Epidemiology
Which age range has the highest prevalence of injection drug use?
18-25
What is the name of the common critical rescue drug for opioid overdose?
Naloxone (Narcan)
HIV and HCV
Screened at least annually
What is the most common cardiac complication in PWID?
Infective endocarditis (most commonly right sided heart valves like tricuspid)
Which drugs are most commonly injected?
Opioids and methamphetamine (also cocaine and ketamine)
What medication is first line for opioid use disorder?
Buprenorphine (Naltrexone is second line)
Combo is Suboxone
Which two infections should only be screened for initially, then based on clinical judgment following?
TB, HBV
What system is afflicted most commonly as a complication of injection drug use?
Skin (abscesses, cellulitis, septic thrombophlebitis)
What is one of the highest risk environmental factors for opioid use disorder?
Family history
What are the most common formulations of naloxone?
Intranasal, intramuscular, autoinjector
Which vaccinations should be offered for PWID?
Hep A, Hep B if no evidence of immunity, Tetanus when appropriate
PWID presents to ED with fever, abdominal pain, left shoulder pain (Kehr sign). What common complication is likely afflicting this patient?
Splenic abscess
About how many people in the US have ever used injection drugs?
~6.5 million
What common medications are used for withdrawal side effects?
Ondansetron, loperamide, trazodone, prochlorperazine, doxepin
Off-label clonidine and lofexidine
Name some safe injection practices that should be addressed with patients who are not ready to or cannot discontinue injection drug use?
Never reuse or share syringes.
Use new/sterile syringes from reliable sources.
Use clean water and new/disinfected preparation equipment.
Use an alcohol swab to clean the injection site.
Dispose of syringes after a single use
BTW Ohio has SSP which are programs for safe needle exchange
What MSK complication is most common among PWID?
Osteomyelitis
How many people in the US report CURRENTLY using injection drugs?
What is the mechanism of action of buprenorphine?
Partial agonist at mu-opioid receptors?
What are the eligibility criteria for PrEP?
Negative HIV test, no signs of acute HIV infection, normal creatinine clearance, and appropriate hepatitis B status (immunity)
A 32-year-old man who injects heroin presents to the emergency department with 3 months of progressive shortness of breath and a persistent dry cough. He reports injecting crushed tablets intravenously several times per week. He denies fever, chills, or recent respiratory infection.
On examination, he is afebrile. Oxygen saturation is 93% on room air. Lung examination reveals faint bilateral crackles. There are multiple healed injection sites and areas of hyperpigmentation on his forearms.
A chest CT demonstrates multiple small, centrilobular pulmonary nodules with a diffuse pattern of micronodules. Infectious evaluation, including testing for tuberculosis, is unrevealing. Diagnosis?
Foreign body granulomatosis