Development of a Risk Reduction Intervention to Reduce Bacterial and Viral Infections for Injection Drug Users

Abstract

Bacterial infections are widespread problems among drug injectors, requiring novel preventive intervention. As part of a NIDA-funded study, we developed an intervention based on the Information-Motivation-Behavioral Skills model, past research, injection hygiene protocols, and data collected from focus groups with 32 injectors in Denver in 2009. Qualitative responses from focus groups indicated that most participants had experienced skin abscesses and believed that bacterial infections were commonly a result of drug cut, injecting intramuscularly, and reusing needles. Access to injection supplies and experiencing withdrawal were the most frequently reported barriers to utilizing risk reduction. Implications for intervention development are discussed.

RESUMEN

Desarrollo de una intervención de reducción de riesgos para disminuir infecciones bacterianas y virales en consumidores de drogas intravenosas

Las infecciones bacterianas son un problema muy extendido en los consumidores de drogas intravenosas que requiere una intervención preventiva novedosa. Como parte de un estudio fundado por NIDA, desarrollamos una intervención basada en el Modelo Información-Motivación-Habilidades Conductuales, investigaciones anteriores, protocolos de higiene para inyectarse y datos recogidos de grupos de enfoque con 32 consumidores en Denver en 2009. Las respuestas cualitativas de los grupos de enfoque indicaron que la mayoría de los participantes habían experimentado abscesos en la piel y pensaban que las infecciones bacterianas eran comunes debido a droga contaminada, las inyecciones intramusculares y la reutilización de agujas. La falta de acceso a las inyecciones y el retraimiento fueron las barreras que se indicaron más frecuentemente para utilizar la reducción de riesgos. Se tratan las implicaciones para el desarrollo de la intervención.

RÉSUMÉ

Développement d'une intervention de réduction du risque pour réduire les infections bactériennes et virales pour les utilisateurs de drogues injectables

Les infections bactériennes sont des problèmes très répandus parmi les consommateurs de drogues injectables, nécessitant une intervention préventive nouvelle. Dans le cadre d'une étude financée par le NIDA, nous avons développé une intervention basée sur le modèle des compétences Informations-Motivations-Comportementales, de recherches antérieures, de protocoles d'hygiène d'injection, et de données recueillies à partir de groupes de discussion avec 32 injecteurs à Denver en 2009. Les réponses qualitatives des groupes de discussion ont indiqué que la plupart des participants avaient subi des abcès de la peau et ont estimé que les infections bactériennes étaient généralement un résultat du coupage des drogues, de l'injection par voie intramusculaire, et de la réutilisation des aiguilles. L'accès à du matériel d'injection et l'expérience de sevrage ont été les obstacles les plus fréquemment rapportés à l'utilisation de réduction des risques. Des implications pour le développement d'intervention sont discutées.

Keywords :

• injection drug use
• bacterial infections
• intervention
• focus groups
• heroin
• qualitative research

THE AUTHORS

Jennifer K. Altman is a graduate student pursuing her Ph.D. in the Clinical Health Psychology program at the University of Colorado, Denver (UCD). Her broad research interests are in the area of behavioral health, and she has worked on numerous projects focused on HIV-related risk, behavior, and substance abuse treatment at Project Safe, part of the substance abuse division of the Department of Psychiatry at the University of Colorado Medical School, Colorado, USA. In addition, she has worked at the Veteran's Affairs Medical Center in Long Beach, California, USA, in the Neuroimaging and Addiction Research Laboratory. Her current research includes work on quality of life, survivorship, and substance abuse within the fields of psychosocial oncology, psychoneuroimmunology, and palliative care.

Karen F. Corsi, Sc.D., M.P.H., is a public health expert and associate professor of psychiatry at the University of Colorado School of Medicine, Colorado, USA. For more than 15 years, she has devoted her career to evaluating the effectiveness of interventions designed to address various social problems. This work has mainly focused on interventions to prevent the spread of HIV among drug users. She is widely published in this area and has presented her work at numerous national and international conferences. Currently, she has a NIDA-sponsored grant focusing on interventions designed to decrease HIV risk behaviors and drug use among methamphetamine users, in addition to several other grants looking at treatment for heroin users, power among methamphetamine-using women, and the medical marijuana industry in Colorado.

Kristina Phillips, Ph.D., is an associate professor in the School of Psychological Sciences at the University of Northern Colorado (UNC), Colorado, USA. She is a clinical psychologist with a background in health psychology and substance abuse. Her primary research interests focus on medical consequences related to substance use and evaluating treatment outcome. She was recently the primary investigator on a NIDA-funded clinical trial that tested a risk reduction intervention for injection drug users in Denver. She is currently working on projects related to health problems associated with methamphetamine use and academic and psychological problems among university marijuana users using ecological momentary assessment.

Michael Stein, M.D., is a professor of Medicine, Health Policy & Practice at the Alpert Medical School of Brown University. Director of General Medicine Research, he has been a leader in the substance abuse research field since the early 1990s. He is a recipient of a NIDA Mid-Career Mentorship Award (K24) and has been principal investigator of more than 10 NIH-funded clinical trials involving substance-abusing populations over the past decade. He is currently working on projects related to buprenorphine treatment in primary care, marijuana and sleep, linking hospitalized opioid users to outpatient buprenorphine care, and risk-taking among emerging adults. An internist, he is an associate director for health services of the Brown University AIDS Program.

GLOSSARY

• Black tar heroin: A crude, gummy form of heroin produced in Mexico and found most commonly in the western United States.

• Dope: Slang reference for heroin.

• Information-Motivation-Behavioral Skills model: A theoretical model proposed by Fisher & Fisher (1992) that explains risk reduction behavior through three major determinants: (1) information or knowledge of transmission and prevention, (2) motivation to reduce risk behavior, and (3) the mastery of behavioral skills necessary to perform preventive skills.

• Intramuscular injection: Injecting a drug into the muscle.

• Methicillin-resistant Staphylococcus aureus (MRSA): A form of staph bacteria that is resistant to commonly used antibiotics.

• Speedball: A combination of heroin and cocaine that is typically injected.

• Subcutaneous injection: Injecting a drug in the fatty layer of tissue just underneath the skin.