Hydromorphone and the risk of infective endocarditis among people who inject drugs: a population-based, retrospective cohort study

Silverman, Michael; Slater, Justin; Jandoc, Racquel; Koivu, Sharon; Garg, Amit X.; Weir, Matthew A.

doi:10.1016/s1473-3099(19)30705-4

Cited by 24 publications

(23 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We suspect these differences are more related to socio-demographics and injection practices, such as reusing syringes and increased frequency of injection, rather than a pathophysiologic predisposition to infection. Crushed opioids are associated with increased rates of endocarditis compared to heroin, so it is also possible that the opioids injected by people with polysubstance use were different than those in the opioid-only group [ 38 ]. Multiple factors play into the risk of developing IDU-associated infections, including drug, socio-behavioral, and medical factors.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

Serota

Bartholomew

Tookes

2020

Clinical Infectious Diseases

View full text Add to dashboard Cite

Background The opioid epidemic has led to increases in injection drug use (IDU)-associated infectious diseases; however, little is known about how more recent increases in stimulant use have affected the incidence and outcomes of hospitalizations for infections among people who inject drugs (PWID). Methods All hospitalizations of PWID for IDU-associated infections in Florida were identified using administrative diagnostic codes and were grouped by substance used (opioids, stimulants, or both) and site of infection. We evaluated the association between substance used and the outcomes: patient-directed discharge (PDD, or “against medical advice”) and in-hospital mortality. Results There were 22,856 hospitalizations for infections among PWID. Opioid use was present in 73%, any stimulants in 43%, and stimulants-only in 27%. Skin and soft tissue infection was present in 50%, sepsis/bacteremia in 52%, osteomyelitis in 10%, and endocarditis in 10%. PWID using opioids/stimulants were youngest, most uninsured, had the highest rate of endocarditis (16%) and hepatitis C (44%). Additionally, 25% of opioid/stimulant users had PDD versus 12% for those using opioids-only. In adjusted models, opioid/stimulant use was associated with PDD compared to opioid-only use (aRR 1.28, 95% CI 1.17-1.40). Younger age and endocarditis were also associated with PDD. Compared to opioid-only use, stimulant-only use had higher risk of in-hospital mortality (aRR 1.26, 95% CI 1.03-1.46). Conclusion While opioid use contributed to most IDU-associated infections, many hospitalizations also involved stimulants. Increasing access to harm reduction interventions could help prevent these infections, while further research on the acute management of stimulant use disorder-associated infections is needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

Serota

Bartholomew

Tookes

2020

Clinical Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…While this study--based on direct interviews--did not find a relationship between hydromorphone-CR and IE, our previous work has demonstrated evidence of such a relationship. Our population-wide study in Ontario with over 60,000 PWID showed a 3.3 fold higher risk of acquiring IE within 120 days when prescribed hydromorphone-CR compared with other opioids (p<0.0001) (24). Moreover, we have also shown that drug excipients within hydromorphone-CR preserve S. aureus survival in vitro (12).…”

Section: Discussionmentioning

confidence: 54%

Risk Factors Of Infective Endocarditis In Persons Who Inject Drugs

Shah

Wong

Ball

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: The rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. Details of injection practices leading to IE are not well characterized.Methods: A case-control study, using one-on-one interviews to understand risk factors and injection practices associated with IE among PWID was conducted. Eligible participants included those who had injected drugs within the last 3 months, were > 18 years old and either never had or were currently admitted for an IE episode. Cases were recruited from the tertiary care centers and controls were recruited from outpatient clinics in patients without IE and addiction clinics in London, Ontario. Results: 33 cases (PWID IE+) and 102 controls (PWID but IE-) were interviewed. Using clean injection equipment from the provincial distribution network was a protective factor against IE (p<0.001). Furthermore, using lighters during the injection process was also protective for IE (OR 2.5; 95% CI 1.11–5.63). Female sex (OR 3.63; 95% CI 1.58-8.36) and injection into multiple sites (OR 4.31; 95% CI 1.33-13.93) were associated with IE. Injection into the feet (57.6% cases; 36.6% control; p= 0.034) was also associated with IE. Discussion: Our pilot study highlights the importance of distributing clean injection materials for IE prevention. Injection into multiple areas may indicate a greater difficulty in accessing common and safer injection sites such as the arm, and thus multi-site injections may be a surrogate marker for injection-related venous damage in entrenched drug users. Moreover, the use of lighters may be correlated with the best practice of heating preparations of drugs prior to injection, which is known to reduce bacterial burden. Lastly, gender differences in injection techniques, which may place women at higher risk of IE, requires further study.

show abstract

“…In contrast, our previous work has demonstrated evidence of such a relationship. Our population-wide study in Ontario with over 60,000 PWID showed a 3.3-fold higher risk of acquiring IE within 120 days when prescribed hydromorphone-CR compared with other opioids (p < 0.0001) [25]. Moreover, we have also shown that drug excipients within hydromorphone-CR preserve S. aureus survival in vitro [12].…”

Section: Discussionmentioning

confidence: 54%

Risk factors of infective endocarditis in persons who inject drugs

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: The rising incidence of infective endocarditis (IE) among people who inject drugs (PWID) has been a major concern across North America. The coincident rise in IE and change of drug preference to hydromorphone controlled-release (CR) among our PWID population in London, Ontario intrigued us to study the details of injection practices leading to IE, which have not been well characterized in literature. Methods: A case-control study, using one-on-one interviews to understand risk factors and injection practices associated with IE among PWID was conducted. Eligible participants included those who had injected drugs within the last 3 months, were > 18 years old and either never had or were currently admitted for an IE episode. Cases were recruited from the tertiary care centers and controls without IE were recruited from outpatient clinics and addiction clinics in London, Ontario. Results: Thirty three cases (PWID IE+) and 102 controls (PWID but IE-) were interviewed. Multivariable logistic regressions showed that the odds of having IE were 4.65 times higher among females (95% CI 1.85, 12.28; p = 0.001) and 5.76 times higher among PWID who did not use clean injection equipment from the provincial distribution networks (95% CI 2.37, 14.91; p < 0.001). Injecting into multiple sites and heating hydromorphone-CR prior to injection were not found to be significantly associated with IE. Hydromorphone-CR was the most commonly injected drug in both groups (90.9% cases; 81.4% controls; p = 0.197). Discussion: Our study highlights the importance of distributing clean injection materials for IE prevention. Furthermore, our study showcases that females are at higher risk of IE, which is contrary to the reported literature. Gender differences in injection techniques, which may place women at higher risk of IE, require further study. We suspect that the very high prevalence of hydromorphone-CR use made our sample size too small to identify a significant association between its use and IE, which has been established in the literature.

show abstract

Hydromorphone and the risk of infective endocarditis among people who inject drugs: a population-based, retrospective cohort study

Cited by 24 publications

References 33 publications

Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

Evaluating Differences in Opioid and Stimulant Use-associated Infectious Disease Hospitalizations in Florida, 2016–2017

Risk Factors Of Infective Endocarditis In Persons Who Inject Drugs

Risk factors of infective endocarditis in persons who inject drugs

Contact Info

Product

Resources

About