Experiences with skin and soft tissue infections among people who inject drugs in Philadelphia: A qualitative study

Harris, Robert S.; Richardson, Jessica; Frasso, Rosemary; Anderson, Evan D.

doi:10.1016/j.drugalcdep.2018.01.029

Cited by 35 publications

(62 citation statements)

References 36 publications

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“…In line with our results, other research has also identified that some people obtain antibiotics from sources other than healthcare providers to treat SSTIs; however, recent research has been qualitative and recent estimates of this type of antibiotic use are not established [ 21 , 23 ]. For their most recent SSTI or ever in their lifetime, 13% and 63% of participants, respectively, had taken antibiotics pills that were not prescribed to them in order to treat a SSTI.…”

Section: Discussionsupporting

confidence: 90%

“…PWUD face multiple barriers when accessing traditional medical services resulting in a long-standing history of mistrusting formalized medical care [16]. PWUD often cite mistreatment and stigma experienced in medical settings [17][18][19][20][21], sometimes noting that they are labeled as "drug seeking" and fear experiencing withdrawal if hospitalized [21]. As a result, some PWUD turn to treatment options outside traditional healthcare settings, for example self-treating abscesses and obtaining antibiotics from sources other than healthcare providers [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Treatment experiences for skin and soft tissue infections among participants of syringe service programs in North Carolina

Figgatt

Salazar²,

Vincent³

et al. 2021

Harm Reduct J

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Introduction Bacterial and fungal infections, such as skin and soft tissue infections (SSTIs) and infective endocarditis (IE), are increasing among people who use drugs in the United States. Traditional healthcare settings can be inaccessible and unwelcoming to people who use drugs, leading to delays in getting necessary care. The objective of this study was to examine SSTI treatment experiences among people utilizing services from syringe services programs. This study was initiated by people with lived experience of drug use to improve quality of care. Methods We conducted a cross-sectional survey among participants of five syringe services programs in North Carolina from July through September 2020. Surveys collected information on each participant’s history of SSTIs and IE, drug use and healthcare access characteristics, and SSTI treatment experiences. We examined participant characteristics using counts and percentages. We also examined associations between participant characteristics and SSTI history using binomial linear regression models. Results Overall, 46% of participants reported an SSTI in the previous 12 months and 10% reported having IE in the previous 12 months. Those with a doctor they trusted with drug use-related concerns had 27 fewer (95% confidence interval = − 51.8, − 2.1) SSTIs per every 100 participants compared to those without a trusted doctor. Most participants with a SSTI history reported delaying (98%) or not seeking treatment (72%) for their infections. Concerns surrounding judgment or mistreatment by medical staff and self-treating the infection were common reasons for delaying or not seeking care. 13% of participants used antibiotics obtained from sources other than a medical provider to treat their most recent SSTI. Many participants suggested increased access to free antibiotics and on-site clinical care based at syringe service programs to improve treatment for SSTIs. Conclusions Many participants had delayed or not received care for SSTIs due to poor healthcare experiences. However, having a trusted doctor was associated with fewer people with SSTIs. Improved access to non-judgmental healthcare for people who use drugs with SSTIs is needed. Expansion of syringe services program-based SSTI prevention and treatment programs is likely a necessary approach to improve outcomes among those with SSTI and IE.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Treatment experiences for skin and soft tissue infections among participants of syringe service programs in North Carolina

Figgatt

Salazar²,

Vincent³

et al. 2021

Harm Reduct J

View full text Add to dashboard Cite

show abstract

“…These include feeling marginalised, judged, medicalised and/or criminalised in relation to drug use ( McCall and Pauly, 2019 ); being stigmatised due to wound odour or appearance of homelessness ( Varley et al, 2020 ); struggling to navigate unfamiliar environments and unequal power relations with medical professionals ( Harris et al, 2013 ). A nascent qualitative literature on delayed care seeking for injecting-related skin and soft tissue infections (SSTI) notes the impact of prior negative experiences of care (R. Harris et al, 2018 ; Phillips et al, 2013 ; Small et al, 2008 ). For many, hospital attendance is associated with pejorative treatment and intense embodied discomfort (unrelieved drug withdrawals and/or pain).…”

Section: Introductionmentioning

confidence: 99%

Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care

Harris

2020

Social Science & Medicine

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In the United Kingdom, increases in premature mortality among the intersecting populations of people made homeless and people who inject drugs map onto the implementation and solidification of fiscal austerity policies over the past decade, rather than drug market fluctuations and trends as in North America. In this context, it is crucial to explore how poverty, multi-morbidity and care delay interplay in exacerbating vulnerability to mortality among an aging population of people who use illicit drugs. The mixed methods Care & Prevent study generated survey data with 455 PWID and in-depth qualitative interviews with a subsample (n = 36). Participants were recruited though drug treatment services and homeless hostels in London from October 2017–June 2019. This paper focuses on qualitative findings, analysed thematically and contextualised in relation to the broader survey sample. Survey participants report an extensive history of rough sleeping (78%); injecting-related bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts emphasise engagement with the medical system as a ‘last resort’, with admission to hospital in a critical or a “near death” condition common. For many severe physical pain and debility were normalised, incorporated into the day to day. In a context of everyday violence and marginalisation, avoidance of medical care can have a protective impetus. Translation of cultural safety principles to care for people who inject drugs in hospital settings offers transformative potential to reduce serious health harms among this population.

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“…In the majority of these cases an injection site infection has been present [ 8 , 9 ]. In a context of barriers to timely medical care access, PWID have been reported to self-medicate with old or incomplete antibiotic prescriptions [ 10 , 11 ]. This is a concern, given potential for antiboitic resistance and vulnerability to MRSA aquistion [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK

et al. 2020

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Background Skin and soft tissue infections (SSTI) are a common but preventable cause of morbidity and mortality among people who inject drugs (PWID). They can be severe, and hospitalisations of PWID with SSTI are rising. The most common SSTI presentations are abscesses and cellulitis. Methods We used data from Care & Prevent, a cross-sectional community survey of PWID in London. We reported the lifetime prevalence of SSTI, severity of infections, key risk factors, and associated sequelae. Pictorial questions were used to assess SSTI severity. Results We recruited 455 PWID. SSTI lifetime prevalence was high: 64% reported an abscess and/ or cellulitis. Over one-third (37%) reported a severe infection, 137 (47%) reported hospitalisation. SSTIrisk factors were: aged 35+ years, injecting once or more times a day, subcutaneous or intra-muscular injections, and making four or more attempts to achieve an injection. Those who reported having other health conditions were at higher odds of having an abscess or cellulitis, with risk tending to increase with number of reported conditions. Half (46%) employed self-care for their worst SSTI, and 43% waited for ten or more days before seeking medical care or not seeking medical care at all.

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Experiences with skin and soft tissue infections among people who inject drugs in Philadelphia: A qualitative study

Cited by 35 publications

References 36 publications

Treatment experiences for skin and soft tissue infections among participants of syringe service programs in North Carolina

Treatment experiences for skin and soft tissue infections among participants of syringe service programs in North Carolina

Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care

Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK

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