Behavioral Characteristics and Injection Practices Associated with Skin and Soft Tissue Infections among People who Inject Drugs: A Community-Based Observational Study

Dahlman, Disa; Håkansson, Anders; Kral, Alex H.; Wenger, Lynn; Ball, Elizabeth; Novak, Scott P.

doi:10.1080/08897077.2016.1263592

Cited by 44 publications

(23 citation statements)

References 52 publications

(176 reference statements)

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“…Evidence suggests PWID prefer to inject in private locations that are more hygienic and afford privacy such that they do not feel pressured to rush injections [27]. Additionally, public injection poses health risks, and has been shown to increase risk of skin and soft tissue infections from unhygienic injection practices [46].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of receptive syringe‐sharing among people who inject drugs in rural Appalachia

et al. 2020

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Background and Aims Syringe‐sharing significantly increases the risk of HIV and viral hepatitis acquisition among people who inject drugs (PWID). Clearer understanding of the correlates of receptive syringe‐sharing (RSS) is a critical step in preventing bloodborne infectious disease transmission among PWID in rural communities throughout the United States. This study aimed to measure the prevalence and correlates of RSS among PWID in a rural county in Appalachia. Design Observational, cross‐sectional sample from a capture–recapture parent study. Setting Cabell County, West Virginia (WV), USA, June–July 2018. Participants The sample was restricted to people who reported injecting drugs in the past 6 months (n = 420). A total of 180 participants (43%) reported recent (past 6 months) RSS. Participants reported high levels of homelessness (56.0%), food insecurity (64.8%) and unemployment (66.0%). Measurements The main outcome was recent re‐use of syringes that participants knew someone else had used before them. Key explanatory variables of interest, selected from the risk environment framework, included: unemployment, arrest and receipt of sterile syringes from a syringe services program (SSP). Logistic regression was used to determine correlates of recent RSS. Findings PWID reporting recent RSS also reported higher prevalence of homelessness, food insecurity and unemployment than their non‐RSS‐engaging counterparts. In adjusted analyses, correlates of RSS included: engagement in transactional sex work [adjusted odds ratio (aOR) = 2.27, 95% confidence interval (CI) = 1.26–4.09], unemployment (aOR = 1.67, 95% CI = 1.03–1.72), number of drug types injected (aOR = 1.33, 95% CI = 1.15–1.53) and injection in a public location (aOR = 2.59, 95% CI = 1.64–4.08). Having accessed sterile syringes at an SSP was protective against RSS (aOR = 0.57, 95% CI = 0.35–0.92). Conclusion The prevalence of receptive syringe‐sharing among people who inject drugs in a rural US county appears to be high and comparable to urban‐based populations. Receptive syringe‐sharing among people who inject drugs in a rural setting appears to be associated with several structural and substance use factors, including unemployment and engaging in public injection drug use. Having recently acquired sterile syringes at a syringe services program appears to be protective against receptive syringe sharing.

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Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of receptive syringe‐sharing among people who inject drugs in rural Appalachia

et al. 2020

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“…Bacterial infections might be prevented through improved skin and injection hygiene [ 32 ] but evidence-based data on relevant interventions is needed. Since sharing of injection equipment has been shown to increase likelihood of SSTI 5–6 fold [ 33 ], access to clean injection equipment for PWID can probably also help reduce the incidence of SSTI. The findings that injection drug use in general, and injection use of heroin in particular, was associated with increased risk of bacterial infections suggest that opioid substitution treatment (OST) could prevent these common health hazards among PWID.…”

Section: Discussionmentioning

confidence: 99%

“…No comparative analyses regarding socioeconomic conditions among PWID with different drug use patterns were possible. Injection frequency, injection habits, periods of abstinence and living conditions during follow-up are likely to affect the infection prevalence [ 2 , 6 , 8 , 21 , 26 , 33 ]. Potentially strong predictors of bacterial infections not included in this study are HIV infection and diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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BackgroundBoth skin and soft tissue infections (SSTI) and systemic bacterial infections are common in people who inject drugs (PWID), but data on incidence and risk factors are lacking. We compared registered diagnoses for such infections in Swedish criminal justice clients with regard to injecting drug use.MethodsBaseline interview data from the Swedish Prison and Probation Service on drug use in PWID and non-PWID with problematic alcohol use were linked to follow-up data from national Swedish registers on hospital diagnoses and/or death. Associations between drug use and later diagnosis of SSTI and systemic bacterial infection (septicemia or bacterial infection of the heart, bone/joints or central nervous system) were analyzed by Cox regression.ResultsIncidence rates of SSTI was 28.3 per 1,000 person-years for PWID (n = 2,444) and 10.0 for non-PWID with problematic alcohol use (n = 735). Incidence rates of systemic bacterial infection was 9.1 per 1,000 person-years for PWID and 2.7 per 1,000 person-years for non-PWID. Injection drug use was associated with a significantly increased risk of bacterial infections, for main drugs heroin (SSTI: Hazard ratio [HR] 2.45; systemic infection: HR 2.75), amphetamine (SSTI: HR 1.60; systemic infection: HR 2.19), and polysubstance use (SSTI: HR 1.92; systemic infection: HR 2.01). In relation to injection use of amphetamine and polysubstance use, PWID mainly using heroin had higher risk of SSTI.ConclusionsInjection drug use predicted both SSTI and systemic bacterial infection, with a particularly high risk of SSTI in PWID mainly using heroin. The results imply the need for increased attention to bacterial infections among PWID, in terms of clinical management, prevention and research.

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“…Three community field sites, located in neighborhoods near large populations of PWID, were utilized to conduct the interviews. Eligibility criteria included injection drug use in the past 30 days as verified by checking for recent signs of venipuncture, being 18 years of age or older, and the ability to provide informed consent [36]. Four persons were interviewed as part of the study, but whose data were later excluded because they answered on the survey that they had not injected drugs in the past 30 days.…”

Section: Methodsmentioning

confidence: 99%

Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs

Dahlman

Kral

Wenger

et al. 2017

Subst Abuse Treat Prev Policy

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BackgroundPeople who inject drugs (PWID) often have poor health and lack access to health care. The aim of this study was to examine whether PWID engage in self-treatment through nonmedical prescription opioid use (NMPOU). We describe the prevalence and features of self-reported physical pain and its association with NMPOU.MethodsPWID (N = 702) in San Francisco, California (age 18+) were recruited to complete interviewer administered surveys between 2011 and 2013. Multivariate logistic regression analysis was conducted to examine the associations among self-reported pain dimensions (past 24-h average pain, pain interference with functional domains) and NMPOU, controlling for age, sex, psychiatric illness, opioid substitution treatment, homelessness, street heroin use and unmet healthcare needs.ResultsAlmost half of the sample reported pain, based on self-reported measures in the 24 h before their interview. The most common pain locations were to their back and lower extremities. Past 24-h NMPOU was common (14.7%) and associated with past 24 h average pain intensity on a 10 point self-rating scale (adjusted odds ratio [AOR] = 2.15, 95% confidence interval [CI] 1.21–3.80), and past 24 h pain interference with general activity (AOR 1.82 [95% CI 1.04–3.21]), walking ability (AOR 2.52 [95% CI 1.37–4.63]), physical ability (AOR 2.01 [95% CI 1.16–3.45]), sleep (AOR 1.98 [95% CI 1.13–3.48]) and enjoyment of life (AOR 1.79 [95% CI 1.02–3.15]).ConclusionBoth pain and NMPOU are common among PWID, and highly correlated in this study. These findings suggest that greater efforts are needed to direct preventive health and services toward this population.

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Behavioral Characteristics and Injection Practices Associated with Skin and Soft Tissue Infections among People who Inject Drugs: A Community-Based Observational Study

Abstract: SSTIs are common among PWID. These data highlight the importance of clinical and public health screening efforts to reduce SSTIs. Needle exchange programs may be good venues for SSTIs screening and treatment.

Cited by 44 publications

References 52 publications

Prevalence and correlates of receptive syringe‐sharing among people who inject drugs in rural Appalachia

Prevalence and correlates of receptive syringe‐sharing among people who inject drugs in rural Appalachia

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

Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs

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