scholarly journals Recurring Severe Injection-related Infections in People Who Inject Drugs and the Need for Safe Injection Sites in Spain

2021 ◽  
Author(s):  
Jorge Valencia ◽  
Jesús Troya ◽  
Jeffrey V Lazarus ◽  
Guillermo Cuevas ◽  
Alejandro Alvaro-Meca ◽  
...  
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Opioid Use Disorder ◽  
Incidence Density ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Complicated Skin ◽  
Safe Injection

Abstract Background and aims: An estimated 68,297 people with opioid use disorder engage in opioid agonist therapy (OAT) in Spain. We aimed to calculate the incidence of severe injection-related infections in people who inject drugs (PWID) engaged in OAT in a harm reduction setting without a safe injection site (SCS).Methods: A retrospective cohort study was performed in PWID engaged in OAT and in a mobile harm reduction unit to identify who was admitted to a referral hospital for any severe injection-related infections between 1 Jan 2016 and 31 Dec 2019. A Cox proportional hazard regression analysis was used to assess factors associated with any severe injection-related infection.Results: 237 PWID engaged in OAT were included. After a median follow-up of 5.5 months (IQR 1.3–22.7), a total of 104 episodes of severe injection-related infections occurred in 56 individuals, and admission for a second event occurred in 35.7% of this same group. The incidence density of any type of severe injection-related infection was 26.8 (20.2–34.8) episodes per 100 PY, and the incidence density of complicated skin and soft tissue infections (SSTIs) that required hospital admission was 20.4 (15.0–27.3) episodes per 100 PY. Fifty-six (53.8%) of all the episodes were patient-directed discharge (PDD), and people who had two or more hospital admissions had a higher PDD frequency.Conclusion: Severe injection-related infections remain highly prevalent among PWID cared for in a harm reduction setting without a SCS. PDD were more frequent in higher-risk individuals who presented two or more hospital readmissions.

scholarly journals Recurring severe injection-related infections in people who inject drugs and the need for safe injection sites in Madrid, Spain

2021 ◽  
Author(s):  
Jorge Valencia ◽  
Jesús Troya ◽  
Jeffrey V Lazarus ◽  
Guillermo Cuevas ◽  
Alejandro Alvaro-Meca ◽  
...  
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Incidence Density ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Complicated Skin

Abstract Background and aims An estimated 58,749 people with opioid use disorder engaged in opioid agonist therapy in 1132 centers in Spain during 2017. We aimed to calculate the incidence of severe injection-related infections in people who inject drugs (PWID) engaged in opioid agonist therapy (OAT) in harm reduction settings without a safe consumption space (SCS). Methods A retrospective cohort study was performed in PWID engaged in (OAT) and in a mobile harm reduction unit to quantify admissions to a referral hospital for any severe injection-related infections between 1 January 2016 and 31 December 2019. A Cox proportional hazard regression analysis was used to assess factors associated with any severe injection-related infection. Results 237 PWID who engaged in OAT were included in the study. After a median follow-up of 5.5 months (IQR 1.3–22.7), a total of 104 episodes of severe injection-related infections occurred among 56 individuals, and admission due to a second event occurred in 35.7% of this same group. The incidence density of any type of severe injection-related infection was 26.8 (20.2–34.8) episodes per 100 person-years, and the incidence density of complicated skin and soft tissue infections that required hospital admission was 20.4 (15.0–27.3) episodes per 100 person-year. Fifty-six (53.8%) of all the episodes were patient-directed discharge, and people who had two or more hospital admissions had a higher PDD frequency. Conclusion Severe injection-related infections remain highly prevalent among PWID cared for in a harm reduction setting without a SCS. Patient-directed discharge was more frequent among higher-risk individuals who presented two or more hospital readmissions.

scholarly journals Harm Reduction Service Utilization Among People Who Inject Drugs in Tajikistan: Prevalence and Precipitating Factors

2020 ◽  
Author(s):  
Mary M. Tate ◽  
Daniel J. Bromberg ◽  
Kamiar Alaei ◽  
Saifuddin Karimov ◽  
Dilshod Saidi ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Methadone Maintenance Therapy ◽  
People Who Use Drugs ◽  
People Living With Hiv ◽  
Opioid Use ◽  
Needle And Syringe Programs

Abstract Tajikistan is in a unique geopolitical location along the global heroin trade route, exacerbating its own opioid use disorder and HIV epidemics. With one of the highest rates of opioid use disorder in the world, and 20,000-30,000 people who inject drugs in the country, Tajikistan’s government and international actors have provided harm reduction measures for people who use drugs, like narcology centers, needle and syringe programs, and methadone maintenance therapy. No implementation science studies have been conducted in Tajikistan and the current implementation gaps in service uptake are unknown. The purpose of this paper is to determine the prevalence of harm reduction service uptake among people who use drugs in Tajikistan, and determine which factors are associated with service uptake. Methods This paper uses data from the National AIDS Registry, subset to patients who use drugs (n=11,029) and cross-sectional data from a bio-behavioral survey conducted in 2017 (n=2,390). Univariate and multivariate logistic regression were used to assess associations between study variables and probably of uptake of narcology center registration, uptake of needle and syringe programs, and registration into methadone maintenance therapy. Results Fewer than half of all people who inject drugs (42.4%) were registered with the narcology center , most people who inject drugs (88.6%) reported always having access to clean syringes, and only 5.3% of PWID had ever engaged in methadone treatment in Tajikistan. There were ethnic differences in service uptake – with ethnic Russians and Uzbeks less likely to use services than ethnic Tajiks. Men who have sex with men and people living with HIV were also more likely to access services than heterosexual or seronegative individuals. Conclusion Narcology center registration and clean needle coverage are high in Tajikistan. Methadone maintenance therapy uptake, however, is low, like in other countries in Eastern Europe and Central Asia. NGO and government initiatives that target risk groups (like LGBTQ+ people and people living with HIV) seem to have been somewhat effective at recruiting their clientele into services. Future research might focus on the “positive deviancy” of these subgroups of people who use drugs to learn how to increase service uptake generally.

scholarly journals Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs

2020 ◽  
Vol 71 (7) ◽  
pp. 1715-1722 ◽  
Author(s):  
Elana S Rosenthal ◽  
Rachel Silk ◽  
Poonam Mathur ◽  
Chloe Gross ◽  
Rahwa Eyasu ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Drug Use ◽  
People Who Inject Drugs ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Hcv Treatment ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
The Impact

Abstract Background People who inject drugs have a high prevalence of hepatitis C virus (HCV) and significant disease associated with drug use; however, HCV treatment often occurs in absence of interventions to address opioid use disorder and drug use–related harms. The impact of concurrent initiation of opioid agonist therapy (OAT) on HCV treatment and drug use outcomes is unknown. Methods In this prospective, open-label, observational trial at a harm reduction organization’s drop-in center in Washington, DC, 100 patients with chronic HCV infection, opioid use disorder, and ongoing injection drug use were treated with sofosbuvir-velpatasvir for 12-weeks and offered buprenorphine initiation. The primary end point was sustained virologic response (SVR), and secondary end points included uptake of and retention in OAT, change in risk behavior, and determinants of SVR. Results Eighty-two patients (82%) achieved SVR, which was not associated with baseline OAT status (P = .33), on-treatment drug use (P >.99), or imperfect daily adherence (P = .35) but was significantly associated with completing 2 or more 28-pill bottles of sofosbuvir-velpatasvir (P < .001) and receiving OAT at week 24 (P = .01). Of 67 patients not already receiving OAT at baseline, 53 (79%) started OAT. At week 24, 68 (68%) patients were receiving OAT. Receipt of OAT was associated with fewer opiate-positive urine drug screens (P = .003), lower human immunodeficiency virus risk-taking behavior scores (P < .001), and lower rates of opioid overdose (P = .04). Conclusions The Novel Model of Hepatitis C Treatment as an Anchor to Prevent HIV, Initiate Opioid Agonist Therapy, and Reduce Risky Behavior study demonstrates high uptake of buprenorphine collocated with HCV treatment, and it shows that concurrent initiation of OAT with HCV treatment can result in high rates of SVR while reducing risks associated with drug use. Clinical Trials Registration NCT03221309.

scholarly journals Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Alyssa M Peckham ◽  
Erika H Young
Keyword(s):  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Postexposure Prophylaxis ◽  
Treatment Access ◽  
Clinical Encounters ◽  
Exposure Prophylaxis ◽  
Improve Patient ◽  
Major Target

Abstract Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include (1) teaching and distribution of materials related to safer injection practice such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and postexposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.

scholarly journals Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Noa Krawczyk ◽  
Adetayo Fawole ◽  
Jenny Yang ◽  
Babak Tofighi
Keyword(s):  
Harm Reduction ◽  
Scoping Review ◽  
English Language ◽  
Data Extraction ◽  
Home Delivery ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Policy And Practice ◽  
Patient Centered ◽  
Long Acting

Abstract Background The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. Methods Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. Results Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. Conclusions The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.

scholarly journals 213. A Comparison of Medication Assisted Therapy Treatment Strategies for Opioid Use Disorder in Persons who Inject Drugs and are Hospitalized with Serious Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S126-S126
Author(s):  
Laura Marks ◽  
Evan Schwarz ◽  
David Liss ◽  
Munigala Satish ◽  
David K Warren ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hospital Readmissions ◽  
Treatment Strategies ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Readmission Rates ◽  
Persons Who Inject Drugs ◽  
Increased Risk ◽  
Hospital Patients ◽  
The Impact

Abstract Background Persons who inject drugs (PWID) with opioid use disorder (OUD) are at increased risk of invasive bacterial and fungal infections, which warrant prolonged, inpatient parenteral antimicrobial therapy. Such admissions are complicated by opioid cravings and withdrawal. Comparisons of medications for OUD during prolonged admissions for these patients have not been previously reported. The aim of this study was to evaluate the impact of different OUD treatment strategies in this population, and their impact on ED and hospital readmissions. Methods We retrospectively analyzed consecutive admissions for invasive bacterial or fungal infections in PWID, admitted between January 2016 and January 2019 at Barnes-Jewish Hospital. Patients in our cohort were required to receive an infectious diseases consult, and an anticipated antibiotic treatment duration of >2 weeks. We collected data on demographics, comorbidities, length of stay, microbiologic data, medications prescribed for OUD, mortality, and readmission rates. We compared 90-day readmission rates by OUD treatment strategies using Kaplan–Meier curves. Results In our cohort of 237 patients, treatment of OUD was buprenorphine (17.5%), methadone (25.3%), or none (56.2%). Among patients receiving OUD treatment, 30% had methadone tapers and/or methadone discontinued upon discharge. Patient demographics were similar for each OUD treatment strategy. Infection with HIV (2.8%), and hepatitis B (3%), and hepatitis C (67%) were similar between groups. Continuation of medications for OUD was associated with increased completion of parenteral antibiotics (odds ratio 2.11; 95% confidence interval 1.70–2.63). When comparing medications for OUD strategies, methadone had the lowest readmission rates, followed by buprenorphine, and no treatment (P = 0.0013) (figure). Discontinuation of methadone during the admission or upon discharge was associated with the highest readmission rates. Conclusion Continuation of OUD treatment without tapering, was associated with improved completion of parenteral antimicrobials in PWID with invasive bacterial or fungal infections lower readmission rates. Tapering OUD treatment during admission was associated with higher readmission rates. Disclosures All authors: No reported disclosures.

Multi-site intervention to improve emergency department care for patients who live with opioid use disorder: A quantitative evaluation

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 784-792 ◽  
Author(s):  
Patrick McLane ◽  
Ken Scott ◽  
Zainab Suleman ◽  
Karen Yee ◽  
Brian R. Holroyd ◽  
...  
Keyword(s):  
Emergency Department ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Emergency Department Care ◽  
Improvement Project ◽  
Health Crisis ◽  
Opioid Agonist Treatment ◽  
Before And After ◽  
Disorder Treatment

ABSTRACTBackgroundOpioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.MethodsThe intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.ResultsThe intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.ConclusionsEmergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.

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