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. 2016 Jun 1:163:126-33.
doi: 10.1016/j.drugalcdep.2016.04.009. Epub 2016 Apr 14.

Nationwide increase in hospitalizations for heroin-related soft tissue infections: Associations with structural market conditions

Daniel Ciccarone  1 , George Jay Unick  2 , Jenny K Cohen  3 , Sarah G Mars  4 , Daniel Rosenblum  5
Affiliations

Nationwide increase in hospitalizations for heroin-related soft tissue infections: Associations with structural market conditions

Daniel Ciccarone et al. Drug Alcohol Depend. .

Abstract

Introduction: Little is known about trends in national rates of injection-related skin and soft tissue infections (SSTI) and their relationship to the structural risk environment for heroin users. Use of Mexican-sourced "Black Tar" heroin, predominant in western US states, may have greater risk for SSTI compared with eastern US powder heroin (Colombian-sourced) due to its association with non-intravenous injection or from possible contamination.

Methods: Using nationally representative hospital admissions data from the Nationwide Inpatient Sample and heroin price and purity data from the Drug Enforcement Administration, we looked at rates of hospital admissions for opiate-related SSTI (O-SSTI) between 1993 and 2010. Regression analyses examined associations between O-SSTI and heroin source, form and price.

Results: Hospitalization rates of O-SSTI doubled from 4 to 9 per 100,000 nationally between 1993 and 2010; the increase concentrated among individuals aged 20-40. Heroin market features were strongly associated with changes in the rate of SSTI. Each $100 increase in yearly heroin price-per-gram-pure was associated with a 3% decrease in the rate of heroin-related SSTI admissions. Mexican-sourced-heroin-dominant cities had twice the rate of O-SSTI compared to Colombian-sourced-heroin-dominant cities.

Discussion: Heroin-related SSTI are increasing and structural factors, including heroin price and source-form, are associated with higher rates of SSTI hospital admissions. Clinical and harm reduction efforts should educate heroin users on local risk factors, e.g., heroin type, promote vein health strategies and provide culturally sensitive treatment services for persons suffering with SSTI.

Keywords: Black tar heroin; Drug markets; Heroin; Injection drug use; Soft tissue infection; Structural risk environment.

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Conflict of interest statement

Conflicts of Interest

No conflict declared by any of the authors

Figures

Figure 1
Figure 1
Figure 1a. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 Figure 1b. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Race Figure 1c. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Age Figure 1d. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Region
Figure 1
Figure 1
Figure 1a. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 Figure 1b. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Race Figure 1c. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Age Figure 1d. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Region
Figure 1
Figure 1
Figure 1a. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 Figure 1b. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Race Figure 1c. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Age Figure 1d. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Region
Figure 1
Figure 1
Figure 1a. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 Figure 1b. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Race Figure 1c. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Age Figure 1d. Rate of Opiate-related SSTI Hospitalizations between 1993 and 2010 by Region
Figure 2
Figure 2
Rates of Opiate-related SSTI over all Opiate Hospitalizations by MSA
Figure 3
Figure 3
Negative Binomial Regression of Hospital Opiate-related SSTI Yearly Counts
See this image and copyright information in PMC

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