Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review

Abstract

Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include: (1) safer injection practices teaching and distribution of materials such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and post-exposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.

Evaluation of Bundled Interventions for Patients With Opioid Use Disorder Experiencing Homelessness Receiving Extended Antibiotics for Severe Infection

“…A multidisciplinary team-based approach to inpatient hospital care for OUD patients has been described utilizing ID consult, along with a designated team for IV antibiotics and addiction consult, in addition to a risk assessment tool, led to increased MOUD use from 29% to 37% on discharge [ 9 ]. In addition, offering resources for safer injection practices, naloxone prescriptions, and low-barrier MOUD is a well-documented harm reduction technique that might benefit this high-risk patient population [ 12 ].…”

A case report of Nocardia spp. infective endocarditis in an injection drug user

“…Notably, the only risk factor observed in this patient was IDU, which has been reported in only two other cases [ 20 , 24 ]. Certain practices, such as needle sharing, licking, washing and nonsterile injection methods, may increase the risk of infections from environmental pathogens [ 25 ]. It is important to emphasize and educate patients about sterile practices to prevent severe infection.…”

Acute Limb Ischemia Caused by Inadvertent Arterial Drug Self-Injection: A Case Report

“…For patients who may not be interested in or able to fully discontinue injection drug use, it is also useful for providers to be aware of various evidence-based harm reduction services such as SSPs (available in many states) and safer injection/consumption facilities (SCFs). Overdose prevention strategies can include prescription of naloxone and use of fentanyl testing strips [ 14 ].…”