Assessing the impact of a temporary class drug order on ethylphenidate-related infections among people who inject drugs in Lothian, Scotland: an interrupted time–series analysis

Alan Yeung, Amanda Weir, Hannah Austin, Kirsty Morrison, Donald Inverarity, Jim Sherval, Naomi Henderson, Shruti Joshi, Roisin Ure, Andrew McAuley

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Abstract

Background and Aims
In April 2015, the UK government enacted a temporary class drug order (TCDO) on ethylphenidate in response to reported harms associated with its use, in particular an outbreak of infections among people who inject drugs (PWID) in Lothian, Scotland. This study assesses the effect that the TCDO had on reducing the most common infections identified during the outbreak: Streptococcus pyogenes and Staphylococcus aureus.

Design
The outbreak was split into a pre-intervention period (35 weeks) and a post-intervention period (26 weeks) based around the date of the TCDO. Segmented negative binomial regression models were used to compare trends in weekly counts of infections between the pre- and post-intervention periods.

Setting and participants
PWID in the Lothian region of Scotland.

Measurements
Cases of S. pyogenes and S. aureus infections reported within the National Health Service, Lothian.

Findings
There were 251 S. pyogenes and/or S. aureus infections recorded among 211 PWID between February 2014 and December 2015: 171 infections in the pre-intervention period and 51 in the post-intervention period. Significant trend changes in weekly S. pyogenes and/or S. aureus infections following the TCDO were found [relative risk (RR) = 0.88, 95% confidence interval (CI) = 0.82–0.94]. PWID who self-reported using novel psychoactive substances (NPS) were at higher risk of acquiring these infections (RR = 1.81, 95% CI = 1.12–2.93), particularly when comparing the risk of infection with NPS use for a specific strain, S. pyogenes emm76.0, against the risk of infection with NPS use for S. pyogenes (emm types other than emm76.0) (RR = 3.49, 95% CI = 1.32–9.21).

Conclusions
The UK government's 2015 temporary class drug order on ethylphenidate was effective in reducing infections among people who inject drugs during an outbreak situation in Lothian, Scotland.
Original languageEnglish
Pages (from-to)1799-1807
Number of pages9
JournalAddiction
Volume112
Issue number10
Early online date11 Jul 2017
DOIs
Publication statusPublished - Oct 2017

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ethylphenidate
Scotland
Streptococcus pyogenes
Infection
Pharmaceutical Preparations
Disease Outbreaks
Staphylococcus aureus
Confidence Intervals

Keywords

  • class drug order
  • ethylphenidate
  • addiction

Cite this

Yeung, Alan ; Weir, Amanda ; Austin, Hannah ; Morrison, Kirsty ; Inverarity, Donald ; Sherval, Jim ; Henderson, Naomi ; Joshi, Shruti ; Ure, Roisin ; McAuley, Andrew. / Assessing the impact of a temporary class drug order on ethylphenidate-related infections among people who inject drugs in Lothian, Scotland: an interrupted time–series analysis. In: Addiction. 2017 ; Vol. 112, No. 10. pp. 1799-1807.
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title = "Assessing the impact of a temporary class drug order on ethylphenidate-related infections among people who inject drugs in Lothian, Scotland: an interrupted time–series analysis",
abstract = "Background and AimsIn April 2015, the UK government enacted a temporary class drug order (TCDO) on ethylphenidate in response to reported harms associated with its use, in particular an outbreak of infections among people who inject drugs (PWID) in Lothian, Scotland. This study assesses the effect that the TCDO had on reducing the most common infections identified during the outbreak: Streptococcus pyogenes and Staphylococcus aureus.DesignThe outbreak was split into a pre-intervention period (35 weeks) and a post-intervention period (26 weeks) based around the date of the TCDO. Segmented negative binomial regression models were used to compare trends in weekly counts of infections between the pre- and post-intervention periods.Setting and participantsPWID in the Lothian region of Scotland.MeasurementsCases of S. pyogenes and S. aureus infections reported within the National Health Service, Lothian.FindingsThere were 251 S. pyogenes and/or S. aureus infections recorded among 211 PWID between February 2014 and December 2015: 171 infections in the pre-intervention period and 51 in the post-intervention period. Significant trend changes in weekly S. pyogenes and/or S. aureus infections following the TCDO were found [relative risk (RR) = 0.88, 95{\%} confidence interval (CI) = 0.82–0.94]. PWID who self-reported using novel psychoactive substances (NPS) were at higher risk of acquiring these infections (RR = 1.81, 95{\%} CI = 1.12–2.93), particularly when comparing the risk of infection with NPS use for a specific strain, S. pyogenes emm76.0, against the risk of infection with NPS use for S. pyogenes (emm types other than emm76.0) (RR = 3.49, 95{\%} CI = 1.32–9.21).ConclusionsThe UK government's 2015 temporary class drug order on ethylphenidate was effective in reducing infections among people who inject drugs during an outbreak situation in Lothian, Scotland.",
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Assessing the impact of a temporary class drug order on ethylphenidate-related infections among people who inject drugs in Lothian, Scotland: an interrupted time–series analysis. / Yeung, Alan; Weir, Amanda; Austin, Hannah; Morrison, Kirsty; Inverarity, Donald; Sherval, Jim; Henderson, Naomi; Joshi, Shruti; Ure, Roisin; McAuley, Andrew.

In: Addiction, Vol. 112, No. 10, 10.2017, p. 1799-1807.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Assessing the impact of a temporary class drug order on ethylphenidate-related infections among people who inject drugs in Lothian, Scotland: an interrupted time–series analysis

AU - Yeung, Alan

AU - Weir, Amanda

AU - Austin, Hannah

AU - Morrison, Kirsty

AU - Inverarity, Donald

AU - Sherval, Jim

AU - Henderson, Naomi

AU - Joshi, Shruti

AU - Ure, Roisin

AU - McAuley, Andrew

N1 - Acceptance date from journal webpage AAM: 12m embargo

PY - 2017/10

Y1 - 2017/10

N2 - Background and AimsIn April 2015, the UK government enacted a temporary class drug order (TCDO) on ethylphenidate in response to reported harms associated with its use, in particular an outbreak of infections among people who inject drugs (PWID) in Lothian, Scotland. This study assesses the effect that the TCDO had on reducing the most common infections identified during the outbreak: Streptococcus pyogenes and Staphylococcus aureus.DesignThe outbreak was split into a pre-intervention period (35 weeks) and a post-intervention period (26 weeks) based around the date of the TCDO. Segmented negative binomial regression models were used to compare trends in weekly counts of infections between the pre- and post-intervention periods.Setting and participantsPWID in the Lothian region of Scotland.MeasurementsCases of S. pyogenes and S. aureus infections reported within the National Health Service, Lothian.FindingsThere were 251 S. pyogenes and/or S. aureus infections recorded among 211 PWID between February 2014 and December 2015: 171 infections in the pre-intervention period and 51 in the post-intervention period. Significant trend changes in weekly S. pyogenes and/or S. aureus infections following the TCDO were found [relative risk (RR) = 0.88, 95% confidence interval (CI) = 0.82–0.94]. PWID who self-reported using novel psychoactive substances (NPS) were at higher risk of acquiring these infections (RR = 1.81, 95% CI = 1.12–2.93), particularly when comparing the risk of infection with NPS use for a specific strain, S. pyogenes emm76.0, against the risk of infection with NPS use for S. pyogenes (emm types other than emm76.0) (RR = 3.49, 95% CI = 1.32–9.21).ConclusionsThe UK government's 2015 temporary class drug order on ethylphenidate was effective in reducing infections among people who inject drugs during an outbreak situation in Lothian, Scotland.

AB - Background and AimsIn April 2015, the UK government enacted a temporary class drug order (TCDO) on ethylphenidate in response to reported harms associated with its use, in particular an outbreak of infections among people who inject drugs (PWID) in Lothian, Scotland. This study assesses the effect that the TCDO had on reducing the most common infections identified during the outbreak: Streptococcus pyogenes and Staphylococcus aureus.DesignThe outbreak was split into a pre-intervention period (35 weeks) and a post-intervention period (26 weeks) based around the date of the TCDO. Segmented negative binomial regression models were used to compare trends in weekly counts of infections between the pre- and post-intervention periods.Setting and participantsPWID in the Lothian region of Scotland.MeasurementsCases of S. pyogenes and S. aureus infections reported within the National Health Service, Lothian.FindingsThere were 251 S. pyogenes and/or S. aureus infections recorded among 211 PWID between February 2014 and December 2015: 171 infections in the pre-intervention period and 51 in the post-intervention period. Significant trend changes in weekly S. pyogenes and/or S. aureus infections following the TCDO were found [relative risk (RR) = 0.88, 95% confidence interval (CI) = 0.82–0.94]. PWID who self-reported using novel psychoactive substances (NPS) were at higher risk of acquiring these infections (RR = 1.81, 95% CI = 1.12–2.93), particularly when comparing the risk of infection with NPS use for a specific strain, S. pyogenes emm76.0, against the risk of infection with NPS use for S. pyogenes (emm types other than emm76.0) (RR = 3.49, 95% CI = 1.32–9.21).ConclusionsThe UK government's 2015 temporary class drug order on ethylphenidate was effective in reducing infections among people who inject drugs during an outbreak situation in Lothian, Scotland.

KW - class drug order

KW - ethylphenidate

KW - addiction

U2 - 10.1111/add.13898

DO - 10.1111/add.13898

M3 - Article

VL - 112

SP - 1799

EP - 1807

JO - Addiction

JF - Addiction

SN - 0965-2140

IS - 10

ER -