Heroin Snorters Risk Transition To Injection Drug Use And Infectious Disease.

By the end of March 1990 470 HIV positive patients, 77% injection drug use (IDU) related, had attended the outpatient department of the Regional Infectious Disease Unit with a cumulative loss to follow-up of only 20%. Coincident with the prescribing of oral methadone and a specific all-day IDU-related HIV medical clinic the total number of appointments increased from 28/month in May 1986 to 300/month in May 1989 ( P< 0.001) and the number of defaulted appointments decreased from a maximum of 60% (17/28) to 16% (48/294, P<0.001) in these months. There was a significant initial increase in the number of defaulted appointments for the infectious disease (ID) clinics from 11% (77/726) to 16% (124/797, P<0.01) which returned to previous levels once a specific IDU-related HIV clinic was established. There was also a significant decline in the number of new patients referred which was greater for the urinary tract infection clinics (108 to 56 per 6 months, P<0.0001) than for the ID clinics (119 to 88 per 6 months, P<0.05).

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Heroin Snorters Risk Transition To Injection Drug Use And Infectious Disease

Nida Notes ◽

10.1151/v14i2bhsrtt ◽

1999 ◽

Vol 14 (2) ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Robert Mathias

Keyword(s):

Infectious Disease ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug

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Disparity in Quality of Infectious Disease vs Addiction Care Among Patients With Injection Drug Use–Associated Staphylococcus aureus Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz289 ◽

2019 ◽

Vol 6 (7) ◽

Cited By ~ 14

Author(s):

David Phillip Serota ◽

Emily D Niehaus ◽

Marcos C Schechter ◽

Jesse T Jacob ◽

Jeb Jones ◽

...

Keyword(s):

Infectious Disease ◽

Staphylococcus Aureus ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug ◽

Evidence Based ◽

High Quality ◽

Staphylococcus Aureus Bacteremia ◽

Addiction Care

Abstract Evidence-based interventions for Staphylococcus aureus bacteremia (SAB) are well known, but it is unclear how they are implemented among patients with injection drug use–associated (IDU) SAB. Of 46 patients with IDU-SAB identified, all received high-quality SAB management; however, few received appropriate recognition or treatment of their underlying substance use disorder.

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Injection and non-injection drug use and infectious disease in Baltimore City: Differences by race

Addictive Behaviors ◽

10.1016/j.addbeh.2014.04.020 ◽

2014 ◽

Vol 39 (9) ◽

pp. 1325-1328 ◽

Cited By ~ 15

Author(s):

Larry Keen ◽

Maria Khan ◽

Lisa Clifford ◽

Paul T. Harrell ◽

William W. Latimer

Keyword(s):

Infectious Disease ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug ◽

Baltimore City

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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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.049 ◽

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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767. Can Integration of Addiction Treatment Facilitate Safe Discharge on OPAT for Patients with Infectious Complications of Injection Drug Use?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.835 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S341-S342

Author(s):

Daniel A Solomon ◽

Christin Price ◽

Jennifer A A Johnson ◽

Mary W Montgomery ◽

Bianca Martin ◽

...

Keyword(s):

Infectious Disease ◽

Drug Use ◽

Injection Drug Use ◽

Addiction Treatment ◽

Infectious Complications ◽

Injection Drug ◽

Opioid Use ◽

Eligibility Criteria ◽

Joint Infections ◽

The Impact

Abstract Background While there is a growing body of evidence that suggests outpatient parental antibiotic treatment (OPAT) for people who inject drugs (PWID) may be safe, research on integrating OPAT with addiction treatment for PWID has been limited. Methods Adults hospitalized for infectious complications of injection drug use (IDU) requiring prolonged IV antibiotics were included in this study. The suitability for OPAT was determined by the infectious disease and addiction consultation services. Eligibility criteria included safe housing, attendance at infectious disease (ID) clinic visits, and engagement with addiction treatment. Demographic and clinical outcomes were summarized, and compared with patients without any IDU history enrolled in OPAT during the same time at the same institution. Results Eighteen OPAT episodes among 17 individuals were included, with 9 (50.0%) males. Mean age was 38.4 (SD 9.5). Types of infection included endocarditis (38.9%), epidural abscess (38.9%), and bone/joint infections (33.3%). Opioid use disorders (OUD) were most common (94.4%), followed by cocaine (33.3%) and benzodiazepines (16.7%). All individuals completed the recommended course of IV antibiotics. All OUD patients received buprenorphine (52.9%) or methadone (47.1%). Two (11.1%) relapsed to drug use during OPAT, but no instances of line tampering, thrombosis, line infection or line dislodgement were identified. No deaths or overdoses were reported. Collectively, 504 inpatient days were avoided. Compared with 390 individuals without any history of IDU, those with IDU history were significantly younger (38.4 vs. 59.0, P < 0.0001), had fewer episodes of endocarditis (38.9% vs. 43.6%) and bone/joint infections (33.3% vs. 41.8%), but more epidural abscesses (38.9% vs. 3.1%). There were no statistical differences in rates of readmission (22.2% vs. 11.3%), line complications (0% vs. 3.5%), mortality (0% vs. 1.0%), ID clinic visit attendance (100.0% vs. 82.0%), or number of days on OPAT (28.0 vs. 30.1). Conclusion Results add further evidence of OPAT’s safety among PWID and that integration of addiction treatment may be feasible. OPAT outcomes were similar to those without any IDU history. More research is needed to study the impact of integrating addiction treatment with OPAT for PWID. Disclosures All authors: No reported disclosures.

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