Infections and mortality among people who use drugs

Abstract

Bacterial and fungal infections associated with injection drug use are increasing substantially alongside trends in drug overdose deaths. Methadone and buprenorphine are two medications (MOUD) known to reduce opioid use disorder symptoms and modify underlying behaviors such as injection drug use, which are a driver of bacterial infections including skin and soft tissue infections (SSTI).The overall objective of this proposal is to expand the knowledge base concerning infection-related mortality and the potential effects of medications for opioid use disorder (MOUD) on infection-related outcomes. The project utilized an extensive dataset of public and private healthcare insurance claims linked with death certificate data for North Carolina residents during 2007 through 2018. The specific aims were to 1) examine the incidence and risk factors of bacterial and fungal infection-related mortality and drug overdose among people who use drugs, and 2) estimate the association between MOUD mortality among people with opioid use-associated skin and soft tissue infections. Bacterial and fungal infections and overdose were contributors to mortality among people with drug use diagnoses. Specifically, within the first year of follow up, overdose mortality incidence was 36 per 10,000 people (95% confidence interval: 33-40). Bacterial and fungal infection-associated mortality incidence was 16 per 10,000 people (95% confidence interval: 14-18). Bacterial and fungal infection-associated mortality was higher as age increased. In contrast, overdose mortality was higher among younger adults. People with opioid use-related skin or infections had a high risk of mortality, with 12 per every 100 people dying within the first 3 years after their initial SSI diagnosis. However, MOUD was associated with reductions in both mortality and hospitalization: for every 100 people on MOUD, there were 4 fewer deaths (95% confidence interval: 2 to 6) compared to what it would have been, had they not been on MOUD. However, few people were on MOUD (16% among the total population) following their infection diagnosis. While bacterial and fungal infections are contributors to mortality among people who use drugs, MOUD are one approach to improve the wellbeing among people who develop these infections.Doctor of Philosoph