Public health officials often measure the harms of injection drug use in overdose deaths — or in the spread of preventable diseases such as HIV and hepatitis C.

But in a new report, the New Jersey Harm Reduction Coalition highlights another serious and overlooked health hazard: painful, costly – and sometimes deadly – bacterial infections.

In 2019, bacterial infections associated with injectable drugs like heroin led to 1,967 emergency room visits and 7,310 inpatient hospital stays in New Jersey, resulting in more than $1 billion in total hospital charges, the study authors found. Those charges were often paid with public dollars, since the majority of people hospitalized — about two-thirds — were covered by Medicaid or Medicare. The report points to a lack of sterile needles, skin disinfectants, and other safer injection supplies as the main causes of these infections.

At least 283 people in New Jersey died from preventable bacterial infections related to injection drug use in 2019, according to the report. Their analysis is based on emergency visit numbers and hospitalization data from the New Jersey State Emergency Department Databases along with health care utilization costs compiled by the federal Agency for Healthcare Research and Quality.

The report recommends training medical providers in how to properly treat drug users and reduce stigma. It also recommends that the state invest in measures to help prevent these types of infections, including greater access to syringe exchanges where people can access clean needles. There are currently only seven such programs across the state of New Jersey – and the ones that exist have had to fight to stay open.

“We think so narrowly about the health and well-being of people who use drugs and how we set up our state programs and how we structure our health care support,” said Jenna Mellor, executive director of the NJ Harm Reduction Coalition, at a press conference on the study Wednesday morning.

The worst infections

The most common type of infection affecting people who inject drugs is a skin condition known as cellulitis, but bacteria in the bloodstream can also lead to more serious infections such as endocarditis, which affects the heart and can have fatal complications, according to the national Sepsis Alliance.

Harm reduction advocates say many more people likely suffer from these infections than the numbers outlined in the report because those afflicted often avoid going to the hospital.

The NJ Harm Reduction Coalition has a street outreach team that works with drug users in New Brunswick. At the press conference, Caitlin O’Neill, the organization's director of harm reduction services, said often when they ask if a client is planning to go to the hospital for a medical issue, they will either say they don’t want to because they know they will face stigma for using drugs — or that they went to a facility and had to leave because they were about to go through withdrawal and weren’t offered anything to help with the symptoms.

“That, to me, is unacceptable, and that, to me, is not health care,” O’Neill said at the press conference.

O’Neill added that the rise of fentanyl puts people at higher risk of infection because the effects wear off more quickly than heroin, meaning people who are addicted have to inject more frequently.

The battle over clean needles

Atlantic City lawmakers voted to close the needle exchange program there last year, with some arguing that it attracted drug users to the city. But the move was blocked by Gov. Phil Murphy’s administration. Murphy signed a law earlier this year transferring the power to open and close needle exchange programs to the state health department.

A bill has also advanced in the New Jersey Legislature that would prevent pharmacies from refusing to sell adults clean needles.

Neither the New Jersey Department of Health nor the Department of Human Services, which runs the Division of Mental Health and Addiction Services, responded to a request for comment on efforts to invest in access to clean needles or otherwise prevent infections.

But NJ Harm Reduction Coalition staff said the issue was on the administration’s radar. “My understanding is that the health department is really committed to opening more [needle exchanges] and setting them up to succeed,” Mellor said.

The study found that not all drug users are equally affected by bacterial infections. Although white people had the most hospitalizations, Black people were 1.5 times more likely to be hospitalized for injection-related infections than their white counterparts.

In addition to recommendations around preventing these infections, the report urged the state to publicly report data on how prevalent they are and how many deaths they cause.