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American Association for Hand Surgery

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Attitudes Towards Safe Injection Facilities Among People Who Inject Drugs Presenting for Treatment of Upper Extremity Infections.
Allison K Baergen, MD1, Jessica M Winter, MD2, Holly Black, MD2, Kaley Donaldson, MD2, Tom Jelic, MD, FRCPC2 and Leif Sigurdson, MD3, (1)University of Ottawa, Ottawa, ON, Canada, (2)University of Manitoba, Winnipeg, MB, Canada, (3)Section of Plastic Surgery, University of Manitoba, Winnipeg, MB, Canada

Introduction: North America is facing an increase in the use of injectable drugs and emergency department presentations of upper extremity infections are just the tip of the iceberg. People who inject drugs (PWID) presenting to emergency departments for treatment of upper extremity infections account for approximately 20% of all upper extremity infections. Multiple studies reveal that of all upper extremity infections presenting to emergency departments, PWID accounted for 80% of admissions. In 2003, North America's first supervised injection facility was opened in Vancouver, Canada. Despite evidence that safe injection facilities (SIF) allow for safer injection conditions and improved health education regarding aseptic injection techniques, SIF have yet to be embraced by other major North American cities. The perspectives of patients presenting with upper extremity infections associated with IVDU have not been specifically explored in the literature.
Materials & Methods: We administered a survey to PWID presenting to the emergency department with IV drug associated hand infections between April 2021 - April 2022. Patients were asked if they were interested in accessing a place where they could receive free, clean supplies for IVDU (in the context of living in a city that does not have a SIF). If patients expressed disinterest, a follow up question was asked to explore the reasons why not. The second component to our survey targeted emergency room physicians (ERPs). ERPs at the same institute were asked two questions; (1) Do you believe that SIFs could reduce the prevalence of injection drug associated hand infections? And (2) Do you believe that SIFs can reduce costs to the health care system?
Results: Initial survey results included responses from eleven PWID, 82% of which said they would use a SIF if available. Reasons for disinterest in a SIF included imminent plans to stop using IV drugs and already established use of convenient needle exchange programs. Twenty-five ERPs responded to the survey questions and 92% of these respondents agreed that establishment of SIFs could reduce prevalence of injection drug associated hand infections as well as health care system costs.
Conclusions: Preliminary results confirm interest in SIFs among PWID presenting to a Canadian emergency department with an upper extremity infection. Additionally, ERPs shared overwhelming support of SIFs and belief in the utility of such harm reduction strategies. We hope these responses will support advocacy work in implanting SIFs across Canada.


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