU), San Diego, CA, USA.
| | - Daniela Abramovitz
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Lourdes Johanna Avelar Portillo
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, CA, USA
| | - Shira Goldenberg
- School of Public Health, San Diego State University (SDSU), San Diego, CA, USA
| | | | | | - Alicia Harvey-Vera
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA; Universidad Xochicalco, Tijuana, Baja California, Mexico
| | - Carlos F Vera
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Gudelia Rangel
- El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico; Border Health Commission, Tijuana, Baja California, Mexico
| | - Steffanie A Strathdee
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Georgia L Kayser
- Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, CA, USA
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Benrubi LM, Silcox J, Hughto J, Stopka TJ, Palacios WR, Shrestha S, Case P, Green TC. Trends and correlates of abscess history among people who inject drugs in Massachusetts: A mixed methods exploration of experiences amidst a rapidly evolving drug supply. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100176. [PMID: 37753348 PMCID: PMC10518505 DOI: 10.1016/j.dadr.2023.100176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 09/28/2023]
Abstract
Background Injection drug use poses significant risk for skin and soft tissue infections, such as abscesses. In places with endemic fentanyl and an increasingly contaminated drug supply, injecting and injection-related harms may be increasing, yet are understudied. We aimed to explore abscess prevalence, experiences, and themes among people who inject drugs (PWID) in the context of an evolving drug supply. Methods Between 2019 and 2022, we surveyed and interviewed Massachusetts- based PWID about current drug use behaviors and abscess experiences. Chi-square tests explored correlates of abscess history and trends for past-year abscess percentages over time. Transcribed interview data were analyzed to identify themes related to abscess risk and opportunities for intervention. Results Of the 297 PWID surveyed, 65.3% reported having an abscess at the injection site in their lifetime; 67.5% of these instances occurred within the last year. Reported past-year abscesses increased from 36.7% to 75.6% between 2019 and 2022. Correlates of past-year abscesses included frequent injection; methamphetamine, crack, or fentanyl use; and injection into the neck or calf. Methadone treatment was associated with significantly fewer recent abscesses. Interview data (n=151) confirmed the identified abscess risks, including syringe sharing and lack of hygienic supplies. Qualitative interviews provided additional data regarding healthcare provider stigma contributing to healthcare avoidance and the self-treatment of abscesses with adverse results. Conclusions Abscesses are an increasing concern among PWID residing in areas of high fentanyl prevalence and a contaminated drug supply. Community drug checking, overdose prevention sites, injection hygiene interventions, and improved access to care are indicated.
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Affiliation(s)
- Leah M. Benrubi
- Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Joseph Silcox
- Brandeis University Opioid Policy Research Collaborative, 415 South Street, Waltham, MA 02453, USA
- University of Massachusetts - Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA
| | - Jaclyn Hughto
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Wilson R. Palacios
- University of Massachusetts, School of Criminology & Justice Studies, 113 Wilder Street, Lowell, MA 01854, USA
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Patricia Case
- Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Traci C. Green
- Brandeis University Opioid Policy Research Collaborative, 415 South Street, Waltham, MA 02453, USA
- COBRE on Opioids and Overdose at Rhode Island Hospital, 1125 North Main St., Providence, RI 02902, USA
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Moon KJ, Bryant I, Trinh A, Hasenstab KA, Carter B, Barclay R, Nawaz S. Differential risks of syringe service program participants in Central Ohio: a latent class analysis. Harm Reduct J 2023; 20:97. [PMID: 37507721 PMCID: PMC10386257 DOI: 10.1186/s12954-023-00824-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Significant heterogeneity exists among people who use drugs (PWUD). We identify distinct profiles of syringe service program (SSP) clients to (a) evaluate differential risk factors across subgroups and (b) inform harm reduction programming. METHODS Latent class analysis (LCA) was applied to identify subgroups of participants (N = 3418) in a SSP in Columbus, Ohio, from 2019 to 2021. Demographics (age, sex, race/ethnicity, sexual orientation, housing status) and drug use characteristics (substance[s] used, syringe gauge, needle length, using alone, mixing drugs, sharing supplies, reducing use, self-reported perceptions on the impact of use, and treatment/support resources) were used as indicators to define latent classes. A five-class LCA model was developed, and logistic regression was then employed to compare risk factors at program initiation and at follow-up visits between latent classes. RESULTS Five latent classes were identified: (1) heterosexual males using opioids/stimulants with housing instability and limited resources for treatment/support (16.1%), (2) heterosexual individuals using opioids with stable housing and resources for treatment/support (33.1%), (3) individuals using methamphetamine (12.4%), (4) young white individuals using opioids/methamphetamine (20.5%), and (5) females using opioids/cocaine (17.9%). Class 2 served as the reference group for logistic regression models, and at the time of entry, class 1 was more likely to report history of substance use treatment, overdose, HCV, sharing supplies, and mixing drugs, with persistently higher odds of sharing supplies and mixing drugs at follow-up. Class 3 was more likely to report history of overdose, sharing supplies, and mixing drugs, but outcomes at follow-up were comparable. Class 4 was the least likely to report history of overdose, HCV, and mixing drugs, but the most likely to report HIV. Class 5 was more likely to report history of substance use treatment, overdose, HCV, sharing supplies, and mixing drugs at entry, and higher reports of accessing substance use treatment and testing positive for HCV persisted at follow-up. CONCLUSIONS Considerable heterogeneity exists among PWUD, leading to differential risk factors that may persist throughout engagement in harm reduction services. LCA can identify distinct profiles of PWUD accessing services to tailor interventions that address risks, improve outcomes, and mitigate disparities.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Ian Bryant
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Anne Trinh
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | | | | | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies (HOPES), The Ohio State University College of Public Health, 381 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA.
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Ozga JE, Syvertsen JL, Zweifler JA, Pollini RA. A community-based study of abscess self-treatment and barriers to medical care among people who inject drugs in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1798-1808. [PMID: 34469034 PMCID: PMC8885857 DOI: 10.1111/hsc.13559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/12/2021] [Accepted: 08/21/2021] [Indexed: 06/13/2023]
Abstract
Skin and soft tissue infections (SSTIs) are the most common medical complication of injection drug use in the United States, though little work has been done assessing SSTI treatment among people who inject drugs (PWID). We examined past-3-month abscess characteristics, treatment utilization, and barriers to medical treatment among N = 494 community-recruited PWID. We used descriptive statistics to determine the frequencies of self-treatment and medical treatment for their most recent past-3-month abscess as well as barriers to seeking medical treatment. We then used bivariate and multivariate logistic regression to identify factors associated with having an abscess in the past 3 months. Overall, 67% of participating PWID ever had an abscess and 23% had one in the past 3 months. Only 29% got medical treatment for their most recent abscess whereas 79% self-treated. Methods for self-treatment included pressing the pus out (81%), applying a hot compress (79%), and applying hydrogen peroxide (67%). Most (91%) self-treated abscesses healed without further intervention. Barriers to medical treatment included long wait times (56%), being afraid to go (49%), and not wanting to be identified as a PWID (46%). Factors associated independently with having an abscess in the past 3 months were injecting purposely into muscle tissue (adjusted odds ratio [AOR] = 2.64), having difficulty finding a vein (AOR = 2.08), and sharing injection preparation equipment (AOR = 1.74). Our findings emphasize the importance of expanding community-based access to SSTI education and treatment services, particularly at syringe service programs where PWID may be more comfortable seeking resources.
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Affiliation(s)
- Jenny E. Ozga
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, WV, USA
| | | | - John A. Zweifler
- Department of Family and Community Medicine, University of California San Francisco-Fresno, Fresno, CA, USA
| | - Robin A. Pollini
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, WV, USA
- Pacific Institute for Research and Evaluation, Calverton, MD, USA
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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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7
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Freibott CE, Phillips KT, Anderson BJ, Stewart C, Liebschutz JM, Stein MD. Under the Skin: The Relationship Between Subcutaneous Injection and Skin Infections Among People Who Inject Drugs. J Addict Med 2022; 16:164-168. [PMID: 33813580 PMCID: PMC8486890 DOI: 10.1097/adm.0000000000000844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES People who inject drugs (PWID) are at increased risk for numerous negative health outcomes. Subcutaneous injections (aka skin popping) can result in greater risk of skin and soft tissue infections (SSTIs), but less is known about PWID who choose this route of administration. This study compares subcutaneous injectors to intravenous injectors, characterizes those who inject subcutaneously, and examines whether subcutaneous injection is associated with SSTIs in the past year. METHODS A cohort of hospitalized PWID (n = 252) were interviewed regarding injection-related behaviors, history of SSTI, and knowledge of subcutaneous injection risk. We examined differences between those who do and do not inject subcutaneously and used a negative binomial regression model to estimate adjusted odds associating subcutaneous injection and SSTI. RESULTS Participants averaged 38 years, with 58.3% male, 59.5% White, 20.6% Black, and 15.9% Latinx. PWID who performed subcutaneous injection were not demographically different from other PWID; however, the mean rate of past year SSTIs was higher for persons injecting subcutaneously than for those who did not (1.98 vs 0.96, P < 0.001). Persons injecting subcutaneously did not differ from those who injected intravenously in terms of their knowledge of subcutaneous injection risk (P = 0.112) and knowledge score was not associated with SSTIs (P = 0.457). CONCLUSIONS PWID who perform subcutaneous injections are demographically similar to other PWID but had higher rates of past year SSTIs. Knowledge of subcutaneous injection risk was not associated with SSTI risk.
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Affiliation(s)
| | - Kristina T. Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, 96817
| | - Bradley J. Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, 02906
| | | | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA 15213
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Allen B, Nolan ML. Impact of a Homeless Encampment Closure on Crime Complaints in the Bronx, New York City, 2017: Implications for Municipal Policy. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2022; 19:356-366. [PMID: 37091929 PMCID: PMC10120868 DOI: 10.1080/26408066.2022.2043797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Purpose As part of COVID-19 control policy, the Centers for Disease Control and Prevention has advised local jurisdictions to permit the formation of homeless encampments to prevent community disease spread. This new federal public health guidance is in conflict with existing police policies in many jurisdictions to raze or evict homeless encampments upon discovery. However, no empirical research on homeless encampment policy actions exists. Methods This study utilized interrupted time series to estimate the impact of the 2017 closure of "the Hole"-a longstanding encampment of homeless people who use drugs in the Bronx, New York City-on crime complaints. Daily crime complaints originating from public spaces within 1 mile of the encampment were captured during the 30-day periods before and after closure. Results Closure was associated with no short-term changesin complaints [IRR=1.01; 95% CI (0.81-1.27)], with daily complaints remaining at baseline levels during the post-closure period [IRR 0.99; 95% CI (0.98-1.00)]. Discussion Findings preliminarily suggest that the presence of a homeless encampment may not have been associated with increased levels of crime in the neighborhood where it was located. Future research is necessary to understand the health and social impacts of homeless encampments and inform municipal policymakers.
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Affiliation(s)
- Bennett Allen
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York, United States
| | - Michelle L. Nolan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, United States
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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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10
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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: 8] [Impact Index Per Article: 2.7] [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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Figgatt MC, Salazar ZR, Vincent L, Carden-Glenn D, Link K, Kestner L, Yates T, Schranz A, Joniak-Grant E, Dasgupta N. Treatment experiences for skin and soft tissue infections among participants of syringe service programs in North Carolina. Harm Reduct J 2021; 18:80. [PMID: 34330297 PMCID: PMC8324443 DOI: 10.1186/s12954-021-00528-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/21/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Bacterial and fungal infections, such as skin and soft tissue infections (SSTIs) and infective endocarditis (IE), are increasing among people who use drugs in the United States. Traditional healthcare settings can be inaccessible and unwelcoming to people who use drugs, leading to delays in getting necessary care. The objective of this study was to examine SSTI treatment experiences among people utilizing services from syringe services programs. This study was initiated by people with lived experience of drug use to improve quality of care. METHODS We conducted a cross-sectional survey among participants of five syringe services programs in North Carolina from July through September 2020. Surveys collected information on each participant's history of SSTIs and IE, drug use and healthcare access characteristics, and SSTI treatment experiences. We examined participant characteristics using counts and percentages. We also examined associations between participant characteristics and SSTI history using binomial linear regression models. RESULTS Overall, 46% of participants reported an SSTI in the previous 12 months and 10% reported having IE in the previous 12 months. Those with a doctor they trusted with drug use-related concerns had 27 fewer (95% confidence interval = - 51.8, - 2.1) SSTIs per every 100 participants compared to those without a trusted doctor. Most participants with a SSTI history reported delaying (98%) or not seeking treatment (72%) for their infections. Concerns surrounding judgment or mistreatment by medical staff and self-treating the infection were common reasons for delaying or not seeking care. 13% of participants used antibiotics obtained from sources other than a medical provider to treat their most recent SSTI. Many participants suggested increased access to free antibiotics and on-site clinical care based at syringe service programs to improve treatment for SSTIs. CONCLUSIONS Many participants had delayed or not received care for SSTIs due to poor healthcare experiences. However, having a trusted doctor was associated with fewer people with SSTIs. Improved access to non-judgmental healthcare for people who use drugs with SSTIs is needed. Expansion of syringe services program-based SSTI prevention and treatment programs is likely a necessary approach to improve outcomes among those with SSTI and IE.
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Affiliation(s)
- Mary C Figgatt
- Injury Prevention Research Center, University of North Carolina At Chapel Hill, 725 Martin Luther King Jr. Blvd, CB #7505, Chapel Hill, NC, 27599, USA.
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, 170 Rosenau Hall, CB #740, Chapel Hill, NC, 27599, USA.
| | - Zach R Salazar
- North Carolina Survivors Union, 1116 Grove Street, Greensboro, NC, 27403, USA
| | - Louise Vincent
- North Carolina Survivors Union, 1116 Grove Street, Greensboro, NC, 27403, USA
| | | | - Kelly Link
- Community Hope Alliance, 2012 N Fayetteville St, Asheboro, NC, 27203, USA
| | - Lauren Kestner
- Center for Prevention Services, 1117 E Morehead St #200, Charlotte, NC, 28204, USA
| | - Tyler Yates
- Guilford County Solution To the Opioid Problem, 1601 Walker Ave, Greensboro, NC, 27403, USA
| | - Asher Schranz
- Division of Infectious Disease, Department of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth Joniak-Grant
- Injury Prevention Research Center, University of North Carolina At Chapel Hill, 725 Martin Luther King Jr. Blvd, CB #7505, Chapel Hill, NC, 27599, USA
| | - Nabarun Dasgupta
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, 170 Rosenau Hall, CB #740, Chapel Hill, NC, 27599, USA
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12
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Khan SI, Irfan SD, Khan MNM, Shafiq TKI. The wound that closes doors: Lived experiences and complexities of injection-related injuries and infections among people who inject drugs through an ethnographic lens. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103276. [PMID: 34001413 DOI: 10.1016/j.drugpo.2021.103276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Besides HIV, people who inject drugs (PWID) experience other biomedical adversities, including injection-related injuries and infections. Yet, they are often inadequately addressed due to the prioritisation of HIV-related issues. This article explored the risk environment and socio-structural adversities of PWID living with injection-related injuries and infections, as well as existing management and treatment challenges of these conditions in harm reduction interventions. METHODS We undertook an ethnographic study from April 2018 to December 2019 in selected areas of Dhaka, Bangladesh. This component of the study involved 2500 hours of observations and informal conversations, 35 in-depth interviews and five focus group discussions with PWID experiencing injection-related injuries and infections. We also performed seven key-informant interviews with service providers and clinical experts. We applied thematic analysis and used various theoretical social scientific conceptualisations to analyse the relationship between the biomedical realities and socio-structural vulnerabilities of PWID. RESULTS Our findings indicated that PWID's physical, legal and socio-economic environments predisposed PWID to risky practices which ultimately precipitated injection-related injuries and infections. These injection-related injuries and infections consequently displaced them in spheres of social exclusion, stigmatisation, physical pain and disability and, hence, fueled their feelings of distress and despondence. Our findings also presented limitations in the management strategy of these injection-related injuries and infections. Specifically, service providers misconstrued all these complexities as "abscesses", thus applying a simplistic "one-size-fits-all" approach without accounting for the diversity of these complexities. This led to a paucity of tailored care and management approaches which could precipitate unfavourable treatment outcomes, such as chronic and complicated cases with antibiotic resistance. CONCLUSION Injection-related injuries and infections nestled PWID within various prongs of biomedical and socio-structural adversity, without viable and targeted treatment modalities. Thus, it is integral to nurture a multifaceted harm reduction intervention tailored to their biomedical and socio-structural needs.
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Affiliation(s)
- Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh.
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh
| | - Tanveer Khan Ibne Shafiq
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh
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13
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Eaton EF, Vettese T. Management of Opioid Use Disorder and Infectious Disease in the Inpatient Setting. Infect Dis Clin North Am 2021; 34:511-524. [PMID: 32782099 DOI: 10.1016/j.idc.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Acute bacterial infections such as endocarditis and skin and soft tissue infections are a common cause of hospitalization among persons with opioid use disorder (OUD). These interactions with acute care physicians provide an opportunity to diagnose OUD and treat patients with medications for OUD, including buprenorphine. When available, Addiction Medicine Consultation can be effective at linking patients to addiction treatment and also engaging patients in care for acute bacterial infections. In health systems without access to addiction medicine experts, infectious diseases providers, hospitalists, and other clinicians serve a valuable role in the diagnosis and treatment of OUD.
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Affiliation(s)
- Ellen F Eaton
- Division of Infectious Disease, University of Alabama at Birmingham, 845 19th Street South, Birmingham, AL 35205, USA.
| | - Theresa Vettese
- Division of General Medicine and Geriatrics, Emory University School of Medicine, 49 Jesse Hill Drive, Atlanta, GA 30303, USA.
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A randomized controlled trial of a brief behavioral intervention to reduce skin and soft tissue infections among people who inject drugs. Drug Alcohol Depend 2021; 221:108646. [PMID: 33677353 PMCID: PMC8055301 DOI: 10.1016/j.drugalcdep.2021.108646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at high risk for skin and soft tissue infections (SSTIs), but few interventions have targeted their reduction. The goal of the current study was to test the effects of a brief skin and needle hygiene behavioral intervention (SKIN) in a two-group randomized controlled trial with 12-month follow-up. METHOD PWID (N = 252) were recruited from inpatient hospital units at a single urban medical center site and randomly assigned to an assessment-only (AO) condition or SKIN, which was a two-session intervention that included psychoeducation, behavioral skills demonstrations, and motivational interviewing. Mixed effects generalized linear models assessed the impact of the intervention on frequency of: 1) self-reported SSTIs, 2) uncleaned skin injections, and 3) injection. RESULTS Participants were 58.3 % male, 59.5 % White, and averaged 38 years of age. SKIN participants had 35 % fewer SSTIs compared to AO (p = .179), a difference of nearly one infection per year. The mean rate of uncleaned skin injections was about 66 % lower (IRR = 0.34, 95 % CI 0.20; 0.59, p < .001) among SKIN participants compared to AO. Almost one-third of participants reported no injection over follow-up and the mean rate of injection during follow-up was about 39 % lower (IRR = 0.61; 95 % CI 0.36; 1.02, p = .058) among persons randomized to SKIN than AO. CONCLUSIONS The SKIN intervention reduced uncleaned skin injections but did not reduce SSTIs significantly more than a control condition. Brief interventions can improve high-risk practices among PWID and lead to clinically meaningful outcomes.
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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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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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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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18
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Association of Self-Reported Abscess With High-Risk Injection-Related Behaviors Among Young Persons Who Inject Drugs. J Assoc Nurses AIDS Care 2020; 30:142-150. [PMID: 30822287 DOI: 10.1097/jnc.0000000000000016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abscess is a common source of morbidity for people who inject drugs. We used data from the Study to Assess Hepatitis C Risk to measure prevalence of abscess and identify factors associated with the history of abscess. Of 541 participants, 388 (72%) were male and 149 (28%) were female. Almost half (n = 258, 48%) reported ever having an abscess. Persons who inject drugs with an abscess history were significantly more likely to have more injection partners (p = .01), inject heroin daily (p < .05), and share cookers (p = .001) and less likely to report using new syringes with each injection (p = .02). Most reported self-treating their last abscess and increasing drug use when having an abscess. High-risk injection-related activity was associated not only with infections such as HIV and hepatitis C virus but also with abscess. Nurses should screen patients presenting with abscess for high-risk practices and provide prevention education.
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19
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Doran J, Harris M, Hope VD, Wright T, Edmundson C, Sinka K, Heinsbroek E. Factors associated with skin and soft tissue infections among people who inject drugs in the United Kingdom: A comparative examination of data from two surveys. Drug Alcohol Depend 2020; 213:108080. [PMID: 32526658 DOI: 10.1016/j.drugalcdep.2020.108080] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at high risk of injection-related skin and soft tissue infections (SSTI). If not treated promptly, these can lead to serious health complications, which are a considerable healthcare burden. Data from two community surveys, with different approaches, were used to assess SSTI prevalence and associated factors among PWID to inform intervention implementation. METHODS Data were analysed from two surveys, a national surveillance survey (n=2,874; 2017-18) of infections among PWID in the United Kingdom (UK) and an in-depth survey (n=455; 2018-19) of SSTI among PWID based in London, UK. Multivariable logistic regression models were constructed to ascertain the factors associated with self-reported SSTI. RESULTS High prevalence of SSTI were reported in both samples: 52 % of participants from the national surveillance survey reported having SSTI within the preceding 12 months and 65 % of the London sample reported a lifetime history of SSTI. The factors associated with SSTI in both surveys were similar, including older age; number of years injecting; number of attempts required to inject into the vein; injecting into the hands, feet, groin or neck and re-using or sharing needles/syringes. CONCLUSIONS The number of PWID reporting SSTI in the UK is concerningly high. The two surveys used different recruitment approaches but found similar associations. We provide strong evidence of a relationship between venous access difficulty and SSTI. To stem the increase of SSTI and related complications in the UK, it is crucial that interventions attend to the underlying causes of venous damage among PWID.
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Affiliation(s)
- Jason Doran
- Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; National Infection Service, Public Health England, London, United Kingdom.
| | - Magdalena Harris
- Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Vivian D Hope
- National Infection Service, Public Health England, London, United Kingdom; Public Health Institute, Liverpool John Moore's University, Liverpool, United Kingdom
| | - Talen Wright
- Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claire Edmundson
- National Infection Service, Public Health England, London, United Kingdom
| | - Katy Sinka
- National Infection Service, Public Health England, London, United Kingdom
| | - Ellen Heinsbroek
- National Infection Service, Public Health England, London, United Kingdom
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Castillo M, Ginoza MEC, Bartholomew TS, Forrest DW, Greven C, Serota DP, Tookes HE. When is an abscess more than an abscess? Syringe services programs and the harm reduction safety-net: a case report. Harm Reduct J 2020; 17:34. [PMID: 32487084 PMCID: PMC7268493 DOI: 10.1186/s12954-020-00381-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Syringe services programs (SSPs) are able to offer wrap-around services for people who inject drugs (PWID) and improve health outcomes. Case presentation A 47-year-old man screened positive for a skin and soft tissue infection (SSTI) at an SSP and was referred to a weekly on-site student-run wound care clinic. He was evaluated by first- and third-year medical students, and volunteer attending physicians determined that the infection was too severe to be managed on site. Students escorted the patient to the emergency department, where he was diagnosed with a methicillin-resistant Staphylococcus aureus arm abscess as well as acute HIV infection. Conclusion Student-run wound care clinics at SSPs, in conjunction with ongoing harm reduction measures, screenings, and treatment services, provide a safety-net of care for PWID and help mitigate the harms of injection drug use.
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Affiliation(s)
- Marcus Castillo
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret E C Ginoza
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - David W Forrest
- Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Costaki Greven
- IDEA Exchange, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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21
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Gilbert AR, Hellman JL, Wilkes MS, Rees VW, Summers PJ. Self-care habits among people who inject drugs with skin and soft tissue infections: a qualitative analysis. Harm Reduct J 2019; 16:69. [PMID: 31831010 PMCID: PMC6909440 DOI: 10.1186/s12954-019-0345-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injection drug use is on the rise in the USA, and skin and soft tissue infections (SSTI) are a common complication, resulting in significant morbidity and mortality. Due to structural barriers to care-seeking, many people who inject drugs avoid formal care and resort to self-care techniques, but little is known about the nature of these techniques, or more generally about the accuracy or breadth of this population's knowledge of SSTIs. METHODS Semi-structured qualitative interviews were conducted with 12 people who inject heroin in two metropolitan areas: Sacramento and Boston, USA. RESULTS These interviews reveal a robust and accurate knowledge base regarding skin infections, including the progression from simple cellulitis to an abscess, and acknowledgment of the possibility of serious infections. Nonetheless, there remains a reticence to seek care secondary to past traumatic experiences. A step-wise approach to self-care of SSTI infections was identified, which included themes of whole-body health, topical applications, use of non-prescribed antibiotics, and incision and drainage by non-medical providers. CONCLUSIONS The reported SSTI self-care strategies demonstrate resilience and ingenuity, but also raise serious concerns about inappropriate antibiotic consumption and complications of invasive surgical procedures performed without proper training, technique, or materials. Harm reduction agencies and health care providers should work to obviate the need for these potentially dangerous practices by improving healthcare access for this population. In the absence of robust solutions to meet the needs of this population, education materials should be developed to optimize the efficacy and minimize the harms of these practices, while empowering and supporting the autonomy of people who use drugs and providing clear guidance on when self-care should be abandoned in favor of formal medical care.
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Affiliation(s)
| | - Julia L Hellman
- Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
- UC Davis School of Medicine, Sacramento, CA, 95817, USA
| | | | - Vaughan W Rees
- Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
- Center for Global Tobacco Control, Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Phillip J Summers
- Transitions Clinic, Sacramento, CA, 95817, USA.
- Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA.
- UC Davis School of Medicine, Sacramento, CA, 95817, USA.
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22
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Gibbs D, Peacock A, O'Keefe D, Butler K, Bruno R, Lenton S, Burns L, Larney S. Use of alcohol swabs to clean injecting sites among people who regularly inject drugs in Australia. Drug Alcohol Rev 2019; 39:83-92. [PMID: 31828864 DOI: 10.1111/dar.13006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/18/2019] [Accepted: 10/11/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Cleaning drug injection sites with alcohol swabs prior to injecting reduces risk of abscesses and other skin and soft tissue infections (SSTI). Better understanding of swabbing behaviours can inform interventions to improve injecting hygiene. We aimed to determine the socio-demographic, drug use and injecting risk exposure correlates of swabbing prior to injecting and reasons for not swabbing. DESIGN AND METHODS The Illicit Drug Reporting System recruited participants who had injected drugs at least monthly in the past six months in June-July 2017 from all Australian capital cities via needle and syringe programs and word-of-mouth. A structured interview was used to collect information on drug use and related behaviour, as well as swabbing practices. Logistic regression was used to identify factors associated with not swabbing at last injection. RESULTS Of 853 respondents, one-quarter (26%) reported that they did not swab prior to their last injection. In adjusted analyses, crystal methamphetamine as the last drug injected, past month receptive or distributive syringe sharing, and past month re-use of one's own needle were significantly associated with not swabbing at last injection. Among participants who did not swab at last injection, swabbing was frequently considered unnecessary and a small number disliked using alcohol swabs. DISCUSSION AND CONCLUSIONS Efforts are needed to increase awareness of the importance of injecting hygiene in preventing SSTI. Interventions to increase swabbing should be included as part of a wider package of injecting hygiene education, particularly in light of associations with receptive and/or distributive syringe sharing.
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Affiliation(s)
- Daisy Gibbs
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Kerryn Butler
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | | | - Simon Lenton
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Medical School, Brown University, Providence, USA
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Grigoryan L, Germanos G, Zoorob R, Juneja S, Raphael JL, Paasche-Orlow MK, Trautner BW. Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review. Ann Intern Med 2019; 171:257-263. [PMID: 31330541 DOI: 10.7326/m19-0505] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Use of antibiotics without a prescription may increase unnecessary and inappropriate drug use or doses as well as global risk for antimicrobial resistance. PURPOSE To perform a scoping review of research on the prevalence of nonprescription antibiotic use in the United States and to examine the factors that influence it. DATA SOURCES Searches of PubMed, EMBASE, CINAHL, Scopus, and relevant Web sites without language restrictions from January 2000 to March 2019. STUDY SELECTION Studies reporting nonprescription use of antibiotics, storage of antibiotics, intention to use antibiotics without a prescription, and factors influencing nonprescription use. DATA EXTRACTION Two reviewers independently screened citations and full texts and performed data abstraction. DATA SYNTHESIS Of 17 422 screened articles, 31 met inclusion criteria. Depending on population characteristics, prevalence of nonprescription antibiotic use varied from 1% to 66%, storage of antibiotics for future use varied from 14% to 48%, and prevalence of intention to use antibiotics without a prescription was 25%. Antibiotics were obtained without a prescription from various sources, including previously prescribed courses, local markets or stores, and family or friends. Reported factors contributing to nonprescription use included easy access through markets or stores that obtain antibiotics internationally for under-the-counter sales, difficulty accessing the health care system, costs of physician visits, long waiting periods in clinics, and transportation problems. LIMITATION Scarce evidence and heterogeneous methods and outcomes. CONCLUSION Nonprescription antibiotic use is a seemingly prevalent and understudied public health problem in the United States. An increased understanding of risk factors and pathways that are amenable to intervention is essential to decrease this unsafe practice. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
| | - George Germanos
- Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.)
| | - Roger Zoorob
- Baylor College of Medicine, Houston, Texas (L.G., G.G., R.Z.)
| | - Shivanki Juneja
- University of Pennsylvania, Philadelphia, Pennsylvania (S.J.)
| | - Jean L Raphael
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (J.L.R., B.W.T.)
| | | | - Barbara W Trautner
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (J.L.R., B.W.T.)
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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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Mezaache S, Protopopescu C, Debrus M, Morel S, Mora M, Suzan-Monti M, Rojas Castro D, Carrieri P, Roux P. Changes in supervised drug-injecting practices following a community-based educational intervention: A longitudinal analysis. Drug Alcohol Depend 2018; 192:1-7. [PMID: 30195241 DOI: 10.1016/j.drugalcdep.2018.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND People who inject drugs face several health issues because of unsafe injecting practices. We aimed to evaluate changes in supervised drug-injecting practices following the implementation of a face-to-face educational intervention. METHODS The national study ANRS-AERLI was conducted in 17 harm reduction (HR) facilities in France between 2011 and 2013. Eight offered the intervention and nine did not. We conducted a pre-post analysis focusing on injecting practices data, collected in the 8 HR facilities providing the intervention. The intervention consisted of providing face-to-face educational sessions including direct observation of injecting practices, counseling about safer injecting, and shared discussion. Injecting practices were collected following a checklist and classified as safe or unsafe. To assess changes in injecting practices, practices were compared before (at baseline) and after at least one educational session. FINDINGS Mixed logistic models showed that the 78 participants included were more likely to improve in the following drug-use steps: setting up a clean preparation area (Adjusted Odds Ratio (AOR) = 3.4, 95% Confidence Interval (95% CI) = 1.6-7.6), hand washing (AOR = 7.2, 95% CI = 3.1-16.4), skin cleaning (AOR = 5.6, 95% CI = 2.5-12.1), choice of safe injection site (AOR = 6.5, 95% CI = 1.5-28.8) and post-injection bleeding management (AOR = 12.8, 95% CI = 5.5-29.9). Furthermore, participants were less likely to lick their needles before injecting (AOR = 8.1, 95% CI = 1.5-43.4) and to perform booting/flushing (AOR = 2.5, 95% CI = 1.2-5.3). CONCLUSIONS The AERLI intervention seems to be effective in increasing safe drug-injecting practices.
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Affiliation(s)
- Salim Mezaache
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Camélia Protopopescu
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France; AIDES, Pantin, France
| | - Daniel Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France; Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lyon 2, Bron, France; Coalition Plus, Pantin, France
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis. Drug Alcohol Depend 2018; 190:200-208. [PMID: 30055424 DOI: 10.1016/j.drugalcdep.2018.06.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/27/2018] [Accepted: 06/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Skin and soft tissue infections (SSTIs) are prevalent among people who inject heroin (PWIH). Delays in seeking health care lead to increased costs and potential mortality, yet the barriers to accessing care among PWIHs are poorly understood. METHODS We administered a quantitative survey (N = 145) and conducted qualitative interviews (N = 12) with PWIH seeking syringe exchange services in two U.S. cities. RESULTS 66% of participants had experienced at least one SSTI. 38% reported waiting two weeks or more to seek care, and 57% reported leaving the hospital against medical advice. 54% reported undergoing a drainage procedure performed by a non-medical professional, and 32% reported taking antibiotics that were not prescribed to them. Two of the most common reasons for these behaviors were fear of withdrawal symptoms and inadequate pain control, and these reasons emerged as prominent themes in the qualitative findings. These issues are often predicated on previous negative experiences and exacerbated by stigma and an asymmetrical power dynamic with providers, resulting in perceived barriers to seeking and completing care for SSTIs. CONCLUSIONS For PWIH, unaddressed pain and withdrawal symptoms contribute to profoundly negative health care experiences, which then generate motivation for delaying care SSTI seeking and for discharge against medical advice. Health care providers and hospitals should develop policies to improve pain control, manage opioid withdrawal, minimize prejudice and stigma, and optimize communication with PWIH. These barriers should also be addressed by providing medical care in accessible and acceptable venues, such as safe injection facilities, street outreach, and other harm reduction venues.
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27
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Harris M, Brathwaite R, McGowan CR, Ciccarone D, Gilchrist G, McCusker M, O'Brien K, Dunn J, Scott J, Hope V. 'Care and Prevent': rationale for investigating skin and soft tissue infections and AA amyloidosis among people who inject drugs in London. Harm Reduct J 2018; 15:23. [PMID: 29739408 PMCID: PMC5941602 DOI: 10.1186/s12954-018-0233-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/02/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Skin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID). International data indicate up to one third of PWID have experienced an SSTI within the past month. Complications include sepsis, endocarditis and amyloid A (AA) amyloidosis. AA amyloidosis is a serious sequela of chronic SSTI among PWID. Though there is a paucity of literature reporting on AA amyloidosis among PWID, what has been published suggests there is likely a causal relationship between AA amyloidosis and injecting-related SSTI. If left untreated, AA amyloidosis can lead to renal failure; premature mortality among diagnosed PWID is high. Early intervention may reverse disease. Despite the high societal and individual burden of SSTI among PWID, empirical evidence on the barriers and facilitators to injecting-related SSTI prevention and care or the feasibility and acceptability of AA amyloidosis screening and treatment referral are limited. This study aims to fill these gaps and assess the prevalence of AA amyloidosis among PWID. METHODS Care and Prevent is a UK National Institute for Health Research-funded mixed-methods study. In five phases (P1-P5), we aim to assess the evidence for AA amyloidosis among PWID (P1); assess the feasibility of AA amyloidosis screening, diagnostic and treatment referral among PWID in London (P2); investigate the barriers and facilitators to AA amyloidosis care (P3); explore SSTI protection and risk (P4); and co-create harm reduction resources with the affected community (P5). This paper describes the conceptual framework, methodological design and proposed analysis for the mixed-methods multi-phase study. RESULTS We are implementing the Care and Prevent protocol in London. The systematic review component of the study has been completed and published. Care and Prevent will generate an estimate of AA amyloidosis prevalence among community recruited PWID in London, with implications for the development of screening recommendations and intervention implementation. We aim to recruit 400 PWID from drug treatment services in London, UK. CONCLUSIONS Care and Prevent is the first study to assess screening feasibility and the prevalence of positive proteinuria, as a marker for AA amyloidosis, among PWID accessing drug treatment services. AA amyloidosis is a serious, yet under-recognised condition for which early intervention is available but not employed.
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Affiliation(s)
- M Harris
- Department of Public Health, Environments, and Society London, School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - R Brathwaite
- Department of Public Health, Environments, and Society London, School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Catherine R McGowan
- Department of Public Health, Environments, and Society London, School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - D Ciccarone
- Family and Community Medicine, University of California San Francisco, San Franciso, CA, 94143, USA
| | - G Gilchrist
- Institute of Psychiatry, Psychology and Neuroscience, National Addiction Centre, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - M McCusker
- Lambeth Service Users Forum, Lorraine Hewitt House, Brighton Terrace, London, SW9 8DG, UK
| | - K O'Brien
- Camden Drug Services, The Margarete Centre, 108 Hampstead Road, London, NW1 2LS, UK
| | - J Dunn
- Camden Drug Services, The Margarete Centre, 108 Hampstead Road, London, NW1 2LS, UK
| | - J Scott
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - V Hope
- Public Health Institute, Liverpool John Moores University, 79 Tithebarn Street, Liverpool, L2 2ER, UK
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Wurcel AG, Burke D, Skeer M, Landy D, Heimer R, Wong JB, Chui KKH, Stopka TJ. Sex work, injection drug use, and abscesses: Associations in women, but not men. Drug Alcohol Depend 2018; 185:293-297. [PMID: 29482054 PMCID: PMC5991097 DOI: 10.1016/j.drugalcdep.2017.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Abscesses commonly occur among people who inject drugs (PWID). However, whether the risks are comparable between males and females, and the impact of sex work on abscess risk is unclear. The goal of this study was to examine the contemporary associations of gender and sex work with the risk of abscesses in PWID. METHODS Combining data from two cross-sectional studies conducted in the Greater Boston Area with people at risk for HIV and hepatitis C virus (HCV), we used the following inclusion criteria: age 18-45 years and report of illicit or non-prescription drug injection within the 30 days prior to the survey. Information on demographics, injection-mediated risks, and sexual behaviors was collected using Audio Computer-Assisted Self-Interview Software. Multivariable logistic regressions were used to model associations. RESULTS The study sample included 298 people including 30% were female. Females were more likely than men to report sex work (28% vs. 16%, p = .012) and abscess during their lifetime (55% vs. 37% p = .004). Among the females, engaging in sex work increased by >5-fold the odds of reporting abscesses [Adjusted odds ratio 5.42; 95% CI: 1.27, 23.10]. There was no association between sex work and abscesses among men. DISCUSSION We found a female-specific association between sex work, injection drug use, and abscesses among PWID. Although the cross-sectional designs precluded causal inferences, longitudinal studies could enhance understanding of gender-associated risks for abscesses and inform the development of harm reduction interventions.
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Affiliation(s)
- Alysse G. Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, United States,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Deirdre Burke
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, United States
| | - Margie Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - David Landy
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, United States
| | - John B. Wong
- Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Kenneth K. H. Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
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Larney S, Peacock A, Mathers BM, Hickman M, Degenhardt L. A systematic review of injecting-related injury and disease among people who inject drugs. Drug Alcohol Depend 2017; 171:39-49. [PMID: 28013096 DOI: 10.1016/j.drugalcdep.2016.11.029] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/11/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Non-viral injecting-related injuries and diseases (IRID), such as abscesses and vascular damage, can result in significant morbidity and mortality if untreated. There has been no systematic assessment of the prevalence of non-viral IRID among people who inject drugs; this review aimed to address this gap, as well as identify risk factors for experience of specific IRID. METHODS We searched MEDLINE, Embase and CINAHL databases to identify studies on the prevalence of, or risk factors for, IRID directly linked to injecting in samples of people who inject illicit drugs. RESULTS We included 33 studies: 29 reported IRID prevalence in people who inject drugs, and 17 provided data on IRID risk factors. Skin and soft tissue infections at injecting sites were the most commonly reported IRID, with wide variation in lifetime prevalence (6-69%). Female sex, more frequent injecting, and intramuscular and subcutaneous injecting appear to be associated with skin and soft tissue infections at injecting sites. Cleaning injecting sites was protective against skin infections. Other IRID included infective endocarditis (lifetime prevalence ranging from 0.5-12%); sepsis (2-10%); bone and joint infections (0.5-2%); and thrombosis and emboli (3-27%). CONCLUSIONS There were significant gaps in the data, including a dearth of research on prevalence of IRID in low- and middle-income countries, and potential risk and protective factors for IRID. A consistent approach to measurement, including standardised definitions of IRID, is required for future research.
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Affiliation(s)
- Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia; Alpert Medical School, Brown University, Providence, RI, USA.
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | | | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, UK
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
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Irwin A, Jozaghi E, Bluthenthal RN, Kral AH. A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/0022042616679829] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supervised injection facilities (SIFs) have been shown to reduce infection, prevent overdose deaths, and increase treatment uptake. The United States is in the midst of an opioid epidemic, yet no sanctioned SIF currently operates in the United States. We estimate the economic costs and benefits of establishing a potential SIF in San Francisco using mathematical models that combine local public health data with previous research on the effects of existing SIFs. We consider potential savings from five outcomes: averted HIV and hepatitis C virus (HCV) infections, reduced skin and soft tissue infection (SSTI), averted overdose deaths, and increased medication-assisted treatment (MAT) uptake. We find that each dollar spent on a SIF would generate US$2.33 in savings, for total annual net savings of US$3.5 million for a single 13-booth SIF. Our analysis suggests that a SIF in San Francisco would not only be a cost-effective intervention but also a significant boost to the public health system.
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Affiliation(s)
- Amos Irwin
- Criminal Justice Policy Foundation, Silver Spring, MD, USA
- Law Enforcement Against Prohibition, Medford, MA, USA
| | - Ehsan Jozaghi
- BC Centre for Disease Control, University of British Columbia, Vancouver, Canada
| | | | - Alex H. Kral
- Research Triangle Institute, San Francisco, CA, USA
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Dahlman D, Håkansson A, Kral AH, Wenger L, Ball EL, Novak SP. Behavioral characteristics and injection practices associated with skin and soft tissue infections among people who inject drugs: A community-based observational study. Subst Abus 2016; 38:105-112. [PMID: 27897966 DOI: 10.1080/08897077.2016.1263592] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk for bacterial skin and soft tissue infections (SSTIs). Although SSTIs pose significant health risks, little is known about their prevalence and characteristics in the population of PWID in the United States. This study investigates whether behavioral factors related to skin and equipment hygiene and tissue-damaging injection practices are associated with recent SSTIs among PWID. METHODS Active PWID were recruited using targeted sampling in San Francisco in 2011-2013. Interviewers collected information on behavioral risk factors of past-month self-reported SSTIs. Inferential analyses used multivariate logistic regression methods (i.e., generalized linear model) to characterize risk factors for past-month SSTIs. RESULTS The self-reported prevalence of lifetime, past-year, and past-month SSTI was 70%, 29%, and 11%, respectively. Several factors were significantly associated with past-month SSTIs in bivariate analysis, including injecting nonpowder drugs (odds ratio [OR] = 3.57; 95% confidence interval [CI] = 1.23, 10.35; P = .01), needle-licking before injection (OR = 3.36; 95% CI = 1.28, 8.81; P = .01), injecting with someone else's preused syringe/needle (OR = 7.97; 95% CI = 2.46, 25.83; P < .001), being injected by another person (OR = 2.63; 95% CI = 1.02, 6.78; P = .04), infrequent skin cleaning before injection (OR = 2.47; 95% CI = 1.00, 6.10; P = .04), and frequent injections (P = .02). In multivariate analysis, only syringe/needle sharing (adjusted OR = 6.38; 95% CI = 1.90, 21.46) remained statistically significant. CONCLUSION SSTIs are common among PWID. These data highlight the importance of clinical and public health screening efforts to reduce SSTIs. Needle exchange programs may be good venues for SSTIs screening and treatment.
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Affiliation(s)
- Disa Dahlman
- a Division of Psychiatry, Department of Clinical Sciences Lund , Lund University , Lund , Sweden.,b Malmö Addiction Centre, Skåne University Hospital , Malmö , Sweden
| | - Anders Håkansson
- a Division of Psychiatry, Department of Clinical Sciences Lund , Lund University , Lund , Sweden.,b Malmö Addiction Centre, Skåne University Hospital , Malmö , Sweden
| | - Alex H Kral
- c Behavioral and Urban Health Program, RTI International , Research Triangle Park, North Carolina , USA
| | - Lynn Wenger
- c Behavioral and Urban Health Program, RTI International , Research Triangle Park, North Carolina , USA
| | - Elizabeth L Ball
- c Behavioral and Urban Health Program, RTI International , Research Triangle Park, North Carolina , USA
| | - Scott P Novak
- c Behavioral and Urban Health Program, RTI International , Research Triangle Park, North Carolina , USA
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Injection-site vein loss and soft tissue abscesses associated with black tar heroin injection: A cross-sectional study of two distinct populations in USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 39:21-27. [PMID: 27768990 DOI: 10.1016/j.drugpo.2016.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Injection-site vein loss and skin abscesses impose significant morbidity on people who inject drugs (PWID). The two common forms of street heroin available in the USA include black tar and powder heroin. Little research has investigated these different forms of heroin and their potential implications for health outcomes. METHODS A multiple-choice survey was administered to a sample of 145 participants seeking services at reduction facilities in both Sacramento, CA and greater Boston, MA, USA. Multivariate regression models for reporting one or more abscesses in one year, injection-site veins lost in six months, and soft tissue injection. RESULTS Participants in Sacramento exclusively used black tar (99%), while those in Boston used powder heroin (96%). Those who used black tar heroin lost more injection-site veins (β=2.34, 95% CI: 0.66-4.03) and were more likely to report abscesses (AOR=7.68, 95% CI: 3.01-19.60). Soft tissue injection was also associated with abscesses (AOR=4.68, 95% CI: 1.84-11.93). Consistent venous access (AOR: 0.088, 95% CI: 0.011-0.74) and losing more injection sites (AOR: 1.22, 95% CI: 1.03-1.45) were associated with soft tissue injection. CONCLUSION Use of black tar heroin is associated with more frequent abscesses and more extensive vein loss. Poor venous access predisposes people who inject drugs to soft tissue injection, which may constitute a causal pathway between black tar heroin injection and abscess formation. The mechanisms by which black tar heroin contributes to vein loss and abscess formation must be further elucidated in order to develop actionable interventions for maintaining vein health and decreasing the abscess burden. Potential interventions include increased access to clean injection equipment and education, supervised injection facilities, opioid substitution therapy, and supply chain interventions targeting cutting agents.
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Ciccarone D, Unick GJ, Cohen JK, Mars SG, Rosenblum D. Nationwide increase in hospitalizations for heroin-related soft tissue infections: Associations with structural market conditions. Drug Alcohol Depend 2016; 163:126-33. [PMID: 27155756 PMCID: PMC4881875 DOI: 10.1016/j.drugalcdep.2016.04.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Little is known about trends in national rates of injection-related skin and soft tissue infections (SSTI) and their relationship to the structural risk environment for heroin users. Use of Mexican-sourced "Black Tar" heroin, predominant in western US states, may have greater risk for SSTI compared with eastern US powder heroin (Colombian-sourced) due to its association with non-intravenous injection or from possible contamination. METHODS Using nationally representative hospital admissions data from the Nationwide Inpatient Sample and heroin price and purity data from the Drug Enforcement Administration, we looked at rates of hospital admissions for opiate-related SSTI (O-SSTI) between 1993 and 2010. Regression analyses examined associations between O-SSTI and heroin source, form and price. RESULTS Hospitalization rates of O-SSTI doubled from 4 to 9 per 100,000 nationally between 1993 and 2010; the increase concentrated among individuals aged 20-40. Heroin market features were strongly associated with changes in the rate of SSTI. Each $100 increase in yearly heroin price-per-gram-pure was associated with a 3% decrease in the rate of heroin-related SSTI admissions. Mexican-sourced-heroin-dominant cities had twice the rate of O-SSTI compared to Colombian-sourced-heroin-dominant cities. DISCUSSION Heroin-related SSTI are increasing and structural factors, including heroin price and source-form, are associated with higher rates of SSTI hospital admissions. Clinical and harm reduction efforts should educate heroin users on local risk factors, e.g., heroin type, promote vein health strategies and provide culturally sensitive treatment services for persons suffering with SSTI.
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Affiliation(s)
- Daniel Ciccarone
- University of California San Francisco, Dept. of Family and Community Medicine, 500 Parnassus Ave., MU-3E, Box 900, San Francisco, CA 94143-0900, United States.
| | | | - Jenny K Cohen
- University of California San Francisco, Dept. of Medicine, United States
| | - Sarah G Mars
- University of California San Francisco, Dept. of Family and Community Medicine, United States
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Zhao Y, Ma S. Observations on the Prevalence, Characteristics, and Effects of Self-Treatment. Front Public Health 2016; 4:69. [PMID: 27148515 PMCID: PMC4834428 DOI: 10.3389/fpubh.2016.00069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/01/2016] [Indexed: 12/04/2022] Open
Abstract
Aims When facing illness, a person may choose self-treatment as an alternative to hospital (and primary care)-based treatment. Despite its important role in health care, the study on self-treatment remains limited. The goal is to collectively report the observations in the literature on the prevalence, characteristics, and effects of self-treatment. Methods Databases (Medline/PubMed and Google Scholar) were searched. Articles were scrutinized for country of origin, sample size, recall period, prevalence, associated factors, etc. Results Published studies have reported that in some regions, the prevalence of self-treatment is high and varies across illness conditions and treatment approaches. Self-medication is the most popular self-treatment approach. Multiple regional, demographic, personal, cultural, and religious factors have been implicated in the pursuit of self-treatment. In addition, accessibility of health care also plays a role. In general, self-treatment has a positive clinical and financial effect. However, there have been concerns on abuse and possible negative effects. Conclusion This article reviews observations made in recent studies on several important aspects of self-treatment. Comprehensive and systematic study is still lacking. Interventions are needed to solve several problems associated with self-treatment.
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Affiliation(s)
- Yinjun Zhao
- Department of Biostatistics, Yale University , New Haven, CT , USA
| | - Shuangge Ma
- Department of Biostatistics, Yale University , New Haven, CT , USA
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High rates of abscesses and chronic wounds in community-recruited injection drug users and associated risk factors. J Addict Med 2015; 9:87-93. [PMID: 25469653 DOI: 10.1097/adm.0000000000000093] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Abscesses and chronic wounds are common among injection drug users (IDUs) though chronic wounds have been understudied. We assessed the risk factors associated with both acute and chronic wounds within a community-based population of IDUs frequenting the Baltimore City Needle Exchange Program (BNEP). METHODS We performed a cross-sectional study of BNEP clients aged 18 years or more who completed an in-person survey regarding active or prior wounds including abscesses (duration <8 weeks) and chronic wounds (duration ≥8 weeks), injection practices, and skin care. Factors associated with wounds were analyzed using univariate and multivariate logistic regressions. RESULTS Of the 152 participants, 63.2% were men, 49.3% were white, 44.7% were African American, 34.9% had any type of current wound, 17.8% had an active abscess, and 19.7% had a current chronic wound. Abscesses were more common in women (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.10-5.97) and those reporting skin-popping (OR, 5.38; 95% CI, 1.85-15.67). In a multivariate model, risk factors for an abscess included injecting with a family member/partner (adjusted OR [AOR], 4.06; 95% CI, 0.99-16.58). In a multivariable analysis of current chronic wounds, cleaning skin with alcohol before injection was protective (AOR, 0.061; 95% CI, 0.0064-0.58). CONCLUSIONS Abscesses and chronic wounds were prevalent among a sample of IDUs in Baltimore. Abscesses were associated with injection practices, and chronic wounds seemed linked to varying skin and tool cleaning practices. There is a pressing need for wound-related education and treatment efforts among IDUs who are at greatest risk for skin-related morbidity.
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Hope VD, Parry JV, Ncube F, Hickman M. Not in the vein: 'missed hits', subcutaneous and intramuscular injections and associated harms among people who inject psychoactive drugs in Bristol, United Kingdom. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 28:83-90. [PMID: 26689890 DOI: 10.1016/j.drugpo.2015.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 11/06/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The extent of intentional or accidental subcutaneous and intramuscular injections and the factors associated with these have rarely been studied among people who inject drugs, yet these may play an important role in the acquisition bacterial infections. This study describes the extent of these, and in particular the factors and harms associated with accidental subcutaneous and intramuscular injections (i.e. 'missed hits'). METHODS People who inject drugs were recruited using respondent driven sampling. Weighted data was examined using bivariate analyses and logistic regression. RESULTS The participants mean age was 33 years (31% aged under 30-years), 28% were women, and the mean time since first injection was 12 years (N=329). During the preceding three months, 97% had injected heroin, 71% crack-cocaine, and 16% amphetamines; 36% injected daily. Overall, 99% (325) reported that they aimed to inject intravenously; only three aimed to inject subcutaneously and one intramuscularly. Of those that aimed to inject intravenously, 56% (181) reported ever missing a vein (for 51 this occurred more than four times month on average). Factors associated with 'missed hits' suggested that these were the consequence of poor vascular access, injection technique and/or hygiene. 'Missed hits' were twice as common among those reporting sores/open wounds, abscesses, or redness, swelling and tenderness at injection sites. CONCLUSION Intentional subcutaneous and intramuscular injections are rare in this sample. 'Missed hits' are common and appear to be associated with poor injection practice. Interventions are required to reduce risk through improving injecting practice and hygiene.
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Affiliation(s)
- V D Hope
- National Infection service, Public Health England, London, UK; Centre for Research on Drugs & Health Behaviour, Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK.
| | - J V Parry
- National Infection service, Public Health England, London, UK; Centre for Research on Drugs & Health Behaviour, Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - F Ncube
- National Infection service, Public Health England, London, UK
| | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Gothner M, Dudda M, Kruppa C, Schildhauer TA, Swol J. Fulminant Necrotizing Fasciitis of the Thigh, Following an Infection of the Sacro-iliac Joint in an Immunosuppressed, Young Woman. Orthop Rev (Pavia) 2015; 7:5825. [PMID: 26605024 PMCID: PMC4592927 DOI: 10.4081/or.2015.5825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/13/2015] [Indexed: 11/23/2022] Open
Abstract
Necrotizing soft tissue infection of an extremity is a rare but life-threatening disease. The disease is an infection that involves the soft tissue layer and is characterized by rapidly spreading inflammation (especially of the fascial planes and the surrounding tissues) with a high mortality. Early diagnosis is essential for the outcome of the patients. Radical surgical debridement is the treatment of choice. The predisposing factors are immunosuppression, diabetes mellitus and drug abuse. This report presents a case of necrotizing fasciitis in the thigh, following an abscess of the sacro-iliac joint, as a rare complication in a young, immunosuppressed woman. The patient's history revealed intravenous drug abuse and hepatitis C. After immediate diagnosis by magnetic resonance imaging, radical surgical debridement was required and performed. Prior to soft tissue coverage with a split skin graft, five additional sequential debridements were necessary. During her hospital stay, the patient experienced further cerebral and pulmonary septic embolisms and an infection of the elbow. Six months after admission, the patient was discharged in good condition to a rehabilitation center. Necrotizing fasciitis is a life-threatening complication following an abscess of the sacro-iliac joint. Physicians must be vigilant to inflammatory signs and pain in immunosuppressed patients. An abscess of the sacro-iliac joint is rare, but complications of an untreated abscess can be fatal in these patients.
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Affiliation(s)
- Martin Gothner
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil , Bochum, Germany
| | - Marcel Dudda
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil , Bochum, Germany
| | - Christiane Kruppa
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil , Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil , Bochum, Germany
| | - Justyna Swol
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil , Bochum, Germany
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Dahlman D, Håkansson A, Björkman P, Blomé MA, Kral AH. Correlates of Skin and Soft Tissue Infections in Injection Drug Users in a Syringe-Exchange Program in Malmö, Sweden. Subst Use Misuse 2015; 50:1529-35. [PMID: 26583450 DOI: 10.3109/10826084.2015.1023450] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Injection drug users (IDUs) are at increased risk of various medical conditions, including bacterial skin and soft tissue infections (SSTIs). SSTIs, which are painful and can lead to life-threatening complications, are common but scarcely studied. OBJECTIVES To investigate life time, past 12 month and past 30-day prevalence for SSTI related to injection drug use, in IDUs at Malmö syringe exchange program (Malmö SEP). To investigate factors associated with having ever had an SSTI. METHODS IDUs were recruited from Malmö SEP (N = 80). They participated in a survey with questions about demographics, drug use, and experience of SSTIs. Factors independently associated with self-reported SSTI ever were assessed using logistic regression analysis. RESULTS The lifetime reported prevalence of SSTI was 58%, past 12 months 30%, and past 30 days 14%. Factors independently associated with SSTI ever were age (adjusted odds ratio [AOR] = 1.09; 95% confidence interval [CI] = 1.01-1.18), female sex (AOR = 6.75; 95% CI = 1.40-32.47), having ever injected prescribed drugs (AOR = 52.15; 95% CI = 5.17-525.67), and having ever injected in the neck (AOR = 8.08; 95% CI = 1.16-56.08). CONCLUSIONS/IMPORTANCE SSTI is common among IDUs in Malmö. Women and those injecting in the neck or injecting prescribed drugs (crushed tablets/liquids), are more likely to have had an SSTI.
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Affiliation(s)
- Disa Dahlman
- a Malmo Addiction Center , Psychiatry Skane , Malmo , Sweden
| | - Anders Håkansson
- b Department of Clinical Sciences , Lund University , Lund , Sweden
| | - Per Björkman
- c Department of Infectious Diseases, Division of Clinical Sciences , Lund University , Malmo , Sweden
| | - Marianne Alanko Blomé
- c Department of Infectious Diseases, Division of Clinical Sciences , Lund University , Malmo , Sweden
| | - Alex H Kral
- d RTI International , San Francisco , California , USA
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Smith ME, Robinowitz N, Chaulk P, Johnson KE. Self-care and risk reduction habits in older injection drug users with chronic wounds: a cross-sectional study. Harm Reduct J 2014; 11:28. [PMID: 25326686 PMCID: PMC4213493 DOI: 10.1186/1477-7517-11-28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/22/2014] [Indexed: 11/25/2022] Open
Abstract
Background We surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs. Methods Participants ≥18 years old completed a survey regarding chronic wounds (duration ≥8 weeks), injection and hygiene practices. Study staff visually verified the presence of wounds. Participants were categorized into four groups by age and wound status. Factors associated with the presence of chronic wounds in participants ≥45 years were analyzed using logistic regression. Results Of the 152 participants, 19.7% had a chronic wound. Of those with chronic wounds, 18 were ≥45 years old (60.0%). Individuals ≥45 years old with chronic wounds were more likely to be enrolled in a drug treatment program (Odds ratio (OR) 3.4, 95% Confidence interval (CI) 1.0–10.8) and less likely to use cigarette filters when drawing up prepared drug (OR 0.2, 95% CI 0.03–0.7) compared to the same age group without chronic wounds. Compared to individuals <45 years old without chronic wounds, individuals ≥45 with a chronic wound were more likely to report cleaning reused needles with bleach (OR 10.7, 95% CI 1.2–93.9) and to use the clinic, rather than an emergency room, as a primary source of medical care (OR 3.4, 95% CI 1.1–10.4). Conclusions Older IDUs with chronic wounds have different, and perhaps less risky, injection and hygiene behaviors than their peers and younger IDUs without wounds in Baltimore City. Because of these differences, older IDUs with wounds may be more receptive to community-based healthcare and substance abuse treatment messages.
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Affiliation(s)
| | | | | | - Kristine E Johnson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins Medical Institutions, 5200 Eastern Avenue, MFL Building, Center Tower, 3rd Floor, Baltimore, MD 21224, USA.
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