High Rates of Primary Care and Emergency Department Use Among Injection Drug Users in Vancouver

Kerr, Thomas; Wood, Evan; Grafstein, Eric; Ishida, Tomiye; Shannon, Kate; Lai, Ching‐chong; Montaner, Julio S. G.; Tyndall, Mark W.

doi:10.1093/pubmed/fdh189

Cited by 175 publications

(158 citation statements)

References 18 publications

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“…With respect to the banning of precursor chemicals, similar bans have been in place in the U.S. since 1996 and, though temporary disruptions to methamphetamine drug markets have been observed, use of methamphetamine has nevertheless grown unabated Cunningham & Liu, 2003;Reuter, 2003). Therefore, there is an urgent need for evidence-based HIV prevention and drug treatment programs for crystal methamphetamine injectors in order to minimize the harms associated with use of this drug (Reuter, 2003;Kerr et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Increasing use and associated harms of crystal methamphetamine injection in a Canadian setting

Fairbairn

Kerr

Buxton

et al. 2007

Drug and Alcohol Dependence

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Background-There is a growing concern surrounding crystal methamphetamine use in Canada despite surprisingly little empirical data to support such claims. We evaluated the trends in crystal methamphetamine injection and factors associated with injection of the drug among a cohort of injection drug users (IDU) in Vancouver.Methods-We conducted a prospective analysis of factors associated with crystal methamphetamine injection among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS). Since serial measures for each individual were available, variables potentially associated with crystal methamphetamine injection were evaluated using generalized estimating equations (GEE) with logit link for binary outcomes.Results-Overall, 1587 IDU were enrolled into the VIDUS cohort between May 1996 and December 2004. The proportion of IDU who reported injecting crystal methamphetamine during the last six months increased during the study period (Cochran-Armitage trend test, p < 0.001). In multivariate GEE analyses, crystal methamphetamine injection was independently associated with younger age (Adjusted Odds Ratio [AOR]: 4.77, 95% Confidence Interval [CI] = 3.40 -6.70), Caucasian ethnicity (AOR = 2.21, 95% CI = 1.57 -3.12), syringe borrowing (AOR = 1.62, 95% CI = 1.22 -2.13), and syringe lending (AOR = 1.40, 95% CI = 1.02 -1.86).Interpretation-There was a significant trend towards increasing crystal methamphetamine injection in this setting and elevated HIV risk behavior and younger age were independently associated with crystal methamphetamine injection. Given that banning precursor chemicals has had a limited effect on reducing methamphetamine supply in other jurisdictions, pragmatic and effective interventions are needed to address the growing use of this drug.

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Section: Discussionmentioning

confidence: 99%

Increasing use and associated harms of crystal methamphetamine injection in a Canadian setting

Fairbairn

Kerr

Buxton

et al. 2007

Drug and Alcohol Dependence

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“…The prevalence of recent or current skin and soft tissue infections in IDUs has been reported to be one in ten in Vancouver and Sydney [3,4] ; however, other studies from North America and in Europe indicate prevalence can be as high as one in three [5][6][7][8]. In North America these infections are the most common diagnoses in IDUs presenting to emergency departments [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Injection site infections have been associated with poor hygiene and unsafe injection practices including: inadequate cleaning of the hands or the injection sites [11][12][13]; needle and syringe re-use [8,11] ; frequent injection [8,[14][15][16] ; subcutaneous injection [6,11] ; the injection sites used [8,13,16]; the drugs injected [8,11,14,15] ; and drawing blood back into the syringe repeatedly [9]. Higher levels of these infections have also been reported to be associated with environmental factors, including poor housing and homelessness [3,4,13], and with gender [3,4,8,14] and source of income [4].…”

Section: Introductionmentioning

confidence: 99%

The extent of injection site infection in injecting drug users: findings from a national surveillance study

Hope¹,

Marongiu²,

Parry³

et al. 2010

Epidemiol. Infect.

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SUMMARYInjection site infections in injecting drug users (IDUs) are associated with serious morbidity and healthcare costs. Factors associated with symptoms of these were examined through annual (2006)(2007)(2008) unlinked-anonymous survey of IDUs in England, Wales and Northern Ireland. Overall 36% (1863/5209) self-reported having a symptom with no trend over time (35 % 2006, 37 % 2007, 34 % 2008). Symptoms were less common in the North East of England ; increased with years injecting ; and were higher in women, those recently homeless, those recently using a needle exchange, and those injecting both opiates and stimulants. Of those injecting during the previous 4 weeks (n=3733) symptoms were associated with : injecting daily ; injecting o10 times a day; injecting into hands, groin, or legs ; sharing filters; and reusing water to flush syringes. Symptoms of injection site infections are common in IDUs. Better-targeted preventive interventions are needed, and continued surveillance should assist with assessing the impact of new initiatives.

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“…Illicit drug users who engage in risky drug use practices are at especially high risk for HIV and other injection drug use-related medical problems (Friedman, Jose, Deren, Des Jarlais, & Neaigus, 1995;Kerr et al, 2004;Masson et al, 2002). In fact, for the participants in this study, treatment of skin and soft-tissue infections accounted for the majority of their service use.…”

Section: Discussionmentioning

confidence: 81%

Hospital- Versus Community–Based Syringe Exchange: A Randomized Controlled Trial

Masson¹,

Sorensen²,

Perlman³

et al. 2007

AIDS Education and Prevention

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This study examined the effect of syringe exchange program setting on the injection practices, health status, and health service utilization patterns of injection drug users (IDUs) recruited from a public urban hospital. One hundred sixty-six participants were randomized to either communityor hospital-based syringe exchange services. Poisson regression models were used to compare service utilization between groups. In both conditions, risky drug use practices decreased, and physical health functioning improved over time. Hospital-based syringe exchange program (SEP) attendees had 83% more inpatient admissions (p < .0001) and 22% more ambulatory care visits (p NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript < .0001) than those assigned to the community-based SEP condition. Syringe exchange services that are integrated into public hospital settings may serve as a valuable strategy to engage hard to reach IDU populations in behavioral interventions designed to reduce HIV risk transmission behaviors and increase access to, or engagement in, the use of secondary and tertiary preventive medical care.Syringe exchange programs (SEPs) reduce the transmission of HIV and other blood-borne pathogens through the provision of free sterile injection equipment, disposal of used syringes, and referrals to HIV testing and drug treatment. Increasing the availability of sterile syringes through SEPs, pharmacies, and other outlets reduces unsafe injection practices, such as needle sharing, and reduces the spread of HIV infection (Des Jarlais et al., 1996;Hagan & Thiede, 2000;MacDonald, Law, Kaldor, Hales, & Dore, 2003;Valente, Foreman, Junge, & Vlahov, 2001;Vlahov et al., 1997). Moreover, SEPs are a cost-effective HIV prevention strategy (Laufer, 2001).Despite the effectiveness of SEPs, questions about how to operate these programs remain unanswered. Factors such as SEP location, syringe distribution policies, number of hours of operation, days of the week and time of day of operation, ancillary services offered, harm reduction philosophy of staff, law enforcement practices and cultural appropriateness of staff may affect risk behaviors and patterns of SEP use (Bluthenthal, Kral, Lorvick, & Watters, 1997;Kral & Bluthenthal, 2003;Riley et al., 2000;Rockwell, Des Jarlais, Friedman, Perlis, & Paone, 1999). The influence of these factors on the effectiveness of SEPs requires further study.Although SEPs and health care facilities share the mission of preventing or reducing complications of injection drug use, they usually operate independently of one another. In addition, although hospital-based SEPs have been instituted in other countries, including Australia, Canada, and the United Kingdom, this approach has not gained widespread general acceptance in the United States (Commonwealth Department of Health and Ageing, 2002;Hankins, 1998;Parsons et al., 2002). In the United States SEPs are usually freestanding. Integration with the health care system may have advantages, but without fu...

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High Rates of Primary Care and Emergency Department Use Among Injection Drug Users in Vancouver

Cited by 175 publications

References 18 publications

Increasing use and associated harms of crystal methamphetamine injection in a Canadian setting

Increasing use and associated harms of crystal methamphetamine injection in a Canadian setting

The extent of injection site infection in injecting drug users: findings from a national surveillance study

Hospital- Versus Community–Based Syringe Exchange: A Randomized Controlled Trial

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