MRSA, Needle Exchange, and the War on Drugs

There is a winner in the War on Drugs: methicillin-resistant Staphylococcus aureus, also known as MRSA. A recent article in the Journal of Clinical Microbiology reached the following conclusion:

Injecting drug users accounted for 49% of CA-MRSA infections but only 19% of the HA-MRSA infections (odds ratio, 4.2; 95% confidence interval, 2.4 to 7.4). Our study shows that a single clone of CA-MRSA accounts for the majority of infections. This strain originated in the community and is not related to MRSA strains from healthcare settings. Injecting drug users could be a major reservoir for CA-MRSA transmission.

There are two basic groups of MRSA: community-acquired MRSA ('CA-MRSA') where the infection occurs outside of the hospital, and hospital-acquired MRSA ('HA-MRSA') where the infection is happens inside the hospital (also known as nosocomial). CA-MRSA, while sensitive to more antibiotics than HA-MRSA, is a lot more dangerous: it appears to be a better colonizer, and it also produces Panton-Valentine leukocidin toxin (which is both 'flesh eating' and targets your white blood cells).

The distinction between HA-MRSA and CA-MRSA is also breaking down: in Massachusetts, many hospital-acquired staph infections are now genetically CA-MRSA. And this is also being seen in San Francisco (italics mine):

The PFGE results showed that 33% of HA-MRSA isolates were USA300. There are two likely reasons for this finding. First, the organism may actually have been nosocomially transmitted. That the strain is no longer limited in the community but has spread into the hospital indicates the severity of CAMRSA infection. This hypothesis is further supported by the finding that the USA300 isolates we found in the HA group exhibit an antimicrobial susceptibility pattern intermediate between those of CA USA300 and the HA non-USA300 types.

Which can lead to this problem:

This finding raises the concern that CA and HA strains may exchange genetic material, resulting in an organism uniquely adapted to produce aggressive SSTI-like CA-MRSA strains which carry the Panton-Valentine leucocidin gene as well as possessing resistance to multiple antimicrobial agents, like current HA strains. Such a development would further complicate efforts at limiting the impact of nosocomially associated S. aureus infections.

This article details is that injecting drug users are a major reservoir of CA-MRSA. In other words, heroin users essentially function as one of the major sources of CA-MRSA, particularly in poor communities.

This brings me to needle exchange, which is one more bit of science the Bush Administration and its Republican servants have lied about. Dirty needles are a major risk factor in the spread of MRSA; also, needle exchange programs are an opportunity to get drug users into medical treatment and/or better living conditions (i.e., not the street) which also lowers the risk of MRSA.

But needle exchange and other programs that help the living conditions of drug users are not popular with conservatives who believe in 'will-based' policies. Rather than doing the hard work of reducing a chronic problem, they pontificate about morality.

And meanwhile, the antibiotic resistance problem for all of us gets worse.


More like this

Over at Shakespeare's Sister, I came across this link to an announcement of a new Chlorox disinfectant that is "a one-step, labor-saving solution for killing both strains of MRSA." There seems to be some confusion here. Let's start with the basics. MRSA is the bacterium methicillin resistant…
A hospital in the UK has reported an outbreak of nasty MRSA infections.  This time, the organisms are the PVL-producing MRSA. MRSA stands for Methicillin-resistant Staphylococcus aureus.  PVL stands for Panton-Valentine leukocidin.  PVL is a toxin produced by the bacteria.  As the name suggests, it…
Or maybe terrifying is a better word. I just returned from the Network on Antimicrobial Resistance in Staphylococcus aureus meeting, where I learned some very interesting things about S. aureus (since I'm going to refer to MRSA, methicillin resistant S. aureus repeatedly, go check this link if you…
...then what we think makes community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) so infectious might be wrong. A to-be published article in the Journal of Infectious Diseases (Dec. 15) asks "Is Panton-Valentine Leukocidin the major virulence determinant in community-…

So long as you assume that only "those people" get MRSA, and that you don't have to worry about getting it yourself, it might not seem like too much of a threat. Especially if you don't believe in evolution.


that's whole foolishness in a nutshell. It's also why we use the term reservoir. Maybe we need a sexier term like "MRSA-laden insurgents"...

Drug misuse is not a moral problem - it's a health problem. How do you get this across to the moral majority? Here in Britain we have needle exchange programs, and methadone programs to wean people off heroin. Likewise with alcoholism, people can get Antabuse (Disulfiram).
It should not matter how people got addicted, the point is to treat the addiction and reserve any moral judgements. You want to encourage people to seek treatment, not put them off by telling them they're sinners.
As to HA-MRSA, we nurses are doing our bit to fight it by good hand washing technique, and use of gloves. As a further measure, every bed in the ward, and every clinic room has an alcohol disinfectant hand scrub dispenser. Is it the same in America?

I think it's important to draw attention to the fact that limits on government spending in terms of needle exchange programs and intervention programs for injection drug users may help, not hender, the MRSA epidemic that is occuring in our communities. That said, the answer is not simply needle exhange to stop the spread of MRSA among drug users. IV drug users also may share their drugs, drug making equipment, etc., and many are homeless as well so their living conditions and social networks might also lead to the spread of MRSA. Basically more money needs to be spent to learn why there is significantly more MRSA found in this at risk group.
As to Deacon's comment, at least in the hospital I work at in San Francisco there are alcohol disinfectant dispensers in every room and we are succeeding at cutting down on transmission of HA-MRSA strains.