Managing physical health problems in people who inject drugs

Risk Factors for Infective Endocarditis and Serious Injection Related Infections Among People Who Inject Drugs in Los Angeles, CA and Denver, CO

BACKGROUND

Injection drug use-related infective endocarditis (IDU-IE) and bacterial infections have grown in the United States, but little is known about risk factors for these infections in community samples of people who inject drugs (PWID).

METHODS

During 2021-22, PWID were recruited from community settings and surveyed for history of IDU-IE, serious injection related symptoms (SIRI) and untreated infection symptoms in the last 3 months. We used bivariate analysis and multiple logistic regression to examine factors associated with these outcomes.

RESULTS

Among participants (n = 472), 7 % reported ever having IDU-IE, 14 % reported having SIRI symptoms and 20 % reported untreated infection symptoms in the last 3 months. Ever having IDU-IE was associated with HCV (adjusted odds ratio [AOR]=8.37; 95 % confidence interval [CI]=2.46, 28.49), prior MRSA infection (AOR=5.37; 95 % CI=2.44, 11.80), identifying as female and/or gender minority person (AOR=3.14; 95 % CI=1.42, 6.95). SIRI symptoms were associated with greater material hardship (compared to low; AOR=2.47; 95 % CI=1.17, 5.22), fentanyl use (AOR=2.15; 95 % CI=1.01, 4.61), sharing filter/cotton (AOR=1.93; 95 % CI=1.10, 3.39), and licking needle prior to injection (AOR=1.85; 95 % CI=1.02, 3.36). Untreated infection symptoms were associated with poor quality sleep (AOR=2.04; 95 % CI=1.21, 3.43), any mental health diagnoses (AOR=2.01; 95 % CI=3.56), any chronic pain (AOR=1.89; 95 % CI=1.14, 3.11), sharing filters (AOR=1.81; 95 % CI=1.10, 2.98), and prior MRSA infection (AOR=1.75; 95 % CI=1.04, 2.97).

CONCLUSION

Risk factors identified include treatable co-morbidities (i.e., HCV & MRSA history, mental health, pain, opioid use), modifiable health behaviors (i.e., equipment sharing, needle-licking), and addressable structural conditions (material hardship, housing).

Polysubstance Use and Related Risk Behaviors among People Who Inject Drugs in Kenya Preparing for Hepatitis C Virus Treatment

Polysubstance use (PSU), injection drug use (IDU), and equipment sharing are associated with bloodborne infection (BBI) transmission risk, particularly Hepatitis C Virus (HCV), yet data on PSU in low- and middle-income countries (LMICs) is limited. We report on baseline PSU, medication-assisted treatment (MAT) engagement, and motivation to reduce IDU among 95 people who inject drugs (PWID) who accessed needle and syringe programs (NSP) in Nairobi and Coastal Kenya prior to HCV treatment. Bivariate and multivariate logistic regression were used to examine the associations between PSU and behaviors that confer HCV transmission and acquisition risks. Most participants (70.5%) reported PSU in the last 30 days, and one-third (35.8%) reported PSU exclusive to just heroin and cannabis use. Common combinations were heroin and cannabis (49.3%), and heroin, cannabis, and bugizi (flunitrazepam) (29.9%). Participants at baseline were receiving MAT (69.5%), already stopped or reduced IDU (30.5%), and were HIV-positive (40%). PSU was significantly associated with IDU (p = 0.008) and the number of times (p = 0.016) and days (p = 0.007) injected in the last 30 days. Participants reported high PSU and equipment sharing, despite high MAT engagement. While co-locating BBI treatment within existing harm reduction services is necessary to promote uptake and curb re-infection, tailored services may be needed to address PSU, particularly in LMICs.

Latent polydrug use patterns and the provision of injection initiation assistance among people who inject drugs in three North American settings

INTRODUCTION

We sought to identify latent profiles of polysubstance use patterns among people who inject drugs in three distinct North American settings, and then determine whether profile membership was associated with providing injection initiation assistance to injection-naïve persons.

METHODS

Cross-sectional data from three linked cohorts in Vancouver, Canada; Tijuana, Mexico; and San Diego, USA were used to conduct separate latent profile analyses based on recent (i.e., past 6 months) injection and non-injection drug use frequency. We then assessed the association between polysubstance use patterns and recent injection initiation assistance provision using logistic regression analyses.

RESULTS

A 6-class model for Vancouver participants, a 4-class model for Tijuana participants and a 4-class model for San Diego participants were selected based on statistical indices of fit and interpretability. In all settings, at least one profile included high-frequency polysubstance use of crystal methamphetamine and heroin. In Vancouver, several profiles were associated with a greater likelihood of providing recent injection initiation assistance compared to the referent profile (low-frequency use of all drugs) in unadjusted and adjusted analyses, however, the inclusion of latent profile membership in the multivariable model did not significantly improve model fit.

DISCUSSION AND CONCLUSIONS

We identified commonalities and differences in polysubstance use patterns among people who inject drugs in three settings disproportionately impacted by injection drug use. Our results also suggest that other factors may be of greater priority when tailoring interventions to reduce the incidence of injection initiation. These findings can aid in efforts to identify and support specific higher-risk subpopulations of people who inject drugs.