Journal Article Annotations
2018, 2nd Quarter
Annotation by Aum Pathare, MD
Type of study: Prospective cohort study
The finding: The risk of skin and soft tissue infection (SSTI), as well as systemic bacterial infections, increases with injection drug use. Heroin use poses higher risk for SSTIs, whereas no difference was noted between heroin, amphetamines, and polysubstance use for systemic infections. Homelessness and hepatitis C were associated with an increased risk for SSTI and systemic infection, whereas residence in a large city, previous overdose, were associated with increased risk of SSTI alone. Incarceration was associated with decreased risk for both conditions.
Strength and weaknesses: A relatively large sample, the reliability of the addiction severity index (ASI) scale, and use of a similar population with alcohol use as references, instead of healthy controls, are the study’s strengths.
The lack of data for factors such as frequency of use, living and injection conditions, HIV status, and diabetes are limitations. As criminal justice clients are the subjects, the sample is an enriched one, and might not be representative of the general population.
Relevance: Bacterial infections in patients who inject drugs are a recognized, but ill studied and poorly characterized issue. Heroin use has a distinctly higher contribution to infection, with the US opioid-use epidemic potentially amplifying the problem. Opioid substitution thus becomes an important strategy in reducing the risk of infection for this population, in addition to harm reduction through access to clean injection equipment. Reduction in stigma against use of psychoactive drugs, expansion of services to effectively address HCV transmission and overdose, are other methods that are globally underutilized and vital to prevent infections. As these infections are the most common reason for injectable drug users to seek medical care, C-L psychiatrists can be involved early in the management of substance use, and collaborate with outpatient providers and community programs to ensure continuity of treatment through mechanisms such as “warm handoff” programs.