Severe illness and death among injecting drug users in Scotland: a case-control study

Abstract

Between April and September 2000, 60 injecting drug users in Scotland died or were hospitalized with severe illness. Laboratory investigations suggested that Clostridium novyi and other bacteria were important aetiological agents. To determine associated environmental/behavioural factors a case-control study was undertaken with 19 'definite' and 32 'probable' cases in Glasgow, Scotland. For every deceased case (n=19), up to three proxy individuals were interviewed. Three controls were identified for each case. Multivariate logistic regression analyses compared (i) all cases and controls; (ii) definite cases and matched controls; (iii) probable cases and matched controls. In all three analyses injecting into muscle or skin and injecting most of the time with a filter used by someone else were the variables most strongly associated with illness. Comparing only muscle-injecting cases and controls, cases were significantly more likely to have injected larger amounts of heroin per average injection than were controls. The findings make an important epidemiological contribution to the understanding of the public health and clinical implications of the contamination of illicit drugs by histotoxic clostridia.

Addressing the efficacy of dihydrocodeine versus methadone as an alternative maintenance treatment for opiate dependence: a randomized controlled trial

“…It would appear, however, that our sample injected less but were more often multiple‐drug users. The HIV prevalence rate in the study sample was low in comparison to other groups researched in Edinburgh [17,18].…”

Infections with Spore-forming Bacteria in Persons Who Inject Drugs, 2000–2009

“…Practices such as skin or muscle popping (intentionally or accidentally injecting into skin or muscle) ( 10 , 27 , 28 ) or the use of large amounts of citric acid to dissolve heroin can damage soft tissue, leading to necrosis and providing a suitable environment for anaerobic bacteria, such as Clostridium spp., to thrive. Older age (a proxy for a longer injecting career) and female sex have been associated with infections and injuries at injecting sites ( 29 , 30 ), which are associated with difficulty accessing veins.…”

“…Clinical, demographic, and risk factor information was obtained from a questionnaire administered to patients by clinicians or microbiologists. Information about cases of C. novyi infection and anthrax were obtained from reports and documentation of the respective outbreaks ( 7 , 10 – 12 ); case definitions are described in these reports. The analyses presented here are limited to definite and probable C. novyi infections and confirmed anthrax cases.…”

The Cost-Effectiveness and Population Outcomes of Expanded HIV Screening and Antiretroviral Treatment in the United States

“…We estimated the average annual number of sexual partnerships (33–42), average condom use (33, 38–44), and the transmission probability per partnership (8, 45–55), for each sexual behavior mode, based on published data. The model captures HIV transmission via needle-sharing in a similar manner, as a function of the annual number of injections (56–58), average needle-sharing rates (41, 44, 57, 59), and the probability of transmission per shared needle (57, 60, 61). The probability of HIV transmission between two individuals depends on the infected individual’s gender, disease status, and treatment status, and the uninfected individual’s gender and circumcision status.…”