NEW RESEARCH – VALID MEASURE OF A WORSENING OPIOID CRISIS: INJECTION RELATED DISEASE
Unlike changes in opioid overdose deaths and nonlethal ODs historically and increasingly confounded by reported and unreported naloxone reversals, injection-related infectious disease is directly tied to high-risk use, measuring a worsening crisis.
by Clark Miller
Published September 20, 2024
Incidence of injection-related infectious diseases tied to high-risk opioid use – by intravenous injection – has been surging steadily over decades, with data pointing to continuously mounting cases as recent as for 2022.
A newly published study does not provide more recent incidence data, does include data that reinforces the importance of injection-related disease incidence as a valid measure of high-risk opioid use and data that reinforce the established effects and role of American Medicine’s gold standard opioid treatments.
Published in JAMA and reported on in MEDPAGETODAY,
The subhead, that
“These high reinfection rates indicate treatment has reached highest-risk population”,
is certainly one angle that could be taken regarding the results.
Let’s explore additional angles.
From that report –
The secondary analysis, conducted in 2022, included 415 participants from the original trial with sustained virologic response after treatment with direct-acting antiviral therapy. Mean age was 44.7, and 72.8% were men. Overall, 72.8% reported recent injection drug use, 46.3% were living in unstable housing, and 75.4% had received recent methadone or buprenorphine for opioid use disorder.
That is to say, of individuals successfully treated for Hep C (with sustained virologic response) and became reinfected at high rates via high-risk opioid use (by injection), about 3 of every 4 were engaging in injection opioid use and were engaged in gold standard treatment for opioid use disorder by provision of methadone or buprenorphine.
And
In addition, many of the participants lost to follow-up had characteristics associated with higher risk for reinfection, such as use of methadone for opioid use disorder. “Although the number of patients lost to follow-up was small, this overlap in characteristics suggests that patients who were lost to follow-up represented a cohort with higher-risk behaviors, potentially resulting in an underestimation of true reinfection rates,” they explained.
That is to say, the presented reinfection rates due to high-risk opioid use are almost certainly underestimates due to subjects lost to follow-up.
Those observations of course reinforce what is established for American expert treatment approaches for problem opioid use and the worsening crisis: rather than benefit or harm reduction they fuel worsening levels of dependence, high-risk use, and deaths. Established and most recently reaffirmed unequivocally by the largest ever study of its type conducted by NIH.
Here’s the research piece in JAMA –
Takeaways
Incidence of opioid injection-related infectious disease has increased over past decades and years
Use by injection represents high-risk use, and its persistent increase in incidence is a direct measure of a worsening opioid crisis, not confounded, like overdose deaths, by the increasingly moderating effects on OD deaths of Narcan reversals. And not confounded, like nonfatal overdoses, by increasing frequency of unreported overdoses (high-risk use) reversed by naloxone in communities without contact with emergency responders – increasingly unreported due to successful campaigns to equip high-risk opioid users, associates, and others in communities with Narcan.
That distinction and value of valid measures of changes in severity of the crisis are highlighted and heightened by medical and media distorted portrayals of small decreases in opioid overdose deaths as representing gains against the epidemic of high-risk opioid use.
