Investigators

Dhanya Malandkar


Supervisors

Professor Paul Dietze, Doctor Mark Stoové


Background

In 2008, it was estimated that 15.9 million people injected drugs across the world, of whom around 150,000 were Australian. [1] People who inject drugs (PWID) experience significant comorbidities associated with their drug use, but also their background circumstances. For example 68% of a sample of PWID reported depression and 38% reported anxiety.[2] PWID also experience problems related to the injecting practice itself  including blood borne viruses (BBV) such as Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV), and a range of non-BBV harms, such as skin infections, wounds, lacerations and contusions, and substance use related overdose. [3, 4, 5]  Around half of PWID surveyed as part of the Illicit Drug Reporting System report having overdosed at some point in their lives. [6]

Morbidity related to injecting drug use often results in the use of emergency services. It is known that heroin-related emergency care admissions increased between 2008 and 2009. [7] Overseas studies have found that certain illicit drug use, positive HIV status, more frequent injecting, recent trauma, poor access to primary care, difficulties in attending set appointments, and poor relationships between healthcare providers and PWID are all related to increased use of emergency care. [3, 5, 6, 8] However, these issues have not been explored in detail in the Australian context, with most research focused on issues such as blood borne virus transmission.


Aims

The broad objectives of this research are to:

·  Explore health service utilisation patterns of PWID and associated morbidity/mortality outcomes

·  Examine barriers and enablers to health service utilization by PWID

·  Evaluate risks and protective factors associated with health and wellbeing outcomes in PWID


Methods

research will involve two main studies and will be based on analyses of the Melbourne Injecting Drug User Cohort Study (MIX). [9] This longitudinal cohort study aims to understand health and social outcomes among 18-30 year old PWID. Over 700 injectors were recruited into MIX between November 2008 and February 2010.

Study 1: Self-reported health service utilisation.

Patterns of health service utilisation will be examined in the MIX cohort using baseline data that will be further explored longitudinally with follow-up data. Links to outcomes such as mental health and quality of life will be a key focus.

Study 2: Health service utilisation using data linkage.

The Victorian Data Linkages (VDL) unit undertakes linkages for researchers using the key datasets of the Victorian Admitted Episodes Dataset (VAED) and the Victorian Emergency Minimum Dataset (VEMD). These will be examined first to determine the accuracy of the self-report data examined in Study 1, and then examined in more detail in a longitudinal frame to examine predictors of key health outcomes such as repeated emergency department presentation.

Overall, these two studies will enable an examination of the:

1.  Types of health services accessed

2.  Morbidities and co-morbidities

3.  Emergency department and hospitalisation trends

4.  Outcomes associated with accessing health care services

5.  Other related outcomes

Finally, the feasibility of developing and piloting a project based on the results of this study will be explored. Potential interventions include working with emergency department staff to better respond to the needs of PWID.


Significance

This research will allow an understanding of ‘push’ and ‘pull’ factors associated with PWID accessing health care services, the relationship between the public healthcare system and PWID, and factors relating to morbidity and mortality in PWID. The study will provide better insight into harm reduction strategies within the Australian healthcare system with a view to ultimately reduce the physical and mental burden faced by PWID, their families and communities, and healthcare providers.

References

1.  Mathers, BM., et al, Global Epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet, 2008. 372(9651):1733-1745.

2.  Maher, L., et al, Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia. Addiction, 2006. 1010(10):1499-1508.

3.  Kerr, T., et al, High rates of primary care and emergency department use among injection drug users in Vancouver. Public Health, 2004. 27(1):62-66

4.  Day, C., et al, The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia. BMC Public Health, 2005. 5: 84. Available at http://www.biomedcentral.com/1471-2458/5/84, accessed 26th January 2012.

5.  Wood, E., et al, Rationale for evaluation North America’s first medically supervised safer-injecting facility. The Lancet, 2004. Vol 4.

6.  Stafford, J. B., L. (2011). Australian Drug Trends 2010: Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trends Series no. 55. Sydney: National Drug and Alcohol Research Centre, University of New South Wales.

7.  Haynes, R., et al, Monograph No 6: Drug trends and crime tracking: relationships between indices of heroin, amphetamine and cannabis use and crime. Drug and Alcohol Office, 2010.

8.  Fairbairn, N., et al, Emergency department utilization among a cohort of HIV-positive injecting drugs users in a Canadian setting. Emergency Medicine, 2011.

9.  Horyniak, D., et al (under review): Recruitment and retention of a sample of people who inject drugs: baseline and 12-month follow-up results from the Melbourne Injecting Drug User Cohort Study (MIX). Centre for population health, Burnet Institute.


Timeline

2012

Contact

For more information relating to this project, please contact Dhanya Malandkar:


Collaborators

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