Opioid Injection Research Articles

Withdrawal-associated injury site pain prevalence and correlates among opioid-using people who inject drugs in Vancouver, Canada

BackgroundPain can return temporarily to old injury sites during opioid withdrawal. The prevalence and impact of opioid withdrawal-associated injury site pain (WISP) in various groups is unknown. MethodsUsing data from observational cohorts, we estimated the prevalence and correlates of WISP among opioid-using people who inject drugs (PWID). Between June and December 2015, data on WISP and opioid use behaviours were elicited from participants in three ongoing prospective cohort studies in Vancouver, Canada, who were aged 18 years and older and who self-reported at least daily injection of heroin or non-medical presciption opioids. ResultsAmong 631 individuals, 276 (43.7 %) had a healed injury (usually pain-free), among whom 112 (40.6 %) experienced WISP, representing 17.7 % of opioid-using PWID interviewed. In a multivariable logistic regression model, WISP was positively associated with having a high school diploma or above (Adjusted Odds Ratio [AOR] = 2.23, 95 % Confidence Interval [CI]: 1.31−3.84), any heroin use in the last six months (AOR = 2.00, 95 % CI: 1.14−3.57), feeling daily pain that required medication (AOR = 2.06, CI: 1.18−3.63), and negatively associated with older age at first drug use (AOR = 0.96, 95 % CI: 0.93−0.99). Among 112 individuals with WISP, 79 (70.5 %) said that having this pain affected their opioid use behaviour, of whom 57 (72.2 %) used more opioids, 19 (24.1 %) avoided opioid withdrawal, while 3 (3.8 %) no longer used opioids to avoid WISP. ConclusionsWISP is prevalent among PWID with a previous injury, and may alter opioid use patterns. Improved care strategies for WISP are warrented.

Deconstructing the 'cheque effect': short-term changes in injection drug use after receiving income assistance and associated factors.

Disbursement of income assistance has been temporally associated with intensified drug use and related harms (coined the 'cheque effect'). However, relationships to injection drug use (IDU) remain understudied. We examined short-term 'cheque effects' and associated factors among people who inject drugs (PWID). Cross-sectional analysis nested within a cohort study. Montreal, Quebec, Canada. PWID receiving income assistance, with no employment income. A total of 613 PWID (median age 41, 83% male) contributed 3269 observations from 2011 to 2017. At each cohort visit, an interviewer-administered questionnaire captured retrospective reports of injection-related behaviour during the 2-day periods (i) before and (ii) including/after receiving last month's income assistance payment (number of injections; drugs injected; any receptive syringe-sharing). The relative likelihood (odds) and magnitude (rate) of an increase in injection frequency ('cheque effect') were estimated in relation to social and behavioural factors using logistic and negative binomial regression in a covariate-adjusted two-part model. Prevalence of IDU and syringe-sharing were, respectively, 1.80 and 2.50 times higher in the days following versus preceding cheque receipt (P<0.001). Among people with past-month IDU, most observations showed increased injection frequency (52%) or no change in injection frequency (44%). The likelihood of a 'cheque effect' was positively associated with cocaine injection [versus injection of other substances, odds ratio (OR)=2.639, 95% confidence interval (CI)=2.04-3.41], unstable housing (OR=1.272, 95% CI=1.03-1.57) and receiving opioid agonist therapy (OR=1.597, 95% CI=1.27-2.00) during the same month. Magnitude of the 'cheque effect' was positively associated with cocaine injection [rate ratio (RR)=1.795, 95% CI=1.43-2.16], unstable housing (RR= 1.198, 95% CI =1.02-1.38) and frequent injection (RR=2.938, 95% CI=2.43-3.44), but inversely associated with opioid agonist therapy (RR=0.817, 95% CI=0.68-0.95) and prescription opioid injection (RR=0.794, 95% CI=0.66-0.93). Among people who inject drugs in Montreal, Canada, injection drug use and receptive syringe-sharing appear to be more prevalent in the 2days after versus before receiving income assistance. The odds and rate of individual-level increases in injection frequency appear to be positively associated with cocaine injection (versus injection of other substances) and unstable housing.

Medications for Opioid use Disorder Associated With Less Against Medical Advice Discharge Among Persons Who Inject Drugs Hospitalized With an Invasive Infection.

To identify the incidence, characteristics, and factors associated with against medical advice (AMA) discharge among hospitalized patients with opioid use disorder (OUD) and injection related infections (eg, endocarditis, osteomyelitis, epidural abscesses). This retrospective cohort study evaluated adults with OUD admitted to an academic medical center from January 1, 2016 to January 7, 2019 for an invasive injection related infection. Multivariable logistic regression was used to determine independent factors associated with AMA discharge. Among 262 adults admitted with serious injection related infections and comorbid OUD, 138 received inpatient medications for opioid use disorder (MOUD). Univariate analysis showed a decreased odds ratio (OR) of AMA discharge when patients received MOUD inpatient (OR 0.55; 95% CI 0.34-0.91.). Adjusting for covariates associated with social determinants of health and other substance use, inpatient receipt of MOUD was associated with a decreased risk of AMA discharge (adjusted OR 0.49; 95% CI 0.028-0.84). Among patients with OUD and serious injection related infections, inpatient initiation of MOUD is associated with decreased risk of AMA discharge.

夜間・休日のオピオイド注射薬供給連携システムの構築と運用 第 1 報 困難感尺度と連携尺度

夜間・休日のオピオイド注射薬供給連携システムの構築と運用 第 1 報 困難感尺度と連携尺度

Using actor-partner interdependence modeling to understand recent illicit opioid use and injection drug use among men in community supervision and their female partners in New York City

BackgroundThe United States’ opioid crisis disproportionately affects individuals in the criminal justice system. Intimate partners can be a source of social support that helps reduce substance use, or they can serve as a driver of continued or increased substance use. Better understanding of the association between intimate partner characteristics and illicit opioid use and injection drug use among individuals in community supervision could be vital to developing targeted interventions. MethodsUsing actor-partner interdependence models, we examined individual and partner characteristics associated with recent illicit opioid use and injection drug use among males in community supervision settings in New York City (n = 229) and their female partners (n = 229). ResultsHigher levels of depression (aOR 1.98, 95% CI [1.39–2.82], p ≤ 0.01) and anxiety (aOR 1.98, 95% CI [1.42–2.75], p ≤ 0.01) were associated with recent opioid use among males in community supervision. Females with a partner having higher levels of anxiety were more likely to have recently used opioids (aOR 1.52, 95% CI [1.06–2.16], p ≤ 0.05). Males with a female partner with higher levels of anxiety (aOR 2.16, 95% CI [1.31–3.56], p ≤ 0.01) or depression (aOR 1.70, 95% CI [1.01–2.86], p ≤ 0.05) were more likely to recently inject drugs. Women with a male partner who had been in prison were more likely to have recently injected drugs (aOR 3.71, 95% CI [1.14–12.12], p ≤ 0.05), but women who had a male partner who had been arrested in the past three months were less likely to have recently injected (aOR 0.08, 95% CI [0.02–0.46], p ≤ 0.01). ConclusionsResults suggest that recent individual illicit opioid use and injection drug use is associated not only with individual-level factors, but also with partner factors, highlighting the need for couple-based approaches to address the opioid epidemic.

Comparison of Intrathecal Injection of Fentanyl and Sufentanil on the Onset, Duration, and Quality of Analgesia in Labor: A Randomized, Double-Blind Clinical Trial.

BackgroundLabor pain is a severe pain, and intrathecal opioid injection is one of the analgesia methods to reduce it.ObjectivesWe assessed the effects of intrathecal Fentanyl and Sufentanil on the onset, duration, and quality of analgesia for labor analgesia.MethodsIn this double-blind, randomized clinical trial, 54 healthy nulliparous women 18 - 45 years in the active phase of labor who were requesting labor analgesia were enrolled in two groups fentanyl (F) and sufentanil (S). Patients received 75 µg fentanyl or 7.5 µg sufentanil intrathecally in the fentanyl group (n = 27) and the sufentanil group (n = 27), respectively. Pain relief, onset, duration of analgesia, hemodynamic parameters, patients' satisfaction, and neonatal Apgar score were assessed in this study. Data were analyzed by using SPSS16.ResultsThere were no significant differences between the groups in terms of demographic and hemodynamic parameters. The onset time of analgesia was 5.6 ± 4.3 and 3.6 ± 2.1 minutes, in the sufentanil and fentanyl groups, respectively (P = 0.037). The duration of analgesia was higher in patients who received sufentanil than those who received fentanyl (113 ± 45 vs. 103 ± 22 minutes (P = 0.629)). The pain score in the Fentanyl group was significantly lower at 5, 10, and 15 minutes after spinal analgesia (P < 0.05). The sedation score at 1 and 5 minutes was significantly higher in the fentanyl group than the sufentanil group (P < 0.05). The frequency and severity of pruritus and satisfaction rate in the fentanyl group were significantly higher than the sufentanil group.ConclusionsIntrathecal fentanyl and sufentanil have a similar analgesic effect on labor. Fentanyl is associated with a faster onset of analgesia and more satisfaction, while sufentanil has longer analgesia.

A fentanyl test strip intervention to reduce overdose risk among female sex workers who use drugs in Baltimore: Results from a pilot study

BackgroundIn 2018, there were over 67,000 drug overdose deaths in the United States, with almost half involving illicit fentanyl and other synthetic opioids. While overall age-adjusted drug overdose deaths decreased by 4.6% from 2017 to 2018, synthetic opioid deaths increased 10.0%. This pilot study evaluates the impact of a brief fentanyl test strip (FTS) intervention to increase fentanyl awareness and reduce overdose risk. MethodsFemale sex workers (FSW) reporting past month illicit opioid use were recruited between April 2018 through February 2019 in Baltimore City, Maryland. At baseline, they completed a baseline survey, and received tailored harm reduction messaging, 5 FTS and training, and a naloxone kit, then completed a survey after one month. McNemar's test was used to compare repeated measures. ResultsAmong N = 103, 54% were <40 years, 59% were white, and 24% had overdosed in the past year. Among 68 who completed follow-up, most (84%) used ≥1 FTS to test their drugs, 86% had ≥1 fentanyl-positive result, 57% were surprised by the result, and 69% engaged in harm reduction behaviors following the result (e.g., asked someone to check on them, did a tester shot, used a smaller amount). Significant pretest–posttest reductions in daily illicit opioid use (77% to 56%; p = 0.003), injection frequency (40% to 25%; p = 0.004), benzodiazepine use (22% to 7%; p = 0.008), and solitary drug use (96% vs. 68%; p < 0.001) were observed. No change in preferring drugs containing fentanyl was found. Some (18%) gave their FTS to others. All but three (96%) reported being likely to use FTS in the future. ConclusionsWe found high FTS acceptability and reductions in drug use frequency and solitary drug use following FTS use among FSW who use drugs in Baltimore. These findings demonstrate that FTS-based interventions hold potential in reducing overdose risk.

Multiple Victimizations and Overdose Among Women With a History of Illicit Drug Use

The experiences of violence and overdose are highly prevalent among women who use illicit drugs. This study sought to ascertain whether multiple victimizations during adulthood increase the frequency of women's overdose. The sample comprised 218 women recruited at Philadelphia harm reduction sites during 2016-2017. Victimization was assessed as exposure to 16 types of adulthood violence. Three measures were constructed for multiple victimizations: continuous and categorical polyvictimization, and predominant violence domain. Negative binomial regression estimated the incidence rate ratio (IRR) of lifetime overdoses from multiple victimizations. Lifetime history of opioid use (88.6%) and drug injection (79.5%) were common. Among overdose survivors (68.5%), the median of lifetime overdoses was 3. The majority of participants (58.7%) were victims of predominantly sexual violence, 26.1% experienced predominantly physical abuse/assault, and 3.7% were victims of predominantly verbal aggression/coercive control. Participants reported a mean of seven violence types; the higher-score category of polyvictimization (9-16 violence types) comprised 41.7% of the total sample. In multivariable models, one-unit increase in continuous polyvictimization was associated with 4% higher overdose rates (IRR: 1.04, 95% confidence interval [CI]: [1.00, 1.08]). Compared to women who were not victimized (11.5%), those in the higher-score category of polyvictimization (IRR: 2.01; 95% CI: [1.06, 3.80]) and exposed to predominantly sexual violence (IRR: 2.10, 95% CI: [1.13, 3.91]) were expected to have higher overdose rates. Polyvictimization and sexual violence amplified the risk of repeated overdose among drug-involved women. Female overdose survivors need to be screened for exposure to multiple forms of violence, especially sexual violence. Findings underscore the need to scale-up victimization support and overdose prevention services for disenfranchised women.

Anticipated use of a supervised drug consumption site among syringe services program clients in King County, Washington: Assessing the role of opioid overdose and injection behavior

BackgroundUS jurisdictions are considering implementing supervised drug consumption sites (SCSs) to combat the overdose epidemic. No sanctioned SCS exists in the US, but King County, Washington has proposed Community Health Engagement Locations (CHELs), which would include supervised drug consumption. We assessed characteristics of people engaged in syringe services programs (SSPs) who anticipated SCS use. MethodsWe estimated prevalence of anticipated SCS use in a 2017 cross-sectional sample of King County SSP participants (N = 377). We used Poisson regression with robust standard errors to estimate likelihood of anticipated SCS use by overdose history (experienced, witnessed only, neither), public injection frequency (always, some/most times, never), drug use behaviors, and sociodemographic characteristics. ResultsThe sample was primarily male (66.8 %), white (69.5 %), and averaged 37 years old. Almost two-thirds of participants witnessed or experienced an overdose in the past year (43.2 % witnessed only; 19.6 % experienced overdose). Four in five SSP participants (83.0 %) anticipated any SCS use. Anticipated SCS use was higher among participants who experienced an overdose (risk ratio [RR] = 1.14, 95 % CI = 1.04, 1.24) than those with no overdose experience. In multivariable analyses, anticipated SCS use was higher among people reporting injecting publicly (e.g., always vs. never: aRR = 1.26, 95 % CI = 1.11, 1.43), and lower among people primarily using methamphetamine (aRR = 0.80, 95 % CI = 0.67, 0.96) compared to people primarily using opioids. ConclusionsIn King County, SCS services would be used by people at high risk of overdose, including SSP participants reporting injecting in public. SCSs could be an important step to promote health and safety across communities.

Intraoperative Microvascular Thrombosis Secondary to Henoch-Schönlein Purpura of Hidden Onset

Henoch-Schonlein purpura (HSP) is a systemic small-vessel vasculitis. Here, we report a case of recurrent microvascular thrombosis during microsurgery that initially presented as insidiously developing HSP. A 17-year-old male adolescent underwent latissimus dorsi myocutaneous free tissue transfer for an exposed tibia bone following a motorcycle accident. During microsurgery, gross clots rapidly formed in the artery and vein after anastomoses; Doppler sounds and the flap pallor indicated intravascular thrombosis. Multiple re-anastomoses and salvage interventions failed eventually; the flap was removed for an unknown reason. The patient developed nausea and vomiting, diarrhea, digestive tract hemorrhaging, and abdominal angina refractory to an opioid injection following the flap removal. A palpable petechial rash developed over the entirety of his extremities, bilaterally. Urinalysis revealed severe glomerular injury with microscopic hematuria and nephrotic-range proteinuria. After the 2-month-long consultation, the patient was eventually diagnosed with HSP-induced by preoperative vancomycin therapy. Renal biopsies indicated immunofluorescent deposition of IgA on the glomeruli, confirming grade III–V Henoch-Schonlein nephritis. Clinical and wound problems were corrected following daily bolus injections of 30 mg intravenous methylprednisolone for 7 days. The patient returned to our outpatient clinic 19 months postoperatively with an acceptable esthetic appearance and unrestricted ambulation and physical activity. HSP is rare; however, it is extremely challenging to overcome recurrent and refractory thrombosis during microsurgery in patients with insidiously developing vascular disease. Vancomycin, a commonly used antibiotic, can trigger HSP and is a possible culprit in patients who develop recurrent and unexplained thrombosis during microsurgery.

Preoperative Intrathecal Opioid Injection on Postoperative Analgesia Requirements in Gynecologic Oncology [37H

INTRODUCTION: Decreasing opioid use during postoperative period is a topic of great ongoing interest. We aimed to determine whether regional anesthesia with single-shot intrathecal opioid injections (ITO) reduced intravenous (IV) opioid use after exploratory laparotomy in gynecologic oncology surgeries. METHODS: A retrospective chart review with institution IRB approval of 314 consecutive gynecologic oncology patients undergoing exploratory laparotomy from July 2015 to January 2018 was conducted. Single-shot ITO was offered to all patients undergoing open abdominal surgery. The primary outcomes of interest were self-reported post-operative pain levels and IV opioid use in morphine equivalents during the first 48 hours after surgery. Univariate analyses were performed to estimate the effect of ITO on IV opioid use at 0, 6, 12, 24 and 48 hours after surgery. The relationship between ITO and primary outcomes of interest were determined using longitudinal regression analysis and adjusted for confounding variables. RESULTS: 34% (107/314) received ITO preoperatively. There were no differences in patient age, BMI, number of prior abdominal surgeries, history of opioid dependence, or EBL between the ITO and control groups. Preoperative ITO was associated with significantly lower IV opioid requirement between 0-6 hours after surgery (9.7±8.1 vs 14.3±11.5, P&lt;.0001) and between 6-12 hours after surgery (2.7±3.8 vs 5.4±9.5, P=.0054). In addition to reduced IV opioid use in ITO group, no differences in self-reported postoperative pain levels were noted in the first 48 hours post-operatively. CONCLUSION: Preoperative ITO reduced postoperative opioid requirement for pain control without negatively affecting patients’ self-reported pain level.

Prescription opioid injection among young people who inject drugs in New York City: a mixed-methods description and associations with hepatitis C virus infection and overdose

AimEvidence is emerging that prescription opioid (PO) injection is associated with increased health risks. This mixed-methods study compares the mechanics of PO and heroin injection and examines the demographic and drug-related correlates of lifetime PO injection in a sample of young people who inject drugs (PWID) in New York City (NYC).MethodsQualitative analysis of 46 semi-structured interviews with young adult opioid users ages 18–32. Interview segments describing PO injection were analyzed for common themes. Quantitative analysis of structured interviews with 539 young adult opioid users ages 18–29 recruited via respondent-driven sampling (RDS). Analyses are based on the subsample of 353 participants (65%) who reported having ever injected drugs. All variables were assessed via self-report, except hepatitis C virus status, which was established via rapid antibody testing.ResultsParticipants described injecting POs and reported that preparing abuse-deterrent pills for injection is especially cumbersome, requiring extended manipulation and large amounts of water. Injecting POs, in contrast to injecting heroin, requires repeated injections per injection episode. Among RDS-recruited participants, the majority of injectors reported injecting POs, sporadically (33%) or regularly (26%), but often infrequently (≤ 7 days/month). In separate multivariable analyses controlling for syringe- and cooker-sharing, ever injecting POs was a significant predictor of testing HCV antibody-positive (AOR = 2.97) and lifetime experience of non-fatal overdose (AOR = 2.51). Ever injecting POs was independently associated with lifetime homelessness (AOR = 2.93) and having grown up in a middle-income ($51,000–100,000/year vs. ≤ $50,000/year; AOR = 1.86) or a high-income household (> $100,000/year vs. ≤ $50,000/year; AOR = 2.54).ConclusionsEven in an urban environment like NYC with widespread heroin access, most young PWID have injected POs, although less frequently than heroin. PO injection involves practices that are known to increase risk for blood-borne viral infection (e.g., repeated injections) and predicted testing HCV-positive, as well as overdose. PO injection may also serve as a marker for a subgroup of PWID at elevated risk for multiple drug use-related comorbidities. Programs that provide prevention services to PWID need to tailor harm reduction measures and messaging to the specific practices and harms associated with the injection of POs.

Toxicity of agents used for opioid withdrawal: a case-based approach.

Toxicity of agents used for opioid withdrawal: a case-based approach.

Injection Opioid and Injection Methamphetamine Use in the Rural United States: A Systematic Review and Network Analysis

The abuse of opioid and methamphetamine is a public health crisis in the United States, particularly in rural areas where injection drug use is common. This systematic review of rural injection drug use synthesized the research on injection of opioids and methamphetamine use and assessed the similarity of their research findings to the field of rural injection drug use in the United States. A citation network analysis was used to support the assessment of research similarity and provided a visualization of the field. This citation network analysis exposed a gap in the literature revealing that the state of research may not be fully applicable to the field in its entirety in the United States. In summary, this review provides a representative overview of the state of research in the field of injection drug use. Future research should conduct studies on rural drug use in areas of the country not represented in this review.

Interventions to Increase Completion of Hepatitis B Vaccination in People who Inject Drugs: A Systematic Review and Meta-analysis.

Increases in opioid misuse and injection drug use have resulted in a rise in acute cases of hepatitis B. We conducted a systematic review and meta-analysis of randomized studies to determine the effect (pooled odds ratio) of interventions to increase hepatitis B vaccination completion in people who inject drugs (PWID). Odds ratios from the included studies were combined to create a pooled odds ratio (OR) using the Inverse Heterogeneity Model. Eleven studies met the eligibility criterion of having a randomized intervention to increase hepatitis B virus vaccination completion among PWID. The odds of vaccine completion in the intervention group were greater than in the control/comparison group (pooled OR, 2.53; 95% confidence interval [CI], 1.07–5.99). Subgroup analysis indicated that financial incentives were most effective (OR, 7.01; 95% CI, 2.88–17.06), followed by accelerated vaccine schedules (OR, 1.90; 95% CI, 1.14–3.14). Interventions using financial incentives and accelerated vaccine schedules are moderately effective at increasing hepatitis B vaccination completion in PWID.

Associations between perceived illicit fentanyl use and infectious disease risks among people who inject drugs

BackgroundOver the last several years, fentanyl has been introduced into the illicit drug supply in the United States. While the impact of fentanyl on overdose fatalities is clear, the increase in fentanyl use may also be affecting drug use practices with implications for infectious disease transmission. We conducted a cross-sectional survey to explore associations of perceived illicit fentanyl use with opioid use frequency, injection frequency and syringe sharing among people who inject drugs in two California cities. MethodsPeople who inject drugs (PWID) were recruited from community settings in Los Angeles and San Francisco, CA from June 2017 to September 2018. Multivariable logistic regression was used to explore adjusted associations between perceived illicit fentanyl use and high frequency opioid use, high frequency injection and syringe sharing. ResultsAmong the 395 study participants, the median age of participants was 44 years; 74% of participants were cisgender male; 73% reported to be homeless; 61% lived in San Francisco and 39% in Los Angeles. The prevalence of perceived illicit fentanyl use in the past six months was 50.4% (95% confidence interval (CI): 45.4%-55.3%) among PWID. Findings from our adjusted logistic regression models suggested that people reporting perceived illicit fentanyl use had a greater odds of high frequency opioid use (adjusted odds ratio (aOR) = 2.36; 95% CI: 1.43–3.91; p = 0.001), high frequency injection (aOR = 1.84; 95% CI: 1.08–3.13; p = 0.03) and receptive syringe sharing (aOR = 2.16; 95% CI: 1.06–4.36; p = 0.03), as compared to people using heroin and other street drugs but not fentanyl. ConclusionPeople reporting perceived illicit fentanyl use were at increased risk for injection-related infectious disease risks. Actions must be taken to reduce these risks, including improved access to syringe service programs and opioid treatment and consideration of innovative approaches, such as supervised consumption services.

Opioid-Related Diagnoses and Concurrent Claims for HIV, HBV, or HCV among Medicare Beneficiaries, United States, 2015.

Unsterile opioid injection increases risk for infection transmission, including HIV, hepatitis B virus (HBV), or hepatitis C virus (HCV). We assess prevalence of and risk factors associated with opioid overdose and infections with HIV, HBV, or HCV among Medicare beneficiaries with opioid-related fee-for-service claims during 2015. We conducted a cross-sectional analysis to estimate claims for opioid use and overdose and HIV, HBV, or HCV infections, using data from US Medicare fee-for-service claims. Beneficiaries with opioid-related claims had increased odds for HIV (2.3; 95% confidence interval (CI), 2.3–2.4), acute HBV (6.7; 95% CI, 6.3–7.1), chronic HBV (5.0; 95% CI, 4.7–5.4), acute HCV (9.6; 95% CI, 9.2–10.0), and chronic HCV (8.9; 95% CI, 8.7–9.1). Beneficiaries with opioid-related claims and for HIV, HBV, or HCV infection, respectively, had a 1.1–1.9-fold odds for having a claim for opioid overdose. Independent risk factors for opioid overdose and each selected infection outcome included age, sex, race/ethnicity, region, and residence in a high-vulnerability county. Having opioid-related claims and selected demographic attributes were independent, significant risk factors for having HIV, HBV, or HCV claims among US Medicare beneficiaries. These results might help guide interventions intended to reduce incidences of HIV, HCV, and HBV infections among beneficiaries with opioid-related claims.

1084 Does Viremia in Patients With Hepatitis C Antibody Positivity Alter Mortality in People Who Inject Drugs With Infective Endocarditis?

INTRODUCTION: Injection drug use [IDU] is a well-known risk factor for both infective endocarditis [IE] and hepatitis C virus [HCV] infections. In parallel with the opioid epidemic, the incidence of both infections has increased in recent years. In this retrospective study, the impact of HCV on mortality of people who inject drugs [PWID] with IE is assessed. METHODS: Electronic medical records of adult patients diagnosed with IE according to modified Duke criteria from January 2012 through May 2018 at an academic tertiary medical center were analyzed. Patients were identified as PWID based on IDU documentation within 3 months of admission. The study included all patients with a positive HCV antibody. Patients were then stratified into two groups: “Positive HCV viremia” [positive HCV antibody and viral load] or “Negative HCV viremia” [positive HCV antibody but negative viral load]. Prior HCV treatment, HIV infection, and absence of documented HCV seropositivity precluded study enrollment. Pertinent demographic, clinical, laboratory, microbiologic, and outcome data were recorded and analyzed. RESULTS: One hundred and twenty-nine PWID with IE were identified, of whom 110 [85.2%] had a positive HCV antibody. Of these, 23 patients were excluded due to lack of testing for viral RNA. , resulting in 87 HCV study patients [67.4%]. Fifty-three [61.0%] patients had viremia and 34 [39.1%] did not. Of the 87 study patients, 85.1% were Caucasian and 52.9% were female with a median age of 25. Six [6.9%] patients had previous IE. The most commonly injected drug was prescription opioids [69.0%]. The tricuspid valve was involved in 56.3% of patients and the most common pathogen was Staphylococcus aureus [71.3%]. Prescription opioid injection, S. aureus infection, tricuspid valve involvement, and 10-week mortality did not differ between the viremic and non-viremic HCV groups [Table 1]. CONCLUSION: While several host and clinical factors affect mortality in PWID with IE, HCV viremia does not appear to increase mortality. However, larger, prospective studies will be required to better delineate the significance of HCV viremia among PWID with IE.

Early removal of catheters in an Enhanced Recovery Pathway (ERP) with intrathecal opioid injection does not affect postoperative urinary outcomes

BackgroundPostoperative urinary retention (POUR) and catheter-associated urinary tract infections (CAUTI) are associated with significantly longer hospital length-of-stay and increased costs.1 This study investigates the effect of early removal of urinary catheters on POUR and CAUTI in patients undergoing an ERP with a preoperative intrathecal injection. MethodsRetrospective cohort study of a prospectively maintained database of patients who underwent elective colorectal surgery in an Enhanced Recovery pathway was compared to historical National Surgical Quality Improvement Program cohort of patients. Primary outcomes measured are 30-day POUR and postoperative CAUTI rates. ResultsThe overall POUR rate of ERP patients compared to non-ERP patients was significantly less (8% vs. 13%, p < 0.05). CAUTI rates were not significantly different between pre-ERP and ERP patients (1.2 vs 2.3%, p = 0.19). ConclusionsFor patients undergoing ERP with a preoperative intrathecal opioid injection, early removal of urinary catheter significantly decreased POUR and did not significantly affect CAUTI rates. SummaryThe effect of early removal of urinary catheters on postoperative urinary retention and catheter-associated UTI rates in patients undergoing an ERP with a single preoperative intrathecal opioid injection was studied. Early urinary catheter removal after intrathecal injection was associated with decreased rates of POUR and equivalent CAUTI rates.

Drug-related mortality after discharge from treatment: A record-linkage study of substance abuse clients in Texas, 2006–2012

BackgroundPatients have higher mortality immediately after substance abuse treatment discharge, but there are few data on post-discharge mortality differences across treatment modalities. MethodsA retrospective cohort study examined individuals discharged from substance abuse treatment during 2006–2012 and probabilistically matched treatment records to death records. Logistic regression examined associations between drug-related death (DRD) and demographics; route, frequency, and classes of drugs abused; and treatment. Primary outcome was DRD during post-discharge days 0–28; secondary outcomes examined DRD during days 29–90 and 91–365. ResultsWe examined 178,749 patients discharged from 254,814 treatment episodes. There were 97 DRD during days 0–28 (4.1/1000 person-years), 115 DRD during days 29–90 (2.6/1000 person-years; IRR 0.6 [95% CI 0.5–0.8]), and 293 DRD during days 91–365 (1.9/1000 person-years; IRR 0.5 [0.4–0.6]). Higher 28-day DRD was associated with abuse of opioids (aOR 2.5 [1.4–4.4]), depressants (aOR 2.0 [1.2–3.4]), or alcohol (aOR 1.7 [1.1–2.6]); and opioid injection (aOR 2.2 [1.3–3.7]). Lower DRD was associated with treatment completion (aOR 0.6 [0.4–0.9]), female sex (aOR 0.6 [0.4–0.8]), and employment (aOR 0.5 [0.3–0.9]). Among all patients, DRD rates were higher following residential (IRR 2.6, [1.6–4.2]) and detoxification (IRR 2.9, [1.7–4.9]) treatment compared to outpatient. Patients with prior opioid abuse had higher 28-day DRD after outpatient (6.7/1000 person-years; IRR 4.1 [1.8–9.1]), residential (13.6/1000 person-years; IRR 4.2 [2.2–8.2]), and detoxification (8.8/1000 person-years; IRR 3.2 [1.2, 8.5]) compared to those without. ConclusionsDrug-related mortality is highest during days 0–28 after discharge, especially following residential and detoxification treatment. Opioid abuse is strongly associated with early post-discharge mortality.