An Evaluation of the Health Impact of Injecting Drug Use on Acute Secondary Care Services: The East of Scotland Experience

Author: Caitlin Macleod Hannah O'Neill Murray Flett Graeme Guthrie Andrew Radley John Nagy Stuart Suttie

Theme: Clinical Research Year: 2022

Scotland is “Drug deaths capital of Europe”, and potentially the world, constituting a public health
emergency. Belying this mortality is morbidity. People who inject drugs (PWID) are at risk of a plethora
of injecting-related morbidities, including skin and soft tissue infections, with potential complex
collections, perivascular soft tissue sepsis and vascular injuries such as infected pseudoaneurysms.
This study aimed to characterise hospital admissions for limb-related complications secondary to
injecting drug use to enable better comprehension of the patterns and presentations of injecting
injuries, and overall help to define, target and deliver effective harm reduction strategies.

Retrospective data collection between December 2011-December 2020. Patients were identified
through discharge codes and a prospective operative unit database. Demographic and admission
details were extracted from electronic records and a database created. Two diagnoses could be
recorded for each admission, reflecting the realities of clinical practice. Descriptive statistical analyses
were performed.

There were 805 admissions for 445 patients (1-10 admissions/patient): mean age 37.5 (21.2-61.5)
years and 488 (60.6%; 277 patients, 61.9%) were male. Admissions were generated by: 333 groin
abscesses; 75 other abscesses; 109 pseudoaneurysms; 126 necrotising soft tissue infections (NSTI);
137 cellulitis cases; 168 deep venous thromboses (DVT); 59 infected DVTs and 138 other pathologies.
Overall 570 (70.8%) admissions were cared for by surgical specialities, with most, 412, under vascular
surgery. Surgery was required for 409 admissions (50.8%), with 534 operations performed (1-
7/admission). There were 31 lower limb amputations. During follow-up 97 (21.8%) patients died,
mean age 43.6 (26.8-62.8).

There is a high burden of limb-related morbidity secondary to injecting drug use requiring acute
secondary care services. These limb-related complications can threaten both life and limb, often
reflecting complex, high-tariff pathology with substantial emergency healthcare needs. These patients
are high risk for further morbidity and early mortality and should be targeted for harm reduction.

Disclosure of Interest Statement: None.

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