Prevalence and correlates of prescription opioid residue injection

Abstract

Background: There is growing evidence of intravenous administration of prescription opioids (POs) in several countries. Preparation of POs for injection may leave residues in containers and filters used by people who inject drugs and may lead to adverse health outcomes if they are injected.Methods: This exploratory study used cross-sectional data from the COSMO study, a prospective cohort of out-of-treatment cocaine users carried out in Montréal (Canada) between October 2010 and August 2015. For this analysis, only one visit per participant was selected, that is, the first time the participant reported PO injection during the study.The outcome of interest, "injection of PO residues", was defined as having injected PO residues from a filter and/or a container in the last month. Correlates of this outcome were identified using logistic regression analyses.Results: Of the 122 participants who reported PO injection during the study period, 41.8% had injected PO residues. Reporting an unstable source of income (AOR=4.26; 95% CI: 1.03-17.69), a recent overdose (AOR=5.45; 95% CI: 1.50-19.88) and a preponderant use of opiates (mostly opiate use versus other drugs excluding alcohol and cannabis) (AOR=2.46; 95% CI: 1.08-5.63) increased the risk of PO residue injection. The odds of reporting PO residue injection rose by 7% per unit increase in the score of psychological distress (AOR=1.07 per unit increase; 95% CI: 1.01-1.12). Conclusions:The findings of this study suggest that PO residue injection is associated with markers of vulnerability. Further investigation is needed in order to better understand this understudied drug injection practice.

Risk Factors Of Infective Endocarditis In Persons Who Inject Drugs

“…However, in our study, cases (PWID IE+) were more likely to have stable housing compared to controls. This is supported by Roy et a.l (16), who found that unstable housing was not associated with conducting multiple washes (utilizing residual drug for multiple injections), which is often the preparatory method used to inject prescription opioids, such as hydromorphone-CR. We hypothesize that PWID using hydromorphone-CR, which is a more costly illicit substance, can be associated with stable housing, which is reflective of financial stability.…”

“…Prescription rates for hydromorphonecontrolled-release (CR) (Hydromorph Contin ®, Purdue Pharma, Pickering, Ontario) in London are in the top quartile in Ontario (4,13,15). Furthermore, studies have shown that the misuse of prescribed opiates such as hydromorphone-CR amplify risk of infections due to the nature of how these substances are prepared for injection (11,(16)(17)(18). Hydromorphone-CR is difficult to dissolve in solution, often requiring PWID to use unsterile methods to prepare injectates.…”

“…Furthermore, the components of hydromorphone-CR capsules that provide the controlled release, increase survival of HIV (19) and Staphylococcus aureus (12), which cause the vast majority of IE cases (7). Moreover, residual drug remains in cookers and filters after an initial injection, allowing PWID to resolubilize the remaining drug and conduct multiple injections (11,14,16,19,20) (Fig. 1).…”

“…1). This high-risk practice of multiple injections, involves keeping, sharing and reusing injection drug preparation equipment (IDPE), which increases infections among PWID (14,16,20). However, studies have also found that heating the injectate before injection of hydromorphone-CR can significantly reduce the inoculum of bacteria causing IE (12).…”

Risk Factors of Infective Endocarditis in Persons Who Inject Drugs

“…Prescription rates for hydromorphone controlled-release (CR) (Hydromorph Contin ®, Purdue Pharma, Pickering, Ontario) in London are in the top quartile in Ontario (4,13,15). Furthermore, studies have shown that the misuse of prescribed opiates such as hydromorphone-CR amplifies the risk of infections due to the nature of how these substances are prepared for injection (11,(16)(17)(18). Hydromorphone-CR is difficult to dissolve in solution, often requiring PWID to use unsterile methods to prepare injectates.…”