Table 1.
How people who Inject drugs differ from the general population represented In clinical trials for management of severe infections
| Characteristics of People Who Inject Drugs | Implications for Injection Drug Use- Associated Infections |
|---|---|
| Younger age and fewer comorbidities • Median age of IDU-endocarditis patients almost half that of non-IDU-associated endocarditis (33 vs 63 y)79 |
• More physiologic reserve to survive severe infections than older multimorbid patients80,81 • Less likely to experience life-threatening adverse events from antimicrobials82,83 • May be able to tolerate longer courses of riskier antimicrobials (such as trimethoprim-sulfamethoxazole) |
| More mental health disorders • 29% with depression, 22% have attempted suicide, and symptoms of post-traumatic stress disorder are common84 • Higher prevalence of substance-induced mood disorders, personality disorders, and anxiety disorders85,86 |
• Barriers to adhere to medical treatment plans • Drug interactions between psychoactive medications, illicit drugs, and antimicrobials |
| More chronic viral infections • Among PWID, global HIV prevalence is 18%, and in the United States it is 7%87,88 • More than 50% of PWID are antibodypositive for HCV and 9% have chronic hepatitis B virus infection88 |
• Immunodeficiency of advanced HIV increases the chances of both opportunistic and typical infections, as does chronic liver disease from HCV or HBV • Drug interactions between antiretroviral therapy (ART) and antimicrobials often used for the treatment of severe infections |
| Stigmatization by health care system • Many report experiences of dehumanization and discrimination89 • Experiences of trauma during prolonged hospitalization28 |
• Associated with delay in presenting for health care, self-treatment attempts, and seeking informal therapies from nonmedical personnel90,91 • Untreated withdrawal and undertreated pain fuel behaviors like leaving the hospital AMA (or early discharge) and in-hospital illicit drug use92,93 • Stigmatization of drug use may lead PWID to present with more advanced disease, creates barriers to completing care plans, and often results in early discharge without antimicrobials or follow-up30 |
| More social barriers to care • 60% report past-year homelessness94 • 74% uninsured, and 19% did not seek care from a medical provider within the last year95 |
• Difficulty adhering to medical treatment plans while homeless • Lack of access to follow-up medical care and difficulty paying for medications |