Injection Drug Use

Pieper, Barbara; Kirsner, Robert S.; Templin, Thomas; Birk, Thomas J.

doi:10.1001/archderm.143.10.1305

Cited by 40 publications

(28 citation statements)

References 34 publications

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“…The individual burden of heroin-related SSTI in San Francisco has been described as a “hidden epidemic of suffering” (Ciccarone et al, 2000). SSTI have a negative impact on quality of life with persistent pain, mobility restrictions and stigmatization due to disfigurement and wound odor (Palfreyman et al, 2007; Pieper et al, 2007). Stigmatization in turn leads to non-adherence to medical care and self-care practices such as self-lancing abscesses (Bourgois and Schonberg, 2009; Ciccarone et al, 2000; Fink et al, 2013; Messac et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Nationwide increase in hospitalizations for heroin-related soft tissue infections: Associations with structural market conditions

Ciccarone

Unick

Cohen

et al. 2016

Drug and Alcohol Dependence

115

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Introduction Little is known about trends in national rates of injection-related skin and soft tissue infections (SSTI) and their relationship to the structural risk environment for heroin users. Use of Mexican-sourced “Black Tar” heroin, predominant in western US states, may have greater risk for SSTI compared with eastern US powder heroin (Colombian-sourced) due to its association with non-intravenous injection or from possible contamination. Methods Using nationally representative hospital admissions data from the Nationwide Inpatient Sample and heroin price and purity data from the Drug Enforcement Administration, we looked at rates of hospital admissions for opiate-related SSTI (O-SSTI) between 1993 and 2010. Regression analyses examined associations between O-SSTI and heroin source, form and price. Results Hospitalization rates of O-SSTI doubled from 4 to 9 per 100,000 nationally between 1993 and 2010; the increase concentrated among individuals aged 20 to 40. Heroin market features were strongly associated with changes in the rate of SSTI. Each $100 increase in yearly heroin price-per–gram-pure was associated with a 3% decrease in the rate of heroin-related SSTI admissions. Mexican-sourced-heroin-dominant cities had twice the rate of O-SSTI compared to Colombian-sourced-heroin-dominant cities. Discussion Heroin-related SSTI are increasing and structural factors, including heroin price and source-form, are associated with higher rates of SSTI hospital admissions. Clinical and harm reduction efforts should educate heroin users on local risk factors, e.g., heroin type, promote vein health strategies and provide culturally sensitive treatment services for persons suffering with SSTI.

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Section: Introductionmentioning

confidence: 99%

Nationwide increase in hospitalizations for heroin-related soft tissue infections: Associations with structural market conditions

Ciccarone

Unick

Cohen

et al. 2016

Drug and Alcohol Dependence

115

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“…Chronic venous disease leads, at its end stage, to ulceration of the skin, which, in the non-drug-using population, tends to become long lasting and recurs [34]. The progression of venous disease in drug users is unknown, but it is likely to be similarly persistent and costly [35]. …”

Section: Introductionmentioning

confidence: 99%

“…Leg ulceration can also have an impact on quality of life with sufferers citing pain, odour and mobility problems. Injecting drug users are seen increasingly at leg ulcer clinics, but it is unknown how significant the problem in this population is or what the long-term sequelae may be [2,35]. …”

Section: Introductionmentioning

confidence: 99%

Prevalence of skin problems and leg ulceration in a sample of young injecting drug users

et al. 2014

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BackgroundDrug users suffer harm from the injecting process, and clinical services are reporting increasing numbers presenting with skin-related problems such as abscesses and leg ulcers. Skin breakdown can lead to long-term health problems and increased service costs and is often the first indication of serious systemic ill health. The extent of skin problems in injecting drug users has not previously been quantified empirically, and there is a dearth of robust topical literature. Where skin problems have been reported, this is often without clear definition and generic terms such as ‘soft tissue infection’ are used which lack specificity. The aim of this study was to identify the range and extent of skin problems including leg ulceration in a sample of injecting drug users. Definitions of skin problems were developed and applied to descriptions from drug users to improve rigour.MethodsData were collected in needle exchanges and methadone clinics across Glasgow, Scotland, from both current and former drug injectors using face-to-face interviews.ResultsTwo hundred participants were recruited, of which 74% (n = 148) were males and 26% (n = 52) were females. The age range was 21–44 years (mean 35 years). Just under two thirds (64%, n = 127) were currently injecting or had injected within the last 6 months, and 36% (n = 73) had previously injected and had not injected for more than 6 months.Sixty per cent (n = 120) of the sample had experienced a skin problem, and the majority reported more than one problem. Most common were abscesses, lumps, track marks and leg ulcers. Fifteen per cent (n = 30) of all participants reported having had a leg ulcer.ConclusionsThis is an original empirical study which demonstrated unique findings of a high prevalence of skin disease (60%) and surprisingly high rates of leg ulceration (15%). Skin disease in injecting drug users is clearly widespread. Leg ulceration in particular is a chronic recurring condition that is costly to treat and has long-term implications for drug users and services caring for current or former injectors long after illicit drug use has ceased.

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“…Vein injury occurs through scarring, non-sterile injection, and direct toxic effects of the drug and can lead to chronic venous insufficiency (CVI), which increases the risk for chronic lower extremity ulcers (Pieper & Templin, 2001; Pieper, Kirsner, Templin, & Birk, 2007). Wounds can also lead to more severe SSTIs, including gangrene and sepsis, potentially resulting in amputation or death (Callahan, Schecter, & Horn, 1998).…”

mentioning

confidence: 99%

High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors

Smith

Robinowitz

Chaulk

et al. 2015

Journal of Addiction Medicine

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Objectives Abscesses and chronic wounds are common among injection drug users (IDUs) though chronic wounds have been understudied. We assess the risk factors associated with both acute and chronic wounds within a community-based population of IDUs frequenting the Baltimore City Needle Exchange Program (BNEP). Methods We performed a cross-sectional study of BNEP clients ≥18 years who completed an in-person survey regarding active or prior wounds including abscesses (duration <8 weeks) and chronic wounds (duration ≥8 weeks), injection practices, and skin care. Factors associated with wounds were analyzed using univariate and multivariate logistic regression. Results Of the 152 participants, 63.2% were men, 49.3% were Caucasian, 44.7% were African American, 34.9% had any type of current wound, 17.8% had an active abscess, and 19.7% had a current chronic wound. Abscesses were more common in women (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.10–5.97); and those reporting skin-popping (OR, 5.38; 95% CI, 1.85–15.67). In a multivariate model, risk factors for an abscess included injecting with a family member/partner (AOR, 4.06; 95% CI, 0.99–16.58). In a multivariable analysis of current chronic wounds, cleaning skin with alcohol prior to injection was protective (AOR, 0.061; 95% CI, 0.0064–0.58). Conclusions Abscesses and chronic wounds were prevalent among a sample of IDUs in Baltimore. Abscesses were associated with injection practices, and chronic wounds appeared linked to varying skin and tool cleaning practices. There is a pressing need for wound-related education and treatment efforts among IDUs who are at greatest risk for skin-related morbidity.

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Injection Drug Use

Cited by 40 publications

References 34 publications

Nationwide increase in hospitalizations for heroin-related soft tissue infections: Associations with structural market conditions

Nationwide increase in hospitalizations for heroin-related soft tissue infections: Associations with structural market conditions

Prevalence of skin problems and leg ulceration in a sample of young injecting drug users

High Rates of Abscesses and Chronic Wounds in Community-Recruited Injection Drug Users and Associated Risk Factors

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