评估美国患有阿片类药物使用障碍和注射毒品使用史的退伍军人中减少伤害的接受情况和传染病结局。

Assessment of harm reduction receipt and infectious diseases outcomes in United States Veterans with opioid use disorder and history of injection drug use.

机构信息

Department of Internal Medicine, Renaissance School of Medicine, Stony Brook University, 101 Nicolls Rd., Stony Brook, NY, 11794, USA.

Department of Medicine, Northport Veterans Affairs Medical Center, Northport, NY, 11768, USA.

出版信息

Harm Reduct J. 2024 Nov 27;21(1):211. doi: 10.1186/s12954-024-01129-0.

DOI:10.1186/s12954-024-01129-0

PMID:39604953

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11600810/

Abstract

BACKGROUND

Injection drug use (IDU) may lead to negative health outcomes and increased healthcare utilization. In US Veterans (USV) with opioid use disorder (OUD), there is sparse information about healthcare utilization, harm reduction prescription, and outcomes associated with IDU, including severe injection-related infections (SIRI). We assessed psychosocial factors, clinical outcomes, and harm reduction receipt in a cohort of USV with OUD, specifically focusing on persons who inject drugs (PWID).

METHODS

A retrospective cohort study was performed of USV aged ≥ 18 years with a diagnosis of OUD who presented to the Northport Veterans Affairs Medical Center (Long Island, NY) between 2012 and 2022. Demographics, psychosocial factors, history of human immunodeficiency virus (HIV), hepatitis C virus (HCV) infection, and healthcare utilization were compared by IDU status. Prescription of medications for opioid use disorder, naloxone and pre-exposure prophylaxis (PrEP) for HIV were also compared by IDU status. SIRI episodes and associated sequelae were characterized in USV with IDU.

RESULTS

A total of 502 USV with OUD were included and 216 (43%) were PWID. Mean age was 52.6 years. PWID were more likely to use multiple stimulants (14.4% PWID vs. 7.3% non-PWID, p < 0.011), be hospitalized with an infection (26.4% PWID vs. 12.2% non-PWID, p < 0.001) and had more frequent inpatient admissions (n = 5.5 PWID vs. n = 3.51 non-PWID, p = 0.003). Among PWID, 134 (62%) had a history of HCV infection, 9 (4.2%) had HIV, and 35 (16.2%) had at least one SIRI episode. PWID had a higher frequency of current (51.9% PWID vs. 38.5% non-PWID, p = 0.003) or previous MOUD use (45.8% PWID vs. 31.1% non-PWID, p < 0.001). Overall PrEP receipt in our cohort (0.46% PWID vs. 1.4% non-PWID, p = 0.4) was low.

CONCLUSIONS

USV with OUD and a history of IDU had a high prevalence of concurrent stimulant use, HCV, SIRI episodes, and were more likely to be hospitalized than USV with OUD and no history of IDU. Harm reduction strategies such as MOUD or PrEP, can help decrease the risk of infectious diseases, yet PrEP was underutilized in our population regardless of IDU status. USV with OUD would benefit from improved integration of OUD treatment, infectious diseases clinical care and harm reduction interventions.

摘要

背景

注射吸毒（IDU）可能导致不良健康后果和增加医疗保健利用。在美国患有阿片类药物使用障碍（OUD）的退伍军人（USV）中，关于与 IDU 相关的医疗保健利用、减少伤害处方和结果的信息很少，包括严重的注射相关感染（SIRI）。我们评估了一组患有 OUD 的 USV 的心理社会因素、临床结果和减少伤害的情况，特别是关注注射吸毒者（PWID）。

方法

对 2012 年至 2022 年期间在北港退伍军人事务医疗中心（纽约长岛）就诊的年龄≥18 岁、诊断为 OUD 的 USV 进行了回顾性队列研究。比较了 IDU 状态下的人口统计学因素、心理社会因素、人类免疫缺陷病毒（HIV）感染史、丙型肝炎病毒（HCV）感染史和医疗保健利用情况。还比较了 IDU 状态下阿片类药物使用障碍药物、纳洛酮和暴露前预防（PrEP）的处方情况。对 IDU 的 USV 中的 SIRI 发作及其相关后果进行了特征描述。

结果

共纳入 502 名患有 OUD 的 USV，其中 216 名（43%）为 PWID。平均年龄为 52.6 岁。PWID 更有可能使用多种兴奋剂（14.4% PWID 与 7.3%非 PWID，p<0.011）、因感染住院（26.4% PWID 与 12.2%非 PWID，p<0.001）和更频繁的住院治疗（n=5.5 PWID 与 n=3.51 非 PWID，p=0.003）。在 PWID 中，134 名（62%）有 HCV 感染史，9 名（4.2%）有 HIV，35 名（16.2%）至少有一次 SIRI 发作。PWID 目前（51.9% PWID 与 38.5%非 PWID，p=0.003）或以前（45.8% PWID 与 31.1%非 PWID，p<0.001）使用 MOUD 的频率更高。我们队列中 PrEP 的总体使用率（0.46% PWID 与 1.4%非 PWID，p=0.4）较低。

结论

患有 OUD 且有 IDU 史的 USV 更常同时使用兴奋剂、HCV，且发生 SIRI 发作的风险更高，且比无 IDU 史的 USV 更易住院。减少伤害策略，如 MOUD 或 PrEP，可以帮助降低传染病的风险，但无论 IDU 状态如何，PrEP 的使用率都很低。患有 OUD 的 USV 受益于改善 OUD 治疗、传染病临床护理和减少伤害干预措施的整合。