Transcript Syringe Exchange in Cincinnati

INJECTION DRUG USE IN
METROPOLITAN
CINCINNATI
Judith Feinberg, MD
Professor of Medicine
University of Cincinnati College of Medicine
November 12, 2012
Disclosures
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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
78
80
70
62
Admissions for IE
60
60
57
50
50
40
30
61
51
36
31
27
29
20
10
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Heroin submissions
(Percent of total submission of elicit drugs)
1400
Hamilton County* Coroners Crime Lab Heroin
Submissions
19%
1200
10.7%
1000
800
6.5%
600
400
200
4.4% 4.6%
3.7%
3.1% 3.3%
4.3%
3.1%
2.5%
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
*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
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Hospital costs* for 3 representative UH admissions
* does not include physician charges or 5-7 week stay in SNF for IV antibiotics
Case
Demographics
13 day hospitalization cost:
Age, race, sex
IVDU
HCV
HIV
Insurance
$85,643
59 year old black male
Yes
Yes
No
None (Medicaid pending)
20 day hospitalization cost (AVR):
Age, race, sex
IVDU
HCV
HIV
Insurance
$173,753
47 year old black male
Yes
Yes
No
Molina (Medicaid)
17 day hospitalization cost (AVR):
Age, race, sex
IVDU
HCV
HIV
Insurance
$267,037
47 year old white male
Yes
Yes
No
None (Medicaid pending)
Who is at greatest risk for
encountering used syringes?
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First Responders
 Police
 Firemen
 EMTs
Sanitation workers
 Parks & recreation workers
 Children
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Health Risks for First Responders
HIV
 Acute & chronic hepatitis C (HCV)
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 Chronic
HCV #1 reason for liver transplantation in
the U.S.
Acute & chronic hepatitis B (HBV)
 HIV plus chronic HCV and/or chronic HBV coinfection
 Infections at puncture site (cellulitis, abscesses)
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Health Risks for IDUs
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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
Spontaneous
Resolution
15%
(15%)
Chronic
Infection
Chronic
(85%)
85%
Alter MJ, et al. N Eng J Med. 1999;341:556-562.
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
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Cincinnati IDU Survey Data
Gender
Female
Male
Race
Cincinnati IDU Survey Data
Age
35-44 yrs.
25-34 yrs.
19-24 yrs.
13-18 yrs.
Cincinnati IDU Survey Data
Age at first use of IV and other drugs
Percentage
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Age
Cincinnati IDU Survey Data
69/101 (68%) reported finding used/dirty syringes
Cincinnati IDU Survey Data
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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
Lower
Price Hill
Fairview
Fairview
Outside Daycare Center, near UC
Daycare Center Backyard, near UC
Syringe Exchange Programs (SEPs)
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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
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“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”)
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“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