scholarly journals Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder

2017 ◽  
Vol 179 ◽  
pp. 325-329 ◽  
Author(s):  
Michael D. Stein ◽  
Micah T. Conti ◽  
Shannon Kenney ◽  
Bradley J. Anderson ◽  
Jessica N. Flori ◽  
...  
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Adverse Childhood Experience ◽  
Opioid Use ◽  
Childhood Experience ◽  
Adverse Childhood ◽  
Experience Effects

scholarly journals Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Laura R Marks ◽  
Nathanial S Nolan ◽  
Linda Jiang ◽  
Dharushana Muthulingam ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Diagnosis Code ◽  
Opioid Use ◽  
Diagnosis Codes ◽  
All Cause Mortality ◽  
Icd 10

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

scholarly journals Low Knowledge of HIV PrEP Within a Midwestern U.S. Cohort of Persons Who Inject Drugs

2021 ◽  
Author(s):  
Sena Sayood ◽  
Laura R Marks ◽  
Rupa Patel ◽  
Nathanial S Nolan ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Drug Use ◽  
Hiv Infection ◽  
Sexual Intercourse ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Opioid Use ◽  
Persons Who Inject Drugs

Abstract We interviewed persons who inject drugs (PWID) to understand perceptions of PrEP to prevent HIV infection. Knowledge of PrEP was poor. Patients felt PrEP was for sexual intercourse rather than injection drug use, and PWID managed on medications for opioid use disorder (MOUD) felt they had no need for PrEP.

scholarly journals New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

2019 ◽  
Vol 15 (10) ◽  
pp. 606-612
Author(s):  
David P Serota ◽  
Theresa Vettese
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Trial Data ◽  
Injection Drug ◽  
Soft Tissue Infections ◽  
Opioid Use ◽  
Surgical Interventions ◽  
Care Plans ◽  
Severe Infections

Hospitalists are increasingly responsible for the management of infectious consequences of opioid use disorder (OUD), including increasing rates of hospitalization for injection drug use (IDU)-associated infective endocarditis, osteomyelitis, and soft tissue infections. Management of IDU-associated infections poses unique challenges: symptoms of the underlying addiction can interfere with care plans, patients often have difficult psychosocial circumstances in addition to their addiction, and they are often stigmatized by the healthcare system. Although there are few randomized trial data to support one particular approach to management, the literature suggests that successful treatment of IDU-associated infections requires appropriate antimicrobial and surgical interventions in addition to acknowledgment and treatment of the underlying OUD. In this narrative review, the best available evidence is used to answer several of the most commonly encountered questions in the management of IDU-associated infections. These data are used to develop a framework for hospitalists to approach the care of patients with IDU-associated infections.

scholarly journals 1020. Injection Drug Use-Associated Staphylococcus aureus Bacteremia in a Large Urban Hospital in Atlanta, Georgia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S304-S304
Author(s):  
David P Serota ◽  
Colleen Kelley ◽  
Jesse T Jacob ◽  
Susan M Ray ◽  
Marcos C Schechter ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Use ◽  
Injection Drug Use ◽  
Infectious Complications ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
First Episode ◽  
Opioid Use ◽  
Urban Hospital ◽  
Multiple Drugs

Abstract Background Infectious complications of injection drug use (IDU) have increased with the expanding opioid epidemic in the southeast. We assessed the incidence, clinical presentation, and treatment outcomes of IDU-associated Staphylococcus aureus (SA) bacteremia (SAB). Methods We created a retrospective cohort of all adults with community acquired (CA) SAB over 5 years presenting to Grady Memorial Hospital, a 1,000-bed urban county hospital in Atlanta, GA. Charts were reviewed by infectious diseases physicians to obtain clinical and laboratory characteristics, including substance use disorder (SUD), and determine if SAB was IDU-associated. The study period was divided into three periods (P1 = March 2012–January 2014, P2 = January 2014–December 2015, P3 = December 2015–November 2017) to evaluate changes in the incidence of IDU-SAB over time using Poisson regression. Results Among 321 patients with a first episode of CA-SAB, 24 (7%) were IDU-SAB. The number of IDU-SAB cases in each period increased (P1 = 4, P2 = 7, and P3 = 13 [P = 0.07 for trend]). The median age of IDU-SAB patients was 38 (IQR 31–57), 11 (46%) were black, and 15 (63%) had chronic hepatitis C virus infection. Heroin was the most common injected drug (92%) followed by cocaine (25%); multiple drugs were injected in 29%. All but two patients (92%) had a complication of SAB, most commonly endocarditis (50%) and septic pulmonary emboli (38%). The median hospitalization was 23 days (IQR 19.5–37.5) and 5 patients (12%) left the hospital against medical advice (AMA). Readmission for persistent or recurrent SA infection during the study period was common (42%), and three (13%) died ≤6 months from initial presentation, including two with prior discharge AMA. Half of the discharge summaries did not mention SUD as a hospital problem. Outpatient SUD treatment was recommended to eight (33%) patients and a recommendation of abstinence was the intervention for 12 (50%). Conclusion Increasing IDU-SAB was observed over 5 years in our urban Atlanta hospital, primarily due to heroin use. Most cases were associated with complications of SAB with a long length of stay and frequent readmission, but few patients received treatment or harm reduction interventions for their SUD. These data will raise awareness and direct resources to expanding evidence-based opioid use disorder treatment for patients with infectious complications of IDU. Disclosures All authors: No reported disclosures.

scholarly journals Association of Treatment With Medications for Opioid Use Disorder With Mortality After Hospitalization for Injection Drug Use–Associated Infective Endocarditis

2020 ◽  
Vol 3 (10) ◽  
pp. e2016228 ◽  
Author(s):  
Simeon D. Kimmel ◽  
Alexander Y. Walley ◽  
Yijing Li ◽  
Benjamin P. Linas ◽  
Sara Lodi ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Opioid Use

scholarly journals A Vulnerability Assessment for a Future HIV Outbreak Associated With Injection Drug Use in Illinois, 2017–2018

2021 ◽  
Vol 6 ◽  
Author(s):  
Cara Jane Bergo ◽  
Jennifer R. Epstein ◽  
Stacey Hoferka ◽  
Marynia Aniela Kolak ◽  
Mai T. Pho
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Drug Use ◽  
Injection Drug Use ◽  
Negative Binomial ◽  
Cook County ◽  
Injection Drug ◽  
County Level ◽  
Opioid Use ◽  
Zip Code

The current opioid crisis and the increase in injection drug use (IDU) have led to outbreaks of HIV in communities across the country. These outbreaks have prompted country and statewide examination into identifying factors to determine areas at risk of a future HIV outbreak. Based on methodology used in a prior nationwide county-level analysis by the US Centers for Disease Control and Prevention (CDC), we examined Illinois at the ZIP code level (n = 1,383). Combined acute and chronic hepatitis C virus (HCV) infection among persons <40 years of age was used as an outcome proxy measure for IDU. Local and statewide data sources were used to identify variables that are potentially predictive of high risk for HIV/HCV transmission that fell within three main groups: health outcomes, access/resources, and the social/economic/physical environment. A multivariable negative binomial regression was performed with population as an offset. The vulnerability score for each ZIP code was created using the final regression model that consisted of 11 factors, six risk factors, and five protective factors. ZIP codes identified with the highest vulnerability ranking (top 10%) were distributed across the state yet focused in the rural southern region. The most populous county, Cook County, had only one vulnerable ZIP code. This analysis reveals more areas vulnerable to future outbreaks compared to past national analyses and provides more precise indications of vulnerability at the ZIP code level. The ability to assess the risk at sub-county level allows local jurisdictions to more finely tune surveillance and preventive measures and target activities in these high-risk areas. The final model contained a mix of protective and risk factors revealing a heightened level of complexity underlying the relationship between characteristics that impact HCV risk. Following this analysis, Illinois prioritized recommendations to include increasing access to harm reduction services, specifically sterile syringe services, naloxone access, infectious disease screening and increased linkage to care for HCV and opioid use disorder.

scholarly journals Infectious Disease (ID) Learning Unit: What the ID Clinician Needs to Know About Buprenorphine Treatment for Opioid Use Disorder

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Amanda A. Westlake ◽  
Mark P. Eisenberg
Keyword(s):  
Infectious Disease ◽  
Drug Use ◽  
Maintenance Therapy ◽  
Injection Drug Use ◽  
Infectious Complications ◽  
Opioid Use Disorder ◽  
Clinical Use ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Buprenorphine Treatment

Abstract In the context of an escalating opioid epidemic, infectious disease clinicians increasingly treat the infectious complications of injection drug use. In this learning unit, we review the history, pharmacology, and clinical use of buprenorphine as maintenance therapy for opioid use disorder, and we describe the process by which clinicians can obtain a buprenorphine waiver.

scholarly journals 890. Bridging the Gap to Help Address the Opioid Crisis: A Novel Model of Care to Integrate Substance Use, Mental Health, and Infectious Disease Services

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S22-S22
Author(s):  
Kimberly Corace ◽  
Nicholas Schubert ◽  
Melanie Willows ◽  
Guy Herbert ◽  
Gary Garber
Keyword(s):  
Mental Health ◽  
Infectious Disease ◽  
Substance Use ◽  
Drug Use ◽  
Infectious Diseases ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Opioid Use ◽  
Care Model ◽  
Rapid Access

Abstract Background There is a converging public health crisis as the opioid epidemic and increased injection drug use is driving rates of infectious diseases. Multidisciplinary care, integrating infectious diseases, substance use, and mental health services, is crucial to address this crisis. This study evaluated a novel rapid access care model to improve treatment access for opioid use, mental health, and related infectious diseases. Methods The Rapid Access Addiction Medicine (RAAM) clinic is a multidisciplinary, walk-in care model located in a mental health center in Ottawa, Canada. RAAM provides collaborative, inter-agency care, with rapid access to care facilitated through seamless care pathways (i.e., from the emergency department). RAAM offers substance use and mental health treatment, screening and care for infectious diseases, harm reduction, and connection to community services. RAAM patients (N = 411) presenting between April 2018 and January 2019 completed substance use and mental health measures upon intake and 30-day follow-ups. Clinical information was collected via chart review. Results Of the total sample, 20% (n = 83; 66% men) had problematic opioid use. Most patients reported high opioid dependence severity (97%), injection drug use (67%), and polysubstance use (97%), including cocaine (62%), alcohol (40%), and amphetamines (35%). Most patients reported anxiety (86%) and depression (75%). The number of patients tested for HIV, HCV, HBV, and other STIs was 29%, 27%, 28%, and 24%, respectively. Most patients tested (61%) were young adults (aged 16–29). Of those tested, 15% tested positive for HCV and treatment initiation was facilitated for 66% of patients (33% resolved spontaneously). At 30-day follow-up, patients showed significantly reduced substance use and improved depression and anxiety (Ps < 0.05). Conclusion Patients with problematic opioid use have multiple comorbidities, including undiagnosed infectious diseases; thus, highlighting the need for integrated care models like RAAM. Substance use treatment is an opportune setting to identify and treat infectious diseases in order to improve outcomes and reduce disease transmission. Leadership from infectious disease specialists is key to this successful integration. Disclosures All Authors: No reported Disclosures.

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