Podcast #191 - EM ID: How ID Meets IV

Infectious disease can become intertwined with illicit drug use for a variety of reasons.  HIV, hepatitis, and endocarditis are some of the common examples where drug use can lead someone to need help from an infectious disease specialist.  However, Patrick Bafuma interviewed Dr. Michael Silverman regarding some interesting research he did regarding how certain drugs were increasing the risk of serious infections.

Here are some of the interesting highlights from the podcast.  Please listen to the podcast for the full details.

• Oxycodone (immediate release) was removed in Canada due to its high abuse rate.
• Hydromorphone has been used particularly its "controlled release" form call Hydromorph Contin.
• There was a large outbreak in Dr. Silverman's area of HIV which prompted investigation.
  • Plenty of needles were present and IV drug users denied sharing needles.
  • However, Hydromorph Contin requires a more advanced approach to be used IV compared to its immediate release counterparts including some unique heating.
• Part of the process is to "wash" the drug which allows the user to obtain about half of the drug.
  • The wash process is not used for immediate release drugs as it is not needed to get the product.
  • To help remove the large particulate matter, filters are used after the wash process.
• The filters are shared and used needles are often used for mixing of the contents.
  • Those who shared washes are at 22 times greater risk to contract HIV.
• Cellulose found in controlled release opioids found to keep HIV "alive" for three days (much longer than immediate release).
  • Also, cellulose and other ingredients essentially create a blood agar for Staphylococcus aureus to grow significantly.
  • 14% of patients injecting that were tested had the bacteria in their drug paraphernalia. 
• Simply "cooking" (boiling) the water used during the wash reduce risk by 99% both for HIV and Staphylococcus aureus without effecting the drug (which was a myth that concerned IV users).
  • Major education to help share this information helped reduce the number of cases and save lives.
• Those prescribing opioids in patients with concern for IV drug use also switched to immediate release medications which also potentially helped.

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