Homelessness increases risk of infection for injecting drug users

A new report from the Health Protection Agency shows that around three-quarters of injecting drug users (IDUs) have been homeless at some point. In addition, those who have been homeless have higher levels of injecting risk and associated infections, primarily through the sharing of needles and low standards of hygiene.

The report, ‘Shooting Up: Infections Among Injecting Drug Users in the UK', suggests that homeless people who inject drugs are more likely to share needles and syringes: One in four IDUs who reported being homeless in the past year said that they had shared needles and syringes in the last month, compared with one in six who had not been homeless. Sharing needles seriously increases the risk of getting life threatening infections such as hepatitis C and HIV.

IDUs are also more likely to develop abcesses, wounds and bacterial infections such as MRSA. Increasing numbers of IDUs inject in the groin and inject crack-cocaine, which both carry a higher risk of infection.

Almost half of IDUs are infected with hepatitis C, and one in four has been exposed to hepatitis B. However, the number of IDUs in contact with drug services has increased noticeably in recent years and hepatitis B vaccination uptake has risen, with two-thirds of all IDUs reporting taking at least one vaccine dose. Overall one in 75 IDUs in the UK has HIV. In London however, one in every 20 IDUs is infected with HIV.

Dr Fortune Ncube , one of the Agency's experts in blood borne viruses, who compiled the report said: “Injecting drug users who are also homeless are likely to find it harder to maintain hygienic injection practices as a result of having to inject in public places or having difficulty in storing injecting equipment somewhere clean. Injecting drug users in this situation are more susceptible to contracting severe life-threatening infections, as are those IDUs who inject into the groin or inject crack cocaine.

“The recent increase in infections among IDUs indicates a need to re-examine the scope and range of harm reduction services provided for IDUs. Although a lot of work has been done in response to this, such as recent NICE guidelines and National Clinical Guidelines, much more is still needed to bring the levels of infection down.”

Notes:

1. To see the full report please go to http://www.hpa.org.uk/publications/PublicationDisplay.asp?PublicationID=105
2. For further information, contact the Health Protection Agency, Colindale press office on 020 8327 6690/7097/6055/7098.
3. A recent estimate of the numbers of injecting drug users in the UK suggests 140,000 injectors of heroin and crack-cocaine in England , (0.42% in the 15-64 age group).
4. IDUs' experience very high levels of infection, up to 80% of those acquiring hepatitis C develop chronic infection and are at risk from developing cirrhosis and liver cancer.
5. Between 1992 and 2006 there were 62,424 laboratory reported diagnoses in England ; 90% of these diagnoses gave injecting drug use as the route of infection.
6. Transmission of both hepatitis B and hepatitis A continues among IDUs even though there is an effective vaccine for both conditions, proportional uptake of hepatitis B vaccination has increased markedly in recent years.
7. IDUs are members of wider communities and infection among this group may have impact on other community members such as family members, sexual partners and healthcare workers.
8. ‘Shooting Up: Infections Among Injecting Drug Users in the United Kingdom 2006' has been produced in collaboration with Health Protection Scotland, National Public Health Service for Wales , Communicable Disease Surveillance Centre Northern Ireland , and Centre for Research on Drugs & Health Behaviour, London School of Hygiene and Tropical Medicine. The report incorporates data from the Agency's Unlinked Anonymous Prevalence Monitoring Programme (UAPMP) together with laboratory reports of infections and data from cohort studies in IDUs. The Unlinked Anonymous Prevalence Monitoring Programme's (UAPMP) aims to measure the distribution of infection in sub-groups of the adult population, monitor HIV, hepatitis B and hepatitis C in those injectors in contact with specialist services, such as needle exchanges, or on treatment programmes, such as methadone maintenance.
9. For current advice on the immunisation of injecting drug users please refer to The 'Green book' via www.immunisation.nhs.uk .

http://www.hpa.org.uk