scholarly journals 1215. A Mixed Methods Study on Severe Bacterial Infections in People Who Inject Drugs

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S697-S697
Author(s):  
Alexander Hrycko ◽  
Benjamin Eckhardt ◽  
Pedro Mateu-Gelabert ◽  
Courtney Ciervo
Keyword(s):  
Mixed Methods ◽  
Drug Use ◽  
Injection Drug Use ◽  
Bacterial Infections ◽  
Mixed Methods Study ◽  
Injection Drug ◽  
Daily Injection ◽  
Drug Injection ◽  
Structured Interviews ◽  
Causative Microorganism

Abstract Background Severe bacterial infections (SBI) associated with intravenous drug use have been increasing in frequency in the U.S. over the last decade. This mixed methods study aims to identify the risk factors associated with SBI in hospitalized individuals with recent injection drug use. Methods We conducted 34 quantitative and 15 qualitative interviews between August 2020 and June 2021 at Bellevue Hospital in New York City. Eligible participants were (1) >/= 18 year of age, (2) admitted with a SBI, and (3) reported injection drug use within the 90 days prior to admission. Quantitative and qualitative data was obtained using a quantitative survey and in-depth, semi structured interviews of participants respectively. Analysis was performed to examine trends and explore common themes potentially contributing factors to SBI. Results Of the 34 participants included, the median age was 37.5, 85% were male, 53% white, and 65% reported being homeless within the past 3 months. Endocarditis was the most common primary diagnosis (65%). Median length of hospital stay was 24 days and 35% required ICU level care during admission. A causative microorganism was identified in 85% of participants and 50% had Staphylococcus aureus as the sole organism. Discharges against medical advice occurred in 35%. Daily injection drug use in prior 30 days was 95% with a median of 10 injections per day. In the 30 days prior to admission, 50% reported an increase in injection frequency, 80% reported reusing needles and/or syringes, 75% reused cookers, 65% reused cottons. Analysis of qualitative interview data revealed high risk injection behaviors. Participants were not practicing and unaware of strategies to reduce their risk of drug injection-related SBI. Prior hospitalizations for SBI did not impact on this knowledge deficit on what constitutes bacterial infection risk and how to prevent it. Conclusion Study findings highlight the complexity of the injection drug use process and the potential social and physiological pathways leading to SBI. Multiple domains at the structural, network, and individual level that impact drug injection practices and provide context by which these factors predispose and lead to physiological tissue damage and the development of SBI among PWID. Disclosures Benjamin Eckhardt, MD, MS, Gilead Sciences (Grant/Research Support)

scholarly journals Harm reduction via online platforms for people who use drugs in Russia: a qualitative analysis of web outreach work

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Arsen Davitadze ◽  
Peter Meylakhs ◽  
Aleksey Lakhov ◽  
Elizabeth J. King
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Injection Drug ◽  
People Who Use Drugs ◽  
Structured Interviews ◽  
Advantages And Disadvantages ◽  
Online Platforms ◽  
Outreach Work ◽  
Outreach Workers

Abstract Background Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Several organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO “Humanitarian Action,” we explored web outreach work in Telegram instant messenger. Methods Our data were comprised of 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD. We used thematic analysis to study the process of web outreach, harm reduction service provision, and needs of PWUD. Results Three stages of the process of web outreach work were identified: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded in group chat or direct messages. Challenges in addressing clients’ needs happened when clients turned for help after hours, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. The needs of PWUD were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services. Conclusions Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and for recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). Harm reduction organizations should consider incorporating online harm reduction services into their activities. However, further research is needed to explore relative advantages and disadvantages of online harm reduction services.

scholarly journals When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Matayo Baluku ◽  
Twaibu Wamala
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Drug Users ◽  
Time Lag ◽  
Rapid Assessment ◽  
Injecting Drug Users ◽  
Hcv Infection ◽  
Injection Drug ◽  
Structured Interviews ◽  
Increased Risk

Abstract Background In Uganda, injection drug use is a growing but less studied problem. Preventing the transition to injection drug use may help prevent blood-borne viral transmission, but little is known about when and how people transition to injection drug use. A greater understanding of this transition process may aid in the country’s efforts to prevent the continued growth of injection drug use, HIV, and hepatitis C Virus (HCV) infection among people who inject drugs (PWID). Methods Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)—recruited through outreach and snow-ball sampling. Participants were interviewed about their experiences on when and how they transitioned into injection drug use and these issues were also discussed in 12 focus groups held with the participants. Results All the study participants started their drug use career with non-injecting forms including chewing, smoking, and sniffing before transitioning to injecting. Transitioning was generally described as a peer-driven and socially learnt behavior. The participants’ social networks and accessibility to injectable drugs on the market and among close friends influenced the time lag between first regular drug use and first injecting—which took an average of 4.5 years. By the age of 24, at least 81.6% (95.7% for females and 78.4% for males) had transitioned into injecting. Over 84.8% shared injecting equipment during their first injection, 47.2% started injecting because a close friend was already injecting, 26.4% desired to achieve a greater “high” (26.4%) which could reflect drug-tolerance, and 12% out of curiosity. Conclusions Over 81% non-injecting drug users in Kampala and Mbale districts transitioned into injecting by the age of 24; a process that reproduces a population of PWID but also puts them at increased risk of HIV and HCV infection. As Uganda makes efforts to introduce and/or strengthen harm reduction services, interventions targeting non-injecting drug users before they transition into injecting should be considered as a key component for HIV/HCV epidemic control efforts, and their evaluation considered in future researches.

Introduction

2011 ◽  
Author(s):  
Mark A. R. Kleiman ◽  
Jonathan P. Caulkins ◽  
Angela Hawken
Keyword(s):  
United States ◽  
Drug Use ◽  
Injection Drug Use ◽  
The United States ◽  
Illegal Drug ◽  
Injection Drug ◽  
Illegal Drugs ◽  
Drug Injection ◽  
Drug Dealing ◽  
Daily News

The devastation wrought by drugs and drug dealing is familiar from the daily news and carefully documented in academic journals. Illegal drugs get the most attention. A quarter of 14- to 15-year-olds in the United States have already tried an illegal drug. Injection drug use...

scholarly journals Both localized and systemic bacterial infections are predicted by injection drug use: A prospective follow-up study in Swedish criminal justice clients

PLoS ONE ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. e0196944 ◽  
Author(s):  
Disa Dahlman ◽  
Jonas Berge ◽  
Per Björkman ◽  
Anna C. Nilsson ◽  
Anders Håkansson
Keyword(s):  
Criminal Justice ◽  
Drug Use ◽  
Injection Drug Use ◽  
Bacterial Infections ◽  
Injection Drug ◽  
Follow Up Study

scholarly journals Prevalence and Correlates of Providing and Receiving Assistance With the Transition to Injection Drug Use

2020 ◽  
Author(s):  
Rachel E Gicquelais ◽  
Dan Werb ◽  
Charles Marks ◽  
Carolyn Ziegler ◽  
Shruti H Mehta ◽  
...  
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Meta Analysis ◽  
Local Level ◽  
Injection Drug ◽  
Social Risk ◽  
Drug Injection ◽  
Risk Environment ◽  
Injection Initiation ◽  
Statistical Heterogeneity

Abstract Preventing the transition to injection drug use is an important public health goal, as people who inject drugs (PWID) are at high risk for overdose and acquisition of infectious disease. Initiation into drug injection is primarily a social process, often involving PWID assistance. A better understanding of the epidemiology of this phenomenon would inform interventions to prevent injection initiation and to enhance safety when assistance is provided. We conducted a systematic review of the literature to 1) characterize the prevalence of receiving (among injection-naive persons) and providing (among PWID) help or guidance with the first drug injection and 2) identify correlates associated with these behaviors. Correlates were organized as substance use behaviors, health outcomes (e.g., human immunodeficiency virus infection), or factors describing an individual’s social, economic, policy, or physical environment, defined by means of Rhodes’ risk environments framework. After screening of 1,164 abstracts, 57 studies were included. The prevalence of receiving assistance with injection initiation (help or guidance at the first injection) ranged 74% to 100% (n = 13 estimates). The prevalence of ever providing assistance with injection initiation varied widely (range, 13%–69%; n = 13 estimates). Injecting norms, sex/gender, and other correlates classified within Rhodes’ social risk environment were commonly associated with providing and receiving assistance. Nearly all PWID receive guidance about injecting for the first time, whereas fewer PWID report providing assistance. Substantial clinical and statistical heterogeneity between studies precluded meta-analysis, and thus local-level estimates may be necessary to guide the implementation of future psychosocial and sociostructural interventions. Further, estimates of providing assistance may be downwardly biased because of social desirability factors.

scholarly journals The Process of Injection Drug Use Among Homeless Women:A Qualitative Study

2020 ◽  
Author(s):  
Cynthia Kitson ◽  
Patrick O'Byrne
Keyword(s):  
Drug Use ◽  
Qualitative Study ◽  
Injection Drug Use ◽  
Thematic Analysis ◽  
Injection Drug ◽  
Morbidity And Mortality ◽  
Structured Interviews ◽  
Injection Drugs

Abstract Background: The literature on women who use injection drugs (WUID) is antiquated and diluted by data from men. Due to the higher rates of morbidity and mortality among WUID, we undertook a qualitative study to better understand their drug use practices. Methods: We adopted a Deleuzo-Guattarian lens and engaged in semi-structured interviews with 35 women. Data were analyzed applied thematic analysis. Results: We divided these themes into (1) how WUID obtain resources to acquire drug, and (2) the steps involved in preparing, using, and discarding drugs. From our Deleuzo-Guattarian perspective, these findings highlighted that participants stratified their worlds according to rules of cleanliness to create hierarchies of appropriateness and acceptability. Conclusions: These findings, overall, highlight the importance of understanding the constructed world of women who use injection drugs, particularly regarding the ways by which nurses interact with these women to provide care.

scholarly journals Population-based trends in hospitalizations due to injection drug use-related serious bacterial infections, Oregon, 2008 to 2018

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242165
Author(s):  
Jeffrey Capizzi ◽  
Judith Leahy ◽  
Haven Wheelock ◽  
Jonathan Garcia ◽  
Luke Strnad ◽  
...  
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Bacterial Infection ◽  
Injection Drug Use ◽  
Bacterial Infections ◽  
Fold Increase ◽  
Population Based ◽  
Injection Drug ◽  
Discharge Data ◽  
Serious Bacterial Infections

Background Injection drug use has far-reaching social, economic, and health consequences. Serious bacterial infections, including skin/soft tissue infections, osteomyelitis, bacteremia, and endocarditis, are particularly morbid and mortal consequences of injection drug use. Methods We conducted a population-based retrospective cohort analysis of hospitalizations among patients with a diagnosis code for substance use and a serious bacterial infection during the same hospital admission using Oregon Hospital Discharge Data. We examined trends in hospitalizations and costs of hospitalizations attributable to injection drug use-related serious bacterial infections from January 1, 2008 through December 31, 2018. Results From 2008 to 2018, Oregon hospital discharge data included 4,084,743 hospitalizations among 2,090,359 patients. During the study period, hospitalizations for injection drug use-related serious bacterial infection increased from 980 to 6,265 per year, or from 0.26% to 1.68% of all hospitalizations (P<0.001). The number of unique patients with an injection drug use-related serious bacterial infection increased from 839 to 5,055, or from 2.52% to 8.46% of all patients (P<0.001). While hospitalizations for all injection drug use-related serious bacterial infections increased over the study period, bacteremia/sepsis hospitalizations rose most rapidly with an 18-fold increase. Opioid use diagnoses accounted for the largest percentage of hospitalizations for injection drug use-related serious bacterial infections, but hospitalizations for amphetamine-type stimulant-related serious bacterial infections rose most rapidly with a 15-fold increase. People living with HIV and HCV experienced increases in hospitalizations for injection drug use-related serious bacterial infection during the study period. Overall, the total cost of hospitalizations for injection drug use-related serious bacterial infections increased from $16,305,129 in 2008 to $150,879,237 in 2018 (P<0.001). Conclusions In Oregon, hospitalizations for injection drug use-related serious bacterial infections increased dramatically and exacted a substantial cost on the health care system from 2008 to 2018. This increase in hospitalizations represents an opportunity to initiate substance use disorder treatment and harm reduction services to improve outcomes for people who inject drugs.

Gang Involvement and Drug Use Histories Among People Who Inject Drugs in California: A Retrospective Analysis

2019 ◽  
Vol 49 (4) ◽  
pp. 593-606
Author(s):  
Jane Steinberg ◽  
Alex H. Kral ◽  
Stephanie Sumstine ◽  
Lynn D. Wenger ◽  
Laura D’Anna ◽  
...  
Keyword(s):  
Drug Use ◽  
Confidence Interval ◽  
Injection Drug Use ◽  
People Who Inject Drugs ◽  
Multivariate Analyses ◽  
Injection Drug ◽  
Gang Membership ◽  
Drug Injection ◽  
Gang Involvement ◽  
Parental Drug Use

We examined whether gang membership history was associated with earlier age of first drug use, first drug injection, and shorter time to injection (TTI) drug use among people who inject drugs (PWID). PWID ( N = 438) were interviewed in California (2011-2013). Surveys addressed demographics, current/former drug use practices, gang membership, and parental drug use. Multivariate analyses were conducted to identify whether gang membership history was associated with age at first drug use, first injection drug use, and TTI. Gang membership was reported by 23% of sample. Gang membership history was associated with earlier ages of first drug use (–1.35 years; 95% confidence interval [CI]= [−0.50, −2.20]), age at first injection (–1.89 years; 95% CI = [0.00, −3.78]), but not TTI. Gang involvement facilitates drug use including earlier age of first injection drug use.

scholarly journals “The Six Moments:” A Novel Educational Tool to Promote Infection Prevention Practices in Patients Injecting Drugs

2020 ◽  
Vol 41 (S1) ◽  
pp. s437-s438
Author(s):  
Katherine Linsenmeyer ◽  
Justeen Hyde ◽  
Westyn Branch-Elliman
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Bacterial Infections ◽  
Infection Prevention ◽  
Viral Infections ◽  
Fungal Infections ◽  
Fold Increase ◽  
Injection Drug ◽  
Educational Tool ◽  
Medical Trainees

Background: The opioid epidemic has led to a dramatic increase in the rate of invasive bacterial infections, including a 4-fold increase in sepsis and a 12-fold increase in endocarditis. The increase has been demonstrated in both veteran and nonveteran populations (Fig. 1). Thus, an urgent need exists to develop novel tools to educate patients and providers regarding (1) at-risk moments among intravenous drug users and (2) methods for preventing transmission of bacterial and viral infections associated with injection drug use. Methods: We conducted a survey among medical trainees and staff and collected information about knowledge and attitudes about harm-reduction services. To address gaps in knowledge, we developed an educational tool for promoting better infection prevention practices among patients who inject drugs by adapting the WHO Five Moments of Hand Hygiene. Results: In total, 43 medical trainees and staff responded to the survey. All respondents regarded infections as a serious risk among patients who inject drugs, although there was variation in perception about which types of pathogens were the most likely to be acquired through this pathway (ie, bacterial vs viral). Among survey respondents, 15 of 39 (38%) reported that they have counseled patients who inject drugs about infection prevention, whereas 24 (58%) reported that they had never provided counseling. The reason for the lack of counseling was primarily a lack of knowledge and a lack of resources (10 of 24, 42%). One-quarter (6 of 24, 25%) reported that they did perceive infection prevention counseling to be part of their role. To solve this knowledge and resource gap, we developed an educational tool designed to promote understanding of the risk of bacterial, viral, and fungal infections and how to prevent them (Fig. 2, A and B). The “Six Moments” model highlights important high-risk moments and activities, such as skin cleaning, use of clean needles, and avoiding oral contamination of needles, as well as the corresponding pathogens that can be transmitted at each stage. Infection prevention strategies are them applied to demonstrate how these infections can be averted. The tool focuses on simple infection prevention interventions that can be taught to patients and providers not trained in infection control to limit transmission of infections associated with IV drug use and addresses the knowledge gap identified through the provider survey. Conclusions: This novel tool can be part of a comprehensive educational program that translates infection prevention principles and applies them to reduce infectious morbidity and mortality related to injection drug use.Funding: NoneDisclosures: None

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