Correlates of infectious complications of injection drug use among individuals who use drugs in Washington State: An analysis of the 2021 Washington State Syringe Exchange Health Survey

Objectives: Increased use of injection drugs across the United States has likely increased the burden of complications from abscess or skin infections, blood clots or blood infections, and infectious endocarditis (IE) among people who inject drugs (PWID). Among PWID who attended syringe services programs (SSPs) in Washington State, we assessed the prevalence of complications from injection drug use and examined factors that were associated with these outcomes. Methods: In 2021, interviewer-administered surveys were conducted among clients at 21 SSPs in Washington State. Descriptive statistics were used to summarize demographic characteristics and behavioral factors related to IDU. Multivariable logistic regression was used to separately assess the relationship between select demographic and behavioral factors and abscesses or skin infections and blood clots or blood infections. Results: Among 955 individuals who participated in the survey, 886 (92.8%) participants reported that they had injected any drug in the last three months. Of those who reported injection drug use in the last three months, 332 (37.5%) reported having abscess or skin infections, 55 (6.2%) reported having blood clots or blood infections, and 19 (2.1%) reported having IE. Factors associated with reporting an abscess or skin infections include: injecting every day of the week, injecting more than three times a day, sharing a syringe, using the same syringe more than once before disposing of it, participating in a methadone program and injecting drugs like goofball, speedball, heroin, and fentanyl. Factors associated with reporting a blood clot or blood infection include: injecting fentanyl, sharing a syringe, and using the same syringe more than once before disposing of it and receiving buprenorphine/suboxone treatment. Conclusions: Over one-third of PWID reported an abscess or skin infection in the last year and six percent reported a blood clot or blood infection. Sharing a syringe, injecting fentanyl, and reusing the same syringe in the past three months were the factors most strongly associated with both abscess or skin infections and blood clot or blood infections. Unhygienic injection practices among participants may have increased the prevalence of infectious complications suggesting the need for expanded syringe coverage and SSPs access to PWID in Washington State.