Abstract
BackgroundWe surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs.MethodsParticipants ≥18 years old completed a survey regarding chronic wounds (duration ≥8 weeks), injection and hygiene practices. Study staff visually verified the presence of wounds. Participants were categorized into four groups by age and wound status. Factors associated with the presence of chronic wounds in participants ≥45 years were analyzed using logistic regression.ResultsOf the 152 participants, 19.7% had a chronic wound. Of those with chronic wounds, 18 were ≥45 years old (60.0%). Individuals ≥45 years old with chronic wounds were more likely to be enrolled in a drug treatment program (Odds ratio (OR) 3.4, 95% Confidence interval (CI) 1.0–10.8) and less likely to use cigarette filters when drawing up prepared drug (OR 0.2, 95% CI 0.03–0.7) compared to the same age group without chronic wounds. Compared to individuals <45 years old without chronic wounds, individuals ≥45 with a chronic wound were more likely to report cleaning reused needles with bleach (OR 10.7, 95% CI 1.2–93.9) and to use the clinic, rather than an emergency room, as a primary source of medical care (OR 3.4, 95% CI 1.1–10.4).ConclusionsOlder IDUs with chronic wounds have different, and perhaps less risky, injection and hygiene behaviors than their peers and younger IDUs without wounds in Baltimore City. Because of these differences, older IDUs with wounds may be more receptive to community-based healthcare and substance abuse treatment messages.
Highlights
We surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs
We examined the prevalence of chronic wounds and associated injection-related behaviors among an IDU population accessing needle exchange services from the Baltimore City mobile Needle Exchange Program (BNEP), which has been in operation since 1994 [30]
We focused our analysis on the latter subgroup of participants: IDUs who were 45 years of age or older with at least one current chronic wound
Summary
We surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs. It is estimated that the number of adults 50 years or older with substance use problems will double from an annual average of 2.8 million (2002–06) to 5.7 million by 2020 [6]. Age-associated health complications and ongoing chronic drug use may further intensify the social marginalization of older IDUs, which may diminish quality of life, access to health care and social productivity [7,8]. Older IDUs report impaired mental and physical health and functioning compared to age- and gendermatched population standards [15,16]. Older IDUs often self-reported health conditions such as deep vein thrombosis, skin ulcers, respiratory problems, diabetes, hypertension, hepatitis, and liver cirrhosis [8,15]. Studies on venous damage and chronic venous insufficiency (CVI) in IDUs revealed that CVI develops prematurely in IDUs [11,12]
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