Prevalence and Characteristics of Delusional Infestation in Individuals With Opiate Use Disorders Within One Health System: A Retrospective Cross-Sectional Study.

Authors

Manish Shrestha, Department of Medicine, Tower Health Medical Group, Reading, USA
Becky Cox-Davenport, Department of Medicine, Tower Health Medical Group, Reading, USAFollow
Debra Powell, Department of Medicine, Tower Health Medical Group, Reading, USAFollow
Anthony Donato, Department of Medicine, Tower Health Medical Group, Reading, USAFollow

Document Type

Article

Publication Date

12-1-2024

Abstract

OBJECTIVE: The recent development of xylazine adulteration of the illicit opiate supply has been associated with necrotic extremity wounds of unclear pathogenesis. This study sought to understand the prevalence and characteristics of delusional infestation (DI) among patients with opiate use disorders who also carried a diagnosis of cellulitis.

METHODS: A retrospective cross-sectional study was performed in one health system to identify patients with opiate use disorder and cellulitis over the past three years who also described symptoms of DI. We collected demographics, comorbid substance use disorder, and psychiatric diseases and calculated the likelihood of association with drug use by applying the Naranjo Adverse Drug Reaction scale.

RESULTS: Fifteen patients (3.2% of all opiate-dependent individuals) were identified as also having DI. All patients had recurrent symptoms of DI, persisting over 18.3 ± 16 months with 4.6 ± 2.3 different health system contacts. The mean age was 44.4 years (range: 25 to 63 years). Twelve were female (80%, chi-square 5.4, p = 0.02). All had open wounds. Psychiatric comorbidities were common, but only two were schizophrenic, and none were actively psychotic during contact with the health system. Symptoms were either definitely (n = 1) or probably (n = 14) associated with drug exposure, according to the Naranjo Adverse Drug Reaction scale. Thirteen (87%) were also abusing other stimulants. All workups were negative for parasites and eosinophilia.

CONCLUSIONS: The prevalence of DI in patients with opiate use disorder was identified as significantly higher than reported in other populations. The role of DI in the formation of skin wounds deserves further study.

Publication Title

Cureus

Volume

16

Issue

12

First Page

76098

Last Page

76098

Recommended Citation

Shrestha, M., Cox-Davenport, B., Powell, D., & Donato, A. (2024). Prevalence and Characteristics of Delusional Infestation in Individuals With Opiate Use Disorders Within One Health System: A Retrospective Cross-Sectional Study.. Cureus, 16 (12), 76098-76098. https://doi.org/https://doi.org/10.7759/cureus.76098