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In the current substance use treatment system, many people who inject drugs (PWID) go without necessary medical treatment for comorbidities related to injection drug use (IDU). PWID are at risk for skin and soft tissue infections that can escalate to severe bacterial infections (SBI) such as osteomyelitis, sepsis, bacteremia or infective endocarditis. IDU-related infections are not often considered part of holistic drug-user health, leaving practitioners lacking information on how to best meet PWID’s health needs. In order to address this gap, we conducted a cross-sectional study of hospitalizations and emergency department (ED) visits for suspected IDU-related SBIs in New Jersey in 2019.
Methods
This study analyzed hospitalizations and ED visits using the New Jersey State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) from the Healthcare Cost and Utilization Project. The SID & SEDD contain hospital data for all inpatient stays and ED visits, respectively, in acute care hospitals. Hospital visits related to injection drug use were captured by identifying visits in which patients had a diagnosis for any substance use disorder (SUD) commonly associated with IDU and a diagnosis of an SBI.
We present the frequency of hospital visits for IDU-related infections by racial and ethnic group for individuals visiting New Jersey hospitals during 2019. Differences in proportions across racial and ethnic groups were analyzed via chi square tests.
Results
There were 1,967 ED visits and 7,310 hospitalizations related to SBI among PWID. The most common SBI was sepsis (n = 4,078). SBI hospitalizations were significantly more likely to affect males (p<0.001) and individuals 30-49 years old (p<0.001). White/non-Hispanic individuals accounted for most SBI hospitalizations (p<0.001), but Black/non-Hispanic individuals were 1.5 times more likely to be hospitalized compared with their white counterparts (p<0.001).
SBI visits were also significantly more common among patients in the lowest income quartile (p<0.001) and those insured by Medicaid (p<0.001). Individuals covered by public insurance through Medicaid or Medicare were 5.8 times more likely to be hospitalized compared with individuals covered through private health insurance (p<0.001).
283 people likely died of SBIs. Deaths were significantly more common among 30-49 year olds (p<0.001) and Medicaid-enrolled individuals.
Conclusions & Implications
SBIs were common across racial, ethnic, gender, and age groups but were more common among males, people 30-49 years old, and disproportionately affected Black/non-Hispanic and Medicaid-enrolled individuals. Our findings have important implications for social work practitioners, and suggest expanding access to syringe exchange and other harm reduction programs statewide. Our findings also suggest further infrastructure development at hospitals to implement evidence-based SUD treatment strategies, and suggests training health providers on strategies to reduce morbidity for PWID – like coordinating outpatient medications for opioid use disorder receipt, harm reduction center referrals, or education on safer drug use. Given that stigma is often a factor in PWID not seeking medical care, providers could benefit from training in stigma-reducing approaches in their work with PWID.