Understanding and preventing serious bacterial and fungal infections among people who inject drugs

People who inject drugs face extremely high rates of death and disability from severe and invasive bacterial and fungal infections (including infections of the bloodstream, heart valves, and bones) that require hospital admission for treatment with antibiotics and/or surgeries. These infections are devastating for individual patients, and also extremely costly for our health care system. So how can people who inject drugs, and health systems who care for them, prevent these serious infections from occurring? Unfortunately we don't have scientific evidence to inform us. One promising approach to reducing risk in opioid-injectors is medication treatment for opioid addiction (with methadone or buprenorphine) as this helps people to inject less frequency. However risk for serious infections likely reflects multiple factors, including homelessness, use of stimulants or alcohol, and individual injecting practices. Based at the Collaborative Centre for Inclusion Health (CCIH) at University College London, my Fellowship project aims to inform people who inject drugs, clinicians, and health systems on how to prevent serious bacterial and fungal infections. We will analyze a unique large dataset from South London that contains anonymous health records for anyone who has ever been to addiction treatment, linked to their hospital records. We'll assess whether methadone or buprenorphine treatment is associated with decreased risk of infection-related hospitalization or death in people who inject opioids. We'll also assess what other factors are associated with risk (including homelessness, sex work, injecting practices, stimulant or alcohol use), and see whether these change the effectiveness of methadone or buprenorphine. We'll collaborate with groups of people who use drugs in London, UK, and Halifax, Canada to help refine our analysis plan and determine what risk factors may be most important.