INJECTION DRUG USE IN METROPOLITAN CINCINNATI

Judith Feinberg, MDProfessor of MedicineUniversity of Cincinnati College of MedicineNovember 12, 2012

Disclosures

Advisory Board: Janssen, GlaxoSmithKline/ViiV & Merck

Shareholder: Pfizer (stock) Grant Recipient: Janssen, Tobira,

GSK/ViiV, Boehringer Ingelheim & Bristol Myers Squibb

Speakers Bureau: Janssen, Merck, BMS & GSK/ViiV

Endocarditis Admissions at University Hospital 1999-2009

*also includes Batavia, Blue Ash, Amberley, Butler County, Clermont County, Cleves, Madeira, Mariemont

UH Endocarditis Study, 1999-2009

2-fold increase in hospital admissions for endocarditis

4-fold increase in patients with chronic hepatitis C

6-fold increase in positive toxicology screens

reflects a sharp local increase in IDU, from 1999 to 2009

These rates underestimate the true numbers because most endocarditis patients were not tested

Case Demographics13 day hospitalization cost: Age, race, sex IVDU HCV HIV Insurance

$85,64359 year old black maleYesYesNoNone (Medicaid pending)

20 day hospitalization cost (AVR): Age, race, sex IVDU HCV HIV Insurance

$173,75347 year old black maleYesYesNoMolina (Medicaid)

17 day hospitalization cost (AVR): Age, race, sex IVDU HCV HIV Insurance

$267,03747 year old white maleYesYesNoNone (Medicaid pending)

Hospital costs* for 3 representative UH admissions* does not include physician charges or 5-7 week stay in SNF for IV antibiotics

Who is at greatest risk for encountering used

syringes? First Responders

Police Firemen EMTs

Sanitation workers Parks & recreation workers Children

Health Risks for First Responders

HIV Acute & chronic hepatitis C (HCV)

Chronic HCV #1 reason for liver transplantation in the U.S.

Acute & chronic hepatitis B (HBV) HIV plus chronic HCV and/or chronic

HBV co-infection Infections at puncture site (cellulitis,

abscesses)

Health Risks for IDUs

All of the infections listed for First Responders, plus..

Bloodborne bacterial infections Endocarditis (infection of lining of heart) Osteomyelitis (bone infection) Septic emboli, esp lung (infections that are

spread throughout the body by blood) Brain abscesses All of which require at least 6-8 weeks of

intravenous antibiotics, plus other interventions

Hepatitis C: Fate of Acute Infection

15%

Chronic85%

SpontaneousResolution

(15%)

Alter MJ, et al. N Eng J Med. 1999;341:556-562.

Chronic Infection

(85%)

Note: chronic hep C is the most common reason for liver transplantation in the U.S.

Cincinnati IDU Survey Data

N = 101 completed surveys 4 reported already being HIV+ 26 reported already being HCV+ All reported sexual behavior risk

factors in addition to drug use for HIV & HCV transmission or acquisition

Cincinnati IDU Survey Data

Gender Race

Male

Female

Cincinnati IDU Survey Data

Age

19-24 yrs.25-34 yrs.

35-44 yrs. 13-18 yrs.

Cincinnati IDU Survey Data

Age at first use of IV and other drugs

Age

Pe

rce

nta

ge

Cincinnati IDU Survey Data

69/101 (68%) reported finding used/dirty syringes

Cincinnati IDU Survey Data

39% reused found syringes, half without cleaning them (many used inadequate cleaning methods)

PLWHCV* by Zip Code, 2009

* people living with hepatitis C

Heroin Arrests by Zip Code, 2009

*

PLWHA* by Zip Code, 2009

* people living with HIV/AIDS

Location of Most Overdose Deaths, Metro Cincinnati

Lower Price HIll

LowerPrice Hill

Fairview

Fairview

Outside Daycare Center, near UC

Daycare Center Backyard, near UC

Syringe Exchange Programs (SEPs)

16 peer-reviewed scientific studies performed from 1996 to 2007 have shown that SEPs reduce the transmission of HIV, hepatitis B and hepatitis C

6 studies looked at the effect on substance abuse, and all found that this type of program does not promote substance abuse

8 studies also looked at drug treatment enrollment, and all found that SEPs increase enrollment in drug treatment programs

Why SEPs Work to Protect the Public

“one for one” exchange of sterile syringe for a dirty one gives street value to used syringes

IDUs will collect used syringes found in public places to turn in for clean ones

this helps ‘police’ public places and keep them needle-free…

…protecting first responders, other public workers, and children as well as IDUs themselves from chronic viral and serious bacterial infections

Services/Logistics of Proposed Cincinnati SEP (“Cincinnati Exchange

Project”) “one for one” program: a sterile syringe for a dirty one safer sex materials and bleach kits for appropriate

cleaning or used syringes naloxone kits for preventing fatal overdoses rapid tests for HIV, hepatitis C, and pregnancy abscess and wound care education linkage to medical care referrals to mental health services & drug treatment

programs CEP will utilize a customized RV, with rotating locations plan on 3 initial sites, based on our zip code data