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 “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

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

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) &gt;/= 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)

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 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.

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 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 Examining common mental health disorders in people living with HIV on methadone maintenance therapy in Hanoi, Vietnam

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Anisa Y. Mughal ◽  
Melissa Ann Stockton ◽  
Quynh Bui ◽  
Vivian Go ◽  
Brian W. Pence ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Drug Use ◽  
Injection Drug Use ◽  
Hiv Transmission ◽  
Methadone Maintenance ◽  
Injection Drug ◽  
People Living With Hiv ◽  
High Prevalence ◽  
Living With Hiv

Abstract Background Injection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam. Methods This cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance. Results Of the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed. Conclusion There is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.

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