Injecting Drug Users Face Increasing Risk Of Bacterial Infections
One-third of injecting drug users have reported having an abcess, sore or open wound at sites of injection - bacterial infections that are thought to cost the NHS around £47million a year. Recent changes in drug taking such as the increase in people taking crack cocaine, has helped fuel an increase in bacterial infections among drug users.
Crack cocaine users can inject many times a day at various sites on the body. This increases the risk of infection, as does injecting into the groin which has become increasingly common among injecting drug users. Poor hygiene and dirty injecting equipment cause the bacterial infection; which are easily preventable if the injection site is cleaned before using a sterile needle.
These insights into the infection risks among injecting drug users are presented in 'Shooting Up', the Health Protection Agency's annual report examining infections among injecting drug users in the UK.
The report found:
* Bacterial infections seen among injecting drug users range from localised site infections through to invasive disease, and include: Staphylococcus aureus (including community associated MRSA), Severe Group A streptococci, wound botulism and tetanus. Severity can vary from minor skin infections to life threatening bacteraemia.
* HIV infections among injecting drug users remain relatively uncommon in the UK probably as a result of prompt community and public health responses. The overall prevalence of HIV seen among injecting drug users in 2007 was similar to that seen in recent years, with around one in 90 infected overall in England and Wales. Within London this increases to one in 20 while outside London, around one in 150 are infected.
* hepatitis C, the blood borne virus which can lead to cirrhosis and liver cancer. Prevalence also varies according to sub-groups of injecting drug users - those injecting crack-cocaine or cocaine are more likely to have hepatitis C, as are those who inject drugs into their groin.
* Encouraging results were noted in terms of an increase in uptake of hepatitis B vaccine. Uptake has increased from 25% ten years ago to 66% in 2007. However, transmission continues and one in six injecting drug users are thought to be infected.
* High numbers of current and former injecting drug users have reported making use of needle exchange services, with more than 90% of injecting drug users in England, Wales and Northern Ireland reporting access to these services at some point. The sharing of needles and syringes (direct sharing) is a key route by which infections may be transmitted among injecting drug users. Results of a 2007 survey showed that 23% of injecting drug users reported sharing in the four weeks before the survey, compared to the 34% who reported sharing in the same survey in 2002.
Dr Fortune Ncube, Consultant Epidemiologist at the Health Protection Agency and one of the report's authors said:
"Injecting drug users are vulnerable to a wide range of infections which can result in high levels of illness and death. It is important that services to reduce injecting related harm continue and injecting drug users have access to the healthcare services they need. Needle exchange services are key to preventing these infections and the harm they cause.
"Further research needs to be done exploring the risk factors that impact on injecting risk behaviour, such as homelessness, groin injection and crack cocaine use and how these interact with one another.
"The majority of these infections are preventable. A vaccine is available against Hepatitis B and transmission of blood borne viruses like Hepatitis C and HIV are preventable with the use of clean syringes, and using sterile swabs correctly injecting equipment. These will also help stop bacterial infections from occurring. In addition, regular testing can identify the early stages of infectious diseases, resulting in more effective treatment."