Characteristics associated with motivation to stop substance use and improve skin and needle hygiene among hospitalized patients who inject drugs

Abstract

Background: Hospitalizations for people who inject drugs (PWID) are opportunities to address substance use. However, little is known about hospitalized PWIDs’ motivation to stop substance use or improve skin and needle hygiene, common means for reducing injection sequelae. Methods: We used baseline data from a randomized controlled trial of a behavioral intervention to improve skin and needle hygiene among 252 hospitalized PWID between January 2014 and June 2018. We examined motivation (scale 1-10) to stop substance use, use new needles, and clean skin and used multiple linear regression models to evaluate characteristics associated with these outcomes. Results: PWID were recruited during injection-related (154, 61.1%) and non-injection-related hospitalizations (98, 38.9%). Motivation to stop substance use was 7.11 (SD = 2.67), use new needles was 7.8 (SD = 1.9), and clean skin was 6.7 (SD = 2.3). In adjusted models, experiencing an injection-related hospitalization was not significantly associated (p > 0.05) with motivation to stop substance use (β = −0.76, SE = 0.299), use new needles (β = 0.301, SE = 0.255), or clean skin (β = 0.476, SE = 0.323). Number of past-year skin and soft tissue infections was negatively associated with motivation to use new needles (β = −0.109, SE = 0.049, p < 0.05) and clean skin (β = −0.131, SE = 0.062, p < 0.05). Greater opioid withdrawal was associated with lower motivation to use new needles (β = −0.275, SE = 0.92, p < 0.01). Conclusions: Among hospitalized PWID, motivation to stop substance use and improve skin and needle hygiene was moderately high, but injection-related hospitalizations were not associated with greater motivation. Efforts to reduce injection sequelae for all hospitalized PWID are needed.

Keywords:

• Injection drug use
• hospital interventions
• motivation
• skin and needle hygiene

Author contributions

SDK: study design and conception, interpretation of data, drafting and revising manuscript.

KTP: study design and conception, data acquisition and interpretation, revising manuscript.

BJA: study design and conception, data management, analysis, and interpretation, revising manuscript.

MDS: grant funding, study design and conception, data acquisition, management, analysis and interpretation, revising manuscript.

Disclosure statement

Dr. Kimmel has served as a consultant for Abt Associates on Massachusetts Department of Public Health funded project to integrate medications for opioid use disorder into skilled nursing facilities and for the American Academy of Addiction Psychiatry as part of the Opioid Response Network. Dr. Stein has served on grant review committees for Alkermes, Inc.

Additional information

Funding

Dr. Kimmel reports support from National Institute on Drug Abuse (NIDA) [1K23DA054363] and [5R01DA034957]. Dr. Stein reports support from NIDA [R01DA034952]. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.