Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team

Serota, David P.; Tookes, Hansel; Hervera, Belén; Gayle, Babley M.; Roeck, Cara R.; Suarez, Edward; Forrest, D.W.; Kolber, Michael A.; Bartholomew, Tyler S.; Rodríguez, Allan; Doblecki-Lewis, Susanne

doi:10.1080/07853890.2021.1993326

Cited by 24 publications

(16 citation statements)

References 42 publications

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“…In our study, at the Saint John site every patient with IDU-IE and untreated opioid use disorder was offered OAT because the infectious diseases consultation service considers this within their scope of practice. This model has been successful at other hospitals [ 42 , 43 ], but addiction care may or may not be available to patients admitted with non-infectious indications. Despite several years passing since our study period, the removal of Health Canada’s certification requirement to prescribe methadone for OAT, and Canada’s escalating overdose death crisis, the QEII Health Sciences Centre in Halifax still does not have addiction medicine-trained physicians or OAT providers on staff.…”

Section: Discussionmentioning

confidence: 99%

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

et al. 2022

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Background Addiction treatment and harm reduction services reduce risks of death and re-infection among patients with injection drug use-associated infective endocarditis (IDU-IE), but these are not offered at many hospitals. Among hospitalized patients with IDU-IE at the two tertiary-care hospitals in the Canadian Maritimes, we aimed to identify (1) the availability of opioid agonist treatment (OAT) and sterile drug injecting equipment, and (2) indicators of potential unmet addiction care needs. Methods Retrospective review of IDU-IE hospitalizations at Queen Elizabeth II Health Sciences Centre (Halifax, Nova Scotia) and the Saint John Regional Hospital (Saint John, New Brunswick), October 2015 -March 2017. In Halifax, there are no addiction medicine providers on staff; in Saint John, infectious diseases physicians also practice addiction medicine. Inclusion criteria were: (1) probable or definite IE as defined by the modified Duke criteria; and (2) injection drug use within the prior 3 months. Results We identified 38 hospitalizations (21 in Halifax and 17 in Saint John), for 30 unique patients. Among patients with IDU-IE and untreated opioid use disorder, OAT was offered to 36% (5/14) of patients in Halifax and 100% (6/6) of patients in Saint John. Once it was offered, most patients at both sites initiated OAT and planned to continue it after discharge. In Halifax, no patients were offered sterile injecting equipment, and during five hospitalizations staff confiscated patients’ own equipment. In Saint John, four patients were offered (and one was provided) injecting equipment in hospital, and during two hospitalizations staff confiscated patients’ own equipment. Concerns regarding undertreated pain or opioid withdrawal were documented during 66% (25/38) of hospitalizations, and in-hospital illicit or non-medical drug use during 32% (12/38). Two patients at each site (11%; 4/38) had self-directed discharges against medical advice. Conclusions Patients with IDU-IE in the Canadian Maritimes have unequal access to evidence-based addiction care depending on where they are hospitalized, which differs from the community-based standard of care. Indicators of potential unmet addiction care needs in hospital were common.

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Section: Discussionmentioning

confidence: 99%

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

et al. 2022

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“…There has been increased focus on the integration of addiction medicine and infectious disease specialties to develop “Serious Injection-Related Injury (SIRI)” teams due to the significant increase in infections like infective endocarditis [ 59 , 60 ]. These teams are focused on providing both gold standard antibiotic therapies and evidence-based substance use disorder treatment among patients hospitalized with SIRIs [ 61 , 62 ] to optimize health-related outcomes. These teams are well positioned to deliver harm reduction interventions to PWID, including linkage to HIV prevention (e.g.…”

Section: Discussionmentioning

confidence: 99%

Application of machine learning algorithms for localized syringe services program policy implementation – Florida, 2017

et al. 2022

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Background People who inject drugs (PWID) are at an amplified vulnerability for experiencing a multitude of harms related to their substance use, including viral (e.g. HIV, Hepatitis C) and bacterial infections (e.g. endocarditis). Implementation of evidence-based interventions, such as syringe services programs (SSPs), remains imperative, particularly in locations at an increased risk of HIV outbreaks. This study aims to identify communities in Florida that are high-priority locations for SSP implementation by examining state-level data related to the substance use and overdose crises. Methods State-level surveillance data were aggregated at the ZIP Code Tabulation Area (ZCTA) ( n = 983) for 2017. We used confirmed cases of acute HCV infection as a proxy of injection drug use. Least Absolute Selection and Shrinkage Operator (LASSO) regression was used to develop a machine learning model to identify significant indicators of acute HCV infection and high-priority areas for SSP implementation due to their increased vulnerability to an HIV outbreak. Results The final model retained three variables of importance: (1) the number of drug-associated skin and soft tissue infection hospitalizations, (2) the number of chronic HCV infections in people aged 18–39, and 3) the number of drug-associated endocarditis hospitalizations. High-priority SSP implementation locations were identified in both urban and rural communities outside of current Ending the HIV Epidemic counties. Conclusion SSPs are long researched, safe, and effective evidence-based programs that offer a variety of services that reduce disease transmission and assist with combating the overdose crisis. Opportunities to increase services in needed regions across the state now exist in Florida as supported by the expansion of the Infectious Disease Elimination Act of 2019. This study provides details where potential areas of concern may be and highlights regions where future evidence-based harm reduction programs, such as SSPs, would be useful to reduce opioid overdoses and disease transmission among PWID. Key messages The rate of acute HCV in Florida in 2017 was 1.9 per 100,000, nearly twice the national average. Serious injection related infections among PWID are significant indicators of acute HCV infection. High-priority SSP implementation locations in Florida were identified in both urban and rural communities, including those outside of current Ending the HIV Epidemic counties.

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“…Suboptimal access to OAT may reflect system-level issues that separate addiction care from specialized, acute medical care for infections [ 1 , 22 , 29 , 30 ]. In some hospitals, clinicians have tried to overcome this by establishing specialized addiction medicine consultation services [ 33 – 36 ] or by infectious diseases specialists prescribing OAT directly [ 29 , 37 ]. While OAT is known to be beneficial for other injecting-related health outcomes, there has been relatively little research on OAT and risk for injecting-related infections.…”

Section: Introductionmentioning

confidence: 99%

Opioid agonist treatment and risk of death or rehospitalization following injection drug use–associated bacterial and fungal infections: A cohort study in New South Wales, Australia

et al. 2022

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Background Injecting-related bacterial and fungal infections are associated with significant morbidity and mortality among people who inject drugs (PWID), and they are increasing in incidence. Following hospitalization with an injecting-related infection, use of opioid agonist treatment (OAT; methadone or buprenorphine) may be associated with reduced risk of death or rehospitalization with an injecting-related infection. Methods and findings Data came from the Opioid Agonist Treatment Safety (OATS) study, an administrative linkage cohort including all people in New South Wales, Australia, who accessed OAT between July 1, 2001 and June 28, 2018. Included participants survived a hospitalization with injecting-related infections (i.e., skin and soft-tissue infection, sepsis/bacteremia, endocarditis, osteomyelitis, septic arthritis, or epidural/brain abscess). Outcomes were all-cause death and rehospitalization for injecting-related infections. OAT exposure was classified as time varying by days on or off treatment, following hospital discharge. We used separate Cox proportional hazards models to assess associations between each outcome and OAT exposure. The study included 8,943 participants (mean age 39 years, standard deviation [SD] 11 years; 34% women). The most common infections during participants’ index hospitalizations were skin and soft tissue (7,021; 79%), sepsis/bacteremia (1,207; 14%), and endocarditis (431; 5%). During median 6.56 years follow-up, 1,481 (17%) participants died; use of OAT was associated with lower hazard of death (adjusted hazard ratio [aHR] 0.63, 95% confidence interval [CI] 0.57 to 0.70). During median 3.41 years follow-up, 3,653 (41%) were rehospitalized for injecting-related infections; use of OAT was associated with lower hazard of these rehospitalizations (aHR 0.89, 95% CI 0.84 to 0.96). Study limitations include the use of routinely collected administrative data, which lacks information on other risk factors for injecting-related infections including injecting practices, injection stimulant use, housing status, and access to harm reduction services (e.g., needle exchange and supervised injecting sites); we also lacked information on OAT medication dosages. Conclusions Following hospitalizations with injection drug use–associated bacterial and fungal infections, use of OAT is associated with lower risks of death and recurrent injecting-related infections among people with opioid use disorder.

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Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team

Cited by 24 publications

References 42 publications

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

Application of machine learning algorithms for localized syringe services program policy implementation – Florida, 2017

Opioid agonist treatment and risk of death or rehospitalization following injection drug use–associated bacterial and fungal infections: A cohort study in New South Wales, Australia

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