The Heroin Epidemic in America: A Surgeon's Perspective

Bauman, Zachary M.; Morizio, Kate; Singer, Matthew M.; Hood, Courtney R; Feliciano, David V.; Vercruysse, Gary

doi:10.1089/sur.2019.004

Cited by 5 publications

(3 citation statements)

References 82 publications

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“…Attention has been drawn to neglect of political and policy interest into the causes and solutions for skin and soft tissue infections and the importance of supportive interventions such as safe injecting environments [62]. The rapid rise in opiate use and overdose in the United States and the inadequate response to this 'epidemic' has contributed to an increase in use of illegal opioids, injecting and subsequent sepsis complications [74][75][76]. The impact of HIV/AIDS and hepatitis C infection has had a significant effect on injection practices and the delivery of services for PWID, highlighting the importance of harm reduction [77].…”

Section: Other Considerations Relating To Assessment and Managementmentioning

confidence: 99%

Injecting drug use, the skin and vasculature

2020

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Damage to the skin, subcutaneous tissues and blood vessels are among the most common health harms related to injecting drug use. From a limited range of early reports of injecting-related skin and soft tissue damage there is now an increasing literature relating to new drugs, new contaminants and problems associated with unsafe injection practices. Clinical issues range from ubiquitous problems associated with repeated minor localised injection trauma to skin and soft tissue and infections around injection sites, to systemic blood infections and chronic vascular disease. The interplay of limited availability and access to sterile injecting equipment, poor injecting technique, compromised drug purity, drug toxicity and difficult personal and environmental conditions give rise to injection-related health harms. This review of injecting-related skin, soft tissue and vascular damage focuses on epidemiology and causation, clinical examination and investigation, treatment and prevention.

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Section: Other Considerations Relating To Assessment and Managementmentioning

confidence: 99%

Injecting drug use, the skin and vasculature

2020

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“…Deaths from opioid overdose increased by 30% between 2010 and 2015 [1]. More than 64,000 Americans died from drug overdoses in 2016 alonean increase of more than 20% over the previous year [2,3].…”

mentioning

confidence: 99%

“…By breaching cutaneous host defenses and creating a portal of entry, injection drug use may introduce bacteria into soft tissues, increasing the risk for NSTI [7]. Further, many heroin users will resort to ''skin popping'' of potentially infected injection sites leading to vascular sclerosis and a microenvironment of warmth and hypoxia that allows NSTI to progress unabated [3].…”

mentioning

confidence: 99%

Recurrent Necrotizing Soft Tissue Infections with Atypical Pathogens after Injection Drug Abuse: Another Manifestation of the Opioid Crisis

Narayan

Juprasert

Finn

et al. 2020

Surgical Infections

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Background: The United States is in the midst of an opioid crisis. Injection drug use is a major risk factor for necrotizing soft tissue infections (NSTI) by introducing bacteria into the soft tissues. Repetitive infection and atypical pathogens may be tangible manifestations of the opioid crisis. Methods: We describe recidivism in two cases of NSTI involving opioid abuse and atypical pathogens at a single institution and review pertinent international literature. Results: Repetitive NSTI is rare. Patients with chronic injection drug use, however, may be at particular risk of repetitive NSTI and infections with atypical organisms. Conclusions: Care providers must have a heightened awareness of infections with atypical pathogens and risk of repetitive infection in patients with injection drug use. Aggressive surgical management and antibiotic coverage tailored to culture and susceptibility data are necessary for a successful short-term outcome. A successful long-term outcome mandates identification and management of co-existent behavioral health issues.

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Crude Opium, Morphine, Codeine, and Heroin: Past and Present

Dasgupta

2020

Fighting the Opioid Epidemic

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The Heroin Epidemic in America: A Surgeon's Perspective

Cited by 5 publications

References 82 publications

Injecting drug use, the skin and vasculature

Injecting drug use, the skin and vasculature

Recurrent Necrotizing Soft Tissue Infections with Atypical Pathogens after Injection Drug Abuse: Another Manifestation of the Opioid Crisis

Crude Opium, Morphine, Codeine, and Heroin: Past and Present

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