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intravenous drug abuse (IVDA, injection drug use, IDU)

Complications: 1) endocarditis [4] 2) septic arthritis [7] 3) TIA & stroke 4) HIV-1 a) 10% positive for HIV-1 b) half of HIV-1 positive injection drug users are unaware of their HIV-1 serostatus - 1/3 of HIV1-infected IVDA are unaware their infection [5] c) 1/3 admit sharing syringes d) 2/3 report unprotected vaginal sex e) HIV counseling (~20%), HIV testing (~50%) [2] 5) other infections: (characteristic pathogens) a) viruses 1] Cytomegalovirus 2] hepatitis B 3] hepatitis C [4] b) bacteria 1] Staphylococcus aureus, including MRSA [6] 2] Enterococcus 3] Pseudomonas aeruginosa c) fungi: Candida Management: - if patient is not read to quit, counsel on sterile practice - opioid treatment program with buprenorphine-naloxone - methadone maintenance associated with reduced risk of HIV1 [3]

General

substance abuse

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Centers for Disease Control and Prevention HIV Infection and HIV-Associated Behaviors Among Injecting Drug Users - 20 Cities, United States, 2009 MMWR March 2, 2012 / 61(08);133-138 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6108a1.htm
  3. MacArthur GJ et al. Opiate substitution treatment and HIV transmission in people who inject drugs: Systematic review and meta-analysis. BMJ 2012 Oct 4; 345:e5945. PMID: 23038795
  4. Wakeman SE et al Case 35-2014 - A 31-Year-Old Woman with Fevers, Chest Pain, and a History of HCV Infection and Substance-Use Disorder. N Engl J Med 2014; 371:1918-1926. November 13, 2014 PMID: 25390743 http://www.nejm.org/doi/full/10.1056/NEJMcpc1407131
  5. Spiller MW et al HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs - 20 Cities, United States, 2012 MMWR Weekly. March 20, 2015 / 64(10);270-275 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6410a3.htm
  6. Jackson KA, Bohm MK, Brooks JT, et al. Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Persons Who I nject Drugs - Six Sites, 2005-2016. MMWR Morb Mortal Wkly Rep 2018;67:625-628 https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a2.htm
  7. Allison DC et al. Microbiology of bone and joint infections in injecting drug abusers. Clin Orthop Relat Res 2010 Aug; 468:2107 PMID: 20174899 PMCID: PMC2895841 Free PMC article