Factors Associated With Maternal Depression, Anxiety and Mother-Infant Bonding in At-Risk Mothers During Pregnancy: A Cross-Sectional Observational Study.

The United States (US) continues to experience an epidemic of drug-related harm, including both fatal and non-fatal overdose and high rates of injection-related infectious disease. While opioid-related deaths are now declining in most areas of the country and falling overall for white people, overdose death rates are increasing for Black, Hispanic, and Native American people.(; ) At the same time, overdoses involving stimulants such as cocaine and methamphetamine are rapidly increasing.() The rate of overdose deaths involving cocaine rose nearly 400% from 2003 to 2023 (from 1.8 to 8.6 per 100,00), while deaths involving other psychostimulants such as methamphetamine increased by over 2500% (from 0.4 to 10.6 per 100,000).() Non-overdose harms associated with use of illicit drugs have also increased.() Sharing of syringes and other injection equipment such as cotton and cookers remains a leading cause of HIV infection, including several injection-related HIV outbreaks over the past decade.(; ; ; ; ; ) Hepatitis C infections, most of which are caused by syringe sharing, have risen in many areas of the country.(; ) The number of acute hepatitis C cases reported in 2022 was double that of 2015, with injection drug use the most prevalent risk behavior reported among newly infected individuals.() Endocarditis, osteomyelitis, and skin and soft tissue infections related to injection drug use have all dramatically increased over the past decade as well.(; ; ; ) Many of these harms are caused by lack of access to equipment for using drugs such as syringes and pipes. This leads to re-use and sharing of those devices, which has been associated with the spread of bacterial and viral infections among people who use drugs.(; ; ) (; ; ) Women are at higher risk for sharing syringes due to power dynamics with men and their exposure to violence.(; ) A recent systematic review of people who inject drugs worldwide found that injection-related harms are common, and transmission of blood-borne disease through injection equipment is a key contributor to morbidity and mortality among people who inject drugs.()