scholarly journals Injection Drug Use and Infectious Disease Practice: A National Provider Survey

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S340-S340 ◽  
Author(s):  
Alison B Rapoport ◽  
Susan E Beekmann ◽  
Philip M Polgreen ◽  
Christopher F Rowley
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Infectious Diseases ◽  
Substance Use Disorders ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Comprehensive Treatment ◽  
Addiction Services ◽  
Serious Infections ◽  
Provider Volume

Abstract Background The opioid epidemic has swept across the U.S. at a staggering rate, with an estimated half million to one million persons injecting drugs annually. Rates of hospitalization for injection drug use (IDU)-related infection have risen precipitously, comprising an escalating proportion of infectious diseases provider volume in highly impacted regions. Methods In March 2017, the Emerging Infections Network surveyed their national network of infectious diseases (ID) physicians to evaluate perspectives relating to the care of persons who inject drugs (PWID), including the frequency of, and management strategies for, IDU-related infection, the availability of addiction services, and the evolving role of ID physicians in the management of addiction. Results Over half (53%; N = 672) of 1,276 members with an adult ID practice participated; 78% (n = 526) reported treating PWID. Of 526 respondents, 464 (88%) reported seeing ≥1 patient per month with an IDU-related infection; 228 (43%) reported ≥6 per month. In the past year, 79% of respondents reported the majority of IDU-related infections seen required ≥2 weeks of parenteral therapy and reported frequently encountering skin and soft-tissue infections (61%), bacteremia/fungemia (53%), and endocarditis (50%). Strategies most commonly employed for management of prolonged parenteral antibiotic therapy included: completion of entire course on inpatient unit (by 41%) and transfer to supervised facility for completion (35%). Only 35% of respondents agree/strongly agree their health system offers comprehensive treatment of substance use disorders (N = 181). Though nearly half of respondents felt that ID providers should actively manage substance use disorders (46%; N = 241), only 3% reported being waivered to prescribe buprenorphine for treatment of opioid use disorder. Conclusion The majority of infectious diseases physicians frequently care for PWID with serious infections. There is significant diversity amongst providers with regards to the availability of comprehensive addiction services as well as perceptions regarding the role providers should play in the management of addiction. Guidelines for the management of serious infections and concurrent addiction in the midst of the escalating national opioid crisis should be considered. Disclosures All authors: No reported disclosures.

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.

Substance use patterns associated with injection drug use initiation in a low-threshold methadone-maintained sample

2013 ◽  
Vol 19 (6) ◽  
pp. 436-439 ◽  
Author(s):  
Miroslava Kolajova ◽  
Heather G. Fulton ◽  
Christine Darredeau ◽  
Sean P. Barrett
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Use Patterns ◽  
Low Threshold ◽  
Drug Use Initiation

The Relative Influence of Injunctive and Descriptive Social Norms on Methamphetamine, Heroin, and Injection Drug Use Among Homeless Youths: The Impact of Different Referent Groups

2017 ◽  
Vol 48 (1) ◽  
pp. 17-35 ◽  
Author(s):  
Anamika Barman-Adhikari ◽  
Jaih Craddock ◽  
Elizabeth Bowen ◽  
Rohan Das ◽  
Eric Rice
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Injection Drug Use ◽  
Homeless Youth ◽  
Injection Drug ◽  
Relative Influence ◽  
Descriptive Norms ◽  
Staff Members ◽  
Home Based ◽  
The Impact

The current study assessed the relative influence of both injunctive and descriptive norms in the context of different referent groups (i.e., family, street peers, home-based peers, and staff members) on past 30-day methamphetamine, heroin, and injection drug use behaviors of homeless youth. Cross-sectional data ( N = 911) were collected from three drop-in centers in Los Angeles, California. The study consisted of two parts: a social network interview and a computerized self-administered survey. Multivariate logistic regression models examined the association of objection to drug use from referent groups (injunctive norms; that is, street-based peers, home-based peers, relatives, staff members) and drug use of referent groups (descriptive norms) with youths’ substance use behaviors. Multivariate results indicated that the role of injunctive and descriptive norms varied across the three substance use behaviors and by referent group. Findings indicate the need to carefully consider the diversity of homeless youths’ networks in designing substance use interventions.

scholarly journals Infectious Diseases and Injection Drug Use: Public Health Burden and Response

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S213-S217
Author(s):  
Alexandra Levitt ◽  
Jonathan Mermin ◽  
Christopher M Jones ◽  
Isaac See ◽  
Jay C Butler
Keyword(s):  
Public Health ◽  
Drug Use ◽  
Infectious Diseases ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Public Health Burden ◽  
Health Burden

scholarly journals The Dynamics of Infectious Diseases Associated with Injection Drug Use in Lawrence and Lowell, Massachusetts

2021 ◽  
Author(s):  
Gregg S Gonsalves ◽  
A David Paltiel ◽  
Thomas Thornhill ◽  
Suzan Iloglu ◽  
Alfred DeMaria ◽  
...  
Keyword(s):  
Drug Use ◽  
Infectious Diseases ◽  
Injection Drug Use ◽  
Warning System ◽  
Infectious Complications ◽  
Injection Drug ◽  
Health Departments ◽  
Incision And Drainage ◽  
Public Health Departments ◽  
Distributed Lag

Abstract There are a wide variety of infectious complications of injection drug use. Understanding the trajectory of these complications might inform the development of an early warning system for HIV outbreaks that occur regularly among people who inject drugs (PWID). A distributed lag Poisson regression model in the Bayesian setting was used to examine temporal patterns in the incidence of injection-associated infectious diseases and their association with HIV cases in Lawrence and Lowell, Massachusetts between 2005-2018. Current-month HIV counts are associated with fatal overdoses approximately 8 months prior, cases of infective endocarditis 10 months prior, cases of skin and soft tissue infections and incision and drainage procedures associated with these infections, 12 months prior. Collecting data on these other complications associated with injection drug use by public health departments may be important to consider as these complications may serve as input to a sentinel system to trigger early intervention and avert potential outbreaks of HIV.

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.

scholarly journals Infectious Diseases Physicians’ Perspectives Regarding Injection Drug Use and Related Infections, United States, 2017

2018 ◽  
Vol 5 (7) ◽  
Author(s):  
Alison B Rapoport ◽  
Leah S Fischer ◽  
Scott Santibanez ◽  
Susan E Beekmann ◽  
Philip M Polgreen ◽  
...  
Keyword(s):  
United States ◽  
Drug Use ◽  
Infectious Diseases ◽  
Injection Drug Use ◽  
Management Strategies ◽  
The United States ◽  
Injection Drug ◽  
Prolonged Treatment ◽  
Emerging Infections ◽  
Persons Who Inject Drugs

Abstract Background In the context of the opioid epidemic, injection drug use (IDU)–related infections are an escalating health issue for infectious diseases (ID) physicians in the United States. Methods We conducted a mixed methods survey of the Infectious Diseases Society of America’s Emerging Infections Network between February and April 2017 to evaluate perspectives relating to care of persons who inject drugs (PWID). Topics included the frequency of and management strategies for IDU-related infection, the availability of addiction services, and the evolving role of ID physicians in substance use disorder (SUD) management. Results More than half (53%, n = 672) of 1273 network members participated. Of these, 78% (n = 526) reported treating PWID. Infections frequently encountered included skin and soft tissue (62%, n = 324), bacteremia/fungemia (54%, n = 281), and endocarditis (50%, n = 263). In the past year, 79% (n = 416) reported that most IDU-related infections required ≥2 weeks of parenteral antibiotics; strategies frequently employed for prolonged treatment included completion of the entire course in the inpatient unit (41%, n = 218) or at another supervised facility (35%, n = 182). Only 35% (n = 184) of respondents agreed/strongly agreed that their health system offered comprehensive SUD management; 46% (n = 242) felt that ID providers should actively manage SUD. Conclusions The majority of physicians surveyed treated PWID and reported myriad obstacles to providing care. Public health and health care systems should consider ways to support ID physicians caring for PWID, including (1) guidelines for providing complex care, including safe provision of multiweek parenteral antibiotics; (2) improved access to SUD management; and (3) strategies to assist those interested in roles in SUD management.

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