Challenges in the management of skin and soft tissue infections among people who inject drugs in Athens, Greece.

Background: People who inject drugs (PWID) are at an increased risk of developing injection-related skin and soft tissue infections (SSTIs). If not treated promptly, SSTIs can lead to significant health complications. SSTIs are nowadays acknowledged as a major, yet preventable, cause of morbidity and mortality among PWID. Thus, attention has been drawn in designing appropriate SSTIs prevention interventions. Nevertheless, little is known about the profile and injection practices of PWID in Greece. 
Purpose: The purpose of this study is to gain insight intoPWID injection practices in Greece that might be related to the development of SSTIs. 
Methods: Data presented herein originate from records kept from October 2023 through January 2024 by outreach workers of Organization Against Drugs (OKANA) in drug dealing spots of Athens’ historical center. Overall, 46 active PWID approaching outreach workers for medical advice concerning injection-related SSTIs were asked about their injection practices. 
Results: All individuals were experiencing mild to moderate SSTIs. In most cases that was the first time they asked for professional help while a significant number of them reported self-management such as using leftover antibiotics. As far as their socio-demographic characteristics, they were predominately males (83%) of Greek-origin (80%) with a median age of 40 years old. Their main income derived from social benefits (95%), while 41% reported homelessness. Consistent with the change in drug use profile reported worldwide, 95% of them had been currently injecting both opioids and psychostimulants while most of them (80%) had been injecting drugs for more than 10 years. Regarding their injection practices, the vast majority (88%) reported injecting mainly into arms and legs, at least 3 times per day, with at least three attempts to achieve successful injection. Interestingly, most of them (88%) reported not sharing or reusing syringes/needles or other injection equipment. Nevertheless, they appeared inconsistent with other hygiene practices: 59%  had reported omitting skin cleaning before injection, 35% licking the needle before injection and nearly half of them reported being injected by peers.
Conclusion: Our results suggests that although necessary, distribution of sterile injection equipment is not sufficient in preventing SSTIs underlying the importance of implementing more effective SSTIs prevention strategies. It thus appears that outreach interventions should include harm reduction educational programs addressing the potential consequences of risky injection behaviours such as needle-licking as well as early detection of SSTIs. Moreover, outreach workers should focus on motivating PWID with existing SSTIs to seek for early professional advice and treatment. Last but not least, additional resource allocation, such as funding for wound care programs would be an important strategy to prevent SSTIs and improve outcomes among PWUD with SSTIs.