ReviewA systematic review of injecting-related injury and disease among people who inject drugs
Introduction
Although the transmission of blood-borne viral infections such as HIV and hepatitis C virus among people who inject drugs has garnered substantial attention, there has been less focus on other injecting-related injuries and diseases (IRID) in this population. These commonly include soft tissue infections such as abscesses and cellulitis, which occur as a result of micro-organisms (i.e., bacteria and fungi) in the injecting environment. Other infections may include bone and joint infections, infective endocarditis, and sepsis; these can arise as a result of direct introduction of bacteria to the bloodstream, or as complications of untreated of soft tissue infections (Salmon et al., 2009).
In addition to infections, repeated injecting and poor injecting technique may lead to vascular injury and poor venous access; furthermore, drug solutions may contain inactive ingredients that are not water soluble, leading to particles in the vasculature that can cause inflammation and clot formation (Darke et al., 2015, McLean et al., 2009). The likelihood of vascular injury can be further exacerbated by the delivery method (e.g., intravenous versus intramuscular injection), injecting site (e.g., subcutaneous tissue and muscle, major vessels), and type of equipment used (Darke et al., 2001).
Some IRID necessitate urgent medical care, and all can result in poorer health outcomes for people who inject drugs, including risk of mortality, if untreated (Dwyer et al., 2009). From an economic perspective, the costs of hospital care for IRID can be substantial (Sweeney et al., 2009, Tookes et al., 2015). A clearer understanding of the prevalence of IRID is needed to determine the scale of the problem and guide the development of evidence-informed responses. This review aimed to assess prevalence of, and risk factors for, non-viral IRID among people who inject drugs.
Section snippets
Method
This review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist (Moher et al., 2009).
Results
The literature searches returned 3578 unique records. Of these, 3254 were deleted following screening of titles and abstracts, leaving 324 reports to be reviewed in full. Thirty-three reports met the inclusion criteria; 29 reports provided data on IRID prevalence, and 17 provided data on IRID risk factors (Fig. 1). Included studies were largely based on samples from high-income countries, and participants were typically recruited from needle and syringe programs and drug treatment clinics (
Discussion
This review has shown that IRID are a common consequence of injecting drug use. Existing studies have found that up to one-third of people who inject drugs may have experienced infections at injecting sites within the previous month. Serious complications of injecting are also a risk, with studies showing that up to one-tenth may have experienced infective endocarditis or septicaemia at some point in their lives. Although risk factors for skin infections were not able to be formally
Role of funding
No specific funding was received for this study. Sarah Larney had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Contributors
Sarah Larney, Amy Peacock, Bradley Mathers, Matthew Hickman, Louisa Degenhardt
Conflict of interest
No conflict declared
Declaration of interests
We declare no relevant conflicts of interest.
Author contributions
Sarah Larney led the literature search and selection, completed the data analysis and wrote the manuscript. Amy Peacock contributed to the data analysis and manuscript writing. Bradley Mathers contributed to defining/categorising IRID and study design, and critically reviewed the manuscript. Matthew Hickman provided advice on data analysis and critically reviewed the manuscript. Louisa Degenhardt originated the idea for the review, and contributed to study design and manuscript writing.
Acknowledgements
Thank you to Mary Kumvaj for assistance with designing the literature search, and Angus Liu for conducting the initial literature search and assisting with study screening and selection. Amy Peacock, Bradley Mathers and Louisa Degenhardt are supported by fellowships from the Australian National Health and Medical Research Council (nos. 1109366, 1054244, 1041742). The National Drug and Alcohol Research Centre at the University of NSW is supported by funding from the Australian Government
References (44)
- et al.
Echocardiographic findings suggestive of infective endocarditis in asymptomatic danish injection drug users attending urban injection facilities
Am. J. Cardiol.
(2014) - et al.
Demographic, HIV risk behavior, and health status characteristics of “crack” cocaine injectors compared to other injection drug users in three New England cities
Drug Alcohol Depend.
(2006) - et al.
Nationwide increase in hospitalizations for heroin-related soft tissue infections: associations with structural market conditions
Drug Alcohol Depend.
(2016) - et al.
Physical injecting site among injecting drug users in Sydney, Australia
Drug Alcohol Depend.
(2001) - et al.
Prevalences and correlates of non-viral injecting-related injuries and diseases in a convenience sample of Australian injecting drug users
Drug Alcohol Depend.
(2009) - et al.
Factors associated with recent symptoms of an injection site infection or injury among people who inject drugs in three English cities
Int. J. Drug Policy
(2014) - et al.
Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement
J. Clin. Epidemiol.
(2012) - et al.
Lower extremity changes, pain, and function in injection drug users
J. Subst. Abuse Treat.
(2003) - et al.
Injecting-related injury and disease among clients of a supervised injecting facility
Drug Alcohol Depend.
(2009) - et al.
The economic burden to the public health system of treating non-viral injecting-related injury and disease in Australia (a cost of illness analysis)
Aust. N. Z. J. Public Health
(2009)