Infectious and other somatic comorbidity in problem drug users – results of a cross-sectional study with medical examination
Authors:
V. Mravčík 1,2,3; Z. Florián 4; V. Nečas 2,3; J. Štolfa 5,6
Authors place of work:
Klinika adiktologie, 1. lékařská fakulta, Univerzita Karlova v Praze a Všeobecná fakultní nemocnice v Praze
1; Národní ústav duševního zdraví
2; Národní monitorovací středisko pro drogy a závislosti
3; FOCUS – Centrum pro sociální a marketingovou analýzu
4; Výukové pracoviště praktického lékařství, 2. lékařská fakulta, Univerzita Karlova v Praze
5; Katedra všeobecného praktického lékařství, Institut postgraduálního vzdělávání ve zdravotnictví v Praze
6
Published in the journal:
Epidemiol. Mikrobiol. Imunol. 65, 2016, č. 1, s. 56-62
Category:
Original Papers
Summary
Background:
Problem drug use is associated with excess risk of infectious and other somatic diseases resulting mainly from injecting drug use.
Material and methods:
At the end of 2013, a complete medical history and physical examination was done in 40 problem drug users (30 males and 10 females), mean age 35.5 years (37.0 and 30.9, respectively), recruited in 4 low-threshold facilities in Prague. Of them, 37 were ex- or active injecting drug users, predominantly of methamphetamine (pervitin) and less often of buprenorphine.
Results:
The study physician rated the health status as good or satisfactory in 35 participants and as unsatisfactory in five participants (12.5%). The most common pathologies were dental problems (36 participants, i.e. 90.0%) and skin conditions (15.0%). The most prevalent dental pathology was caries while dermatological disorders were mostly trophic skin lesions on the lower legs, including crural ulcers, and injection site infections. Gynaecological pathology was found in 2 of 10 females. The study subjects were most commonly diagnosed with chronic hepatitis C, status post hepatitis A and B, chronic caries, missing teeth, post-thrombotic swelling and trophic skin lesions on the lower legs, purulent skin lesions, and gastroduodenal ulcer. A vast majority of the study participants were smokers. All were referred to various specialists for further examination or treatment, mostly to stomatology, hepatology, gastroenterology, and internal/general medicine departments. However, in reality the treatment participation rate is low among problem drug users due to the drug use-specific factors and needs that limit access to treatment.
Conclusion:
The incidence of diverse somatic comorbidities requiring standard general medical care is significant among problem drug users. Infectious, dermatological, and dental pathologies are predominant. In areas with high prevalence of problem drug use, implementation of a special program should be considered to provide comprehensive medical care taking account of the special needs of this target group.
Keywords:
somatic comorbidity – infectious diseases – problem drug use – injection drug use – methamphetamine – buprenorphine – medical examination – medical care
Zdroje
1. Akinosoglou K, Apostolakis E, Marangos M, Pasvol G. Native valve right sided infective endocarditis. European journal of internal medicine, 2013;24(6):510–519.
2. Brett MM, Hood J, Brazier JS, Duerden BI, Hahne SJ. Soft tissue infections caused by spore-forming bacteria in injecting drug users in the United Kingdom. Epidemiol Infect, 2005;133(4):575582.
3. Coull A, Atherton I, Taylor A, Watterson A. Prevalence of skin problems and leg ulceration in a sample of young injecting drug users. Harm Reduction Journal, 2014;11(1):22.
4. Čejdová E. Komorbidita závislosti na nelegálních návykových látkách a poruch příjmu potravy (Klasifikovaná zápočtová práce pro předmět: Metodologie výzkumu v adiktologii 2) 2014.
5. Darke S, Ward J, Hall W, Heather N, Wodak A. The Opiate Treatment Index (OTI) Researcher’s Manual. National Drug and Alcohol Research Centre, Technical Report No. 11, 1991.
6. De-Carolis C, Boyd GA, Mancinelli L, Pagano S, Eramo S. Methamphetamine abuse and "meth mouth" in Europe. Med Oral Patol Oral Cir. Bucal, 2015;20(2):e205–210.
7. Dwyer R, Topp L, Maher L, Power R, Hellard M, Walsh N, 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;100(1–2):9–16.
8. Ebright JR, Pieper B. Skin and soft tissue infections in injection drug users. Infectious disease clinics of North America, 2002;16(3):697–712.
9. Edlin BR. Prevention and treatment of hepatitis C in injection drug users. Hepatology, 2002;36(5, Suppl. 1):S210–219.
10. EMCDDA. DRID Guidance Module: Example questionnaire for bio-behavioural surveys in people who inject drugs. Lisbon: European monitoring centre for drugs and drug addiction, 2013.
11. Fernandez Guerrero ML, Gonzalez Lopez JJ, Goyenechea A, Fraile J, de Gorgolas M. Endocarditis caused by Staphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome. Medicine, 2009;88(1):1–22.
12. Frasch K, Larsen JI, Cordes J, Jacobsen B, Wallenstein Jensen SO, Lauber C, et al. Physical illness in psychiatric inpatients: comparison of patients with and without substance use disorders. The International journal of social psychiatry, 2013;59(8):757–764.
13. Gordon RJ, Lowy FD. Bacterial infections in drug users. N Engl J Med, 2005;353(18):1945–1954.
14. Grebely J, Raffa JD, Lai C, Krajden M, Kerr T, Fischer B, et al. Low uptake of treatment for hepatitis C virus infection in a large community-based study of inner city residents. J Viral Hepat, 2009;16(5):352–358.
15. Gyarmathy VA, Giraudon I, Hedrich D, Montanari L, Guarita B, Wiessing L. Drug use and pregnancy – challenges for public health. Euro surveillance : bulletin Europeen sur les maladies transmissibles. European communicable disease bulletin, 2009;14(9):33–36.
16. Harris M, Rhodes T. Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors. Harm Reduct J, 2013;10:7.
17. Hicks CW, Sweeney DA, Cui X, Li Y, Eichacker PQ. An overview of anthrax infection including the recently identified form of disease in injection drug users. Intensive care medicine, 2012;38(7):1092–1094.
18. Hirsbein D, Attal P, Gueudry J, Guet I, Brasseur G, Vasseneix C. Endogenous Candida endophthalmitis in drug misusers injecting intravenous buprenorphine. Journal francais d'ophtalmologie, 2008;31(2):180–183.
19. Hobstová J, Vitouš A. Infekční komplikace uživatelů drog v České republice. Čas Lék čes, 2007;146(2):137–141.
20. Hobstová J. Infekční endokarditida u intravenózních uživatelů drog. Postgrad Med, 2010;Suppl. 1/2010.
21. Hope VD, Marongiu A, Parry JV, Ncube F. The extent of injection site infection in injecting drug users: findings from a national surveillance study. Epidemiol Infect, 2010;138(10):1510–1518.
22. Huber G, Seelbach-Gobel B. Substance abuse and pregnancy from an obstetric point of view. Z Geburtshilfe Neonatol, 2014;218(4):142–148.
23. Klochan SA, Taleb M, Hoover MJ, Mauro VF, Anandan V, Willey J, et al. Illicit narcotic injection masquerading as acute pulmonary embolism. Vascular medicine (London, England), 2013;18(2):92–94.
24. Klusoňová H, Štěpánová V, Čížek J, Plíšková L. Virové hepatitidy u problémových uživatelů návykových látek v ČR. Epidemiol Mikrobiol Imunol, 2004;53(2):47–54.
25. Krekulová L, Řehák V, Strumecký O, Němeček V. Situace a trendy v zastoupení genotypů viru hepatitidy C v populaci injekčních uživatelů drog. Epidemiol Mikrobiol Imunol, 2009;58(2):84–89.
26. Lim CC, Lee SH, Wong YC, Hui F. Embolic stroke associated with injection of buprenorphine tablets. Neurology, 2009;73(11):876–879.
27. Lonergan S, Rodriguez RM, Schaulis M, Navaran P. A case series of patients with black tar heroin-associated necrotizing fasciitis. The Journal of emergency medicine, 2004;26(1):47–50.
28. Marchiori E, Lourenco S, Gasparetto TD, Zanetti G, Mano CM, Nobre LF. Pulmonary talcosis: imaging findings. Lung, 2010;188(2):165–171.
29. Marks M, Pollock E, Armstrong M, Morris-Jones S, Kidd M, Gothard P, et al. Needles and the damage done: reasons for admission and financial costs associated with injecting drug use in a Central London Teaching Hospital. The Journal of infection, 2013;66(1):95–102.
30. Mathers B, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick R, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet, 2010;375:1014–1028.
31. McColl MD, Tait RC, Greer IA, Walker ID. Injecting drug use is a risk factor for deep vein thrombosis in women in Glasgow. British journal of haematology, 2001;112(3):641–643.
32. McGuigan CC, Penrice GM, Gruer L, Ahmed S, Goldberg D, Black M, et al. Lethal outbreak of infection with Clostridium novyi type A and other spore-forming organisms in Scottish injecting drug users. Journal of medical microbiology, 2002;51(11):971–977.
33. Metz V, Kochl B, Fischer G. Should pregnant women with substance use disorders be managed differently? Neuropsychiatry, 2012;2(1):29–41.
34. Minařík J. Stimulancia. In: Kalina Kak, editor. Drogy a drogové závislosti 1 Mezioborový přístup. Praha: Úřad vlády České republiky, Národní monitorovací středisko pro drogy a drogové závislosti; 2003. p. 164–168.
35. Miro JM, del Rio A, Mestres CA. Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. Infectious disease clinics of North America, 2002;16(2):273–295.
36. Mravčík V, et al. Bariéry léčby somatické komorbidity u problémových uživatelů drog. Připraveno k publikaci, 2015.
37. Mravčík V, et al. Somatická komorbidita problémových uživatelů drog – výsledky dotazníkového šetření. Připraveno k publikaci, 2015.
38. Mravčík V, Šebáková H, Kania A. Séroprevalence virových hepatitid typu A–C u injekčních uživatelů drog. Epidemiol Mikrobiol Imunol, 2000;49(1):19–23.
39. Mravčík V, Coufalová M, Popov P, Zábranský T, Procházka R. Dotazníková studie mezi praktickými lékaři zaměřená na zkušenosti a postoje k substituci opioidy. Epidemiol Mikrobiol Imunol, 2005;54(1):27–33.
40. Mravčík V, Chomynová P, Grohmannová K, Nečas V, Grolmusová L, Kiššová L, et al. Výroční zpráva o stavu ve věcech drog v České republice v roce 2013. Úřad vlády České republiky: Praha, 2014.
41. Mravčík V, Strada L, Reimer J, Schulte B. Hepatitis C treatment uptake and adherence among injecting drug users in the Czech Republic. Epidemiologie, mikrobiologie, imunologie, 2014;63(4):265–269.
42. Nechanská B, Mravčík V, Sopko B, Velebil P. Rodičky užívající alkohol, tabák a nelegální drogy. Česka gynekologie, 2012;77(5):457–469.
43. Palmateer NE, Hope VD, Roy K, Marongiu A, White JM, Grant KA, et al. Infections with spore-forming bacteria in persons who inject drugs, 2000–2009. Emerging infectious diseases, 2013;19(1):29–34.
44. Phillips KT, Stein MD. Risk practices associated with bacterial infections among injection drug users in Denver, Colorado. The American journal of drug and alcohol abuse, 2010;36(2):92–97.
45. Pospíšilová A, Švestková S. Bércový vřed – etiologie, diagnostika a léčba. Postgraduání medicína, 2002;6: 604.
46. Rapp RC, Xu J, Carr CA, Lane DT, Wang J, Carlson R. Treatment barriers identified by substance abusers assessed at a centralized intake unit. J Subst Abuse Treat, 2006;30(3):227–235.
47. Robinson PG, Acquah S, Gibson B. Drug users: oral health-related attitudes and behaviours. Br Dent J, 2005;198(4):219–224.
48. Saini GK, Gupta ND, Prabhat KC. Drug addiction and periodontal diseases. Journal of Indian Society of Periodontology, 2013;17(5):587–591.
49. Salmon AM, Dwyer R, Jauncey M, van Beek I, Topp L, Maher L. Injecting-related injury and disease among clients of a supervised injecting facility. Drug Alcohol Depend, 2009;101(1–2):132–136.
50. Senbanjo R, Tipping T, Hunt N, Strang J. Injecting drug use via femoral vein puncture: preliminary findings of a point-of-care ultrasound service for opioid-dependent groin injectors in treatment. Harm Reduct J, 2012;9(1):6.
51. Smith ME, Robinowitz N, Chaulk P, Johnson KE. Self-care and risk reduction habits in older injection drug users with chronic wounds: a cross-sectional study. Harm Reduct J, 2014;11(1):28.
52. Spůrová N. Mapování a metodika zvládání somatických komplikací injekčních uživatelů drog. Univerzita Karlova v Praze, 1. lékařská fakulta, Klinika adiktologie: Praha, 2013.
53. Strathdee SA, Hallett TB, Bobrova N, Rhodes T, Booth R, Abdool R, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet, 2010;376(9737):268–284.
54. Štolfa J, Hobstová J, Bencko V. Zdravotní komplikace zneužívání návykových látek a možnosti prevence v primární péči. Praktický lékař, 2009;89(6):295–300.
55. Trmal J, Kellerová J, Koblížková R, Krpálková H, Holasová J. Dopad výměnného programu injekčních jehel a stříkaček na šíření virové hepatitidy typu C. Epidemiol Mikrobiol Imunol, 1999;48(4):171–178.
56. Urbánek P. Virová hepatitida C. Adiktologie, 2010;10(2):102–109.
57. Wang P, Chen X, Zheng L, Guo L, Li X, Shen S. Comprehensive dental treatment for "meth mouth": A case report and literature review. Journal of the Formosan Medical Association, 2014;113(11):867–871.
58. Wiessing L, Ferri M, Grady B, Kantzanou M, Sperle I, Cullen KJ, et al. Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling up Treatment and Prevention. PLoS ONE, 2014;9(7):e103345.
59. Xu J, Wang J, Rapp RC, Carlson RG. The Multidimensional Structure of Internal Barriers to Substance Abuse Treatment and Its Invariance Across Gender, Ethnicity, and Age. J Drug Issues, 2007;37(2):321–340.
Štítky
Hygiene and epidemiology Medical virology Clinical microbiologyČlánok vyšiel v časopise
Epidemiology, Microbiology, Immunology
2016 Číslo 1
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