Author: Gary Jackson

Potential Health Complications of Injection Drug Use

Treatment usually involves an antibiotic regimen and the draining of any abscesses or infected wounds. Identification of IDUs is crucial – both to determine clinical risk and to minimise the risk of unexpected withdrawal. An accurate drug history, including route of administration, should be completed for all patients on admission, acknowledging that this may need to be repeated until an accurate picture is gained.

BONE AND SKELETAL INFECTIONS

Complex or loculated abscesses may be difficult to drain percutaneously due to highly viscous contents or difficulty reliably accessing and draining each individual compartment 10. If imaging-guided percutaneous drainage is not possible, surgical incision and drainage is usually required for abscesses larger than 3 cm 10. Those who regularly inject drugs are at a higher risk of developing an infection at the injection site. Septic arthritis is a painful infection that can cause extreme discomfort and limit the mobility of the infected joint and surrounding area. Septic arthritis is a joint infection that typically occurs when an infection travels through the bloodstream to a joint. In addition to the bloodstream, septic arthritis can develop from a penetrating injury that causes germs to enter the joint from a puncture directly.

Individualized, evidence based treatment, to fit your needs.

Always using new, sterile injection equipment; never sharing injection equipment; thoroughly washing your hands and clean- ing the skin prior to injection; and preparing your drugs on  a clean surface will all help prevent necrotizing fasciitis infections. Injection-related SSTI, particularly superficial uncomplicated abscesses, were common among participants. Several participants reported injection site abscesses within the preceding 4 weeks prior to admission for SBI. Seeking medical care for injection-related SSTI was rare and participants opted for self-treatment given perceived minimal risk, frequent occurrences, and favorable outcomes in the past. Participants without a prior history of hospitalization from injection-related bacterial infections reported anecdotal experiences of SBI from fellow injection drug users. Misusing IV drugs can negatively affect your health in many ways and increase your risk of developing various infections.

Septic Thrombophlebitis

Initially, HIV causes symptoms similar to the flu, including body aches, chills and fever. If left to heal, a collapsed vein may show improvement after the inflammation has gone down. A healed collapsed vein can function normally, with blood flowing through the vein once again.

Opioid withdrawal symptoms and impact on failure to complete treatment course

Needle sharing and use of nonsterile techniques can lead to many infectious complications. Injection site complications include cutaneous abscesses, cellulitis, lymphangitis, lymphadenitis, and thrombophlebitis. Distant focal infectious complications due to septic emboli and bacteremia include bacterial endocarditis and abscesses in various organs and sites. Septic lung emboli and osteomyelitis (particularly lumbar vertebral) are particularly common.

Up to a quarter of people who become infected with HCV will clear the virus on their own and not develop chronic hepatitis C. This does not mean you’re immune, or that you’ll be able to clear it if you’re re-infected. People with active hepatitis C may have elevated liver function tests (LF Ts), fatigue, and jaundice, and active disease can result in cirrhosis, liver cancer, and ultimately liver failure, all of which can be fatal. The hepatitis C virus can be cleared from the body with medication,  and over time, the liver may be able to regenerate itself. Hepatitis C is a serious health risk for people who inject drugs, many of whom have been exposed to the virus at  some point in their  lives. HEPATITIS C (formerly known as “non-A, non-B“ hepatitis and also referred to as “HCV“) is spread through blood- to-blood contact and is very infectious, which means you can acquire it quite easily if exposed to it.

1. Additionally, necrotizing fasciitis may cause a crackling or popping sensation under the skin resulting from gas trapped in the soft tissues.
2. Currently, there is only prevention by avoiding blood-to-blood contact with use of sterile injection equipment, by not sharing injection equipment, and through safer sex.
3. It is one of the most important reasons people who inject should avoid sharing injection equipment of any kind.
4. This is of particular concern given that 52% of deaths related to drug use are the result of untreated hepatitis C leading to cirrhosis and liver cancer, and 11% are due to HIV/AIDS 6.

HEPATITIS B ( “HBV”) is spread through blood-to-blood contact of the kind that occurs when injection equipment is shared; contact with infected body fluids like semen, blood, vaginal fluids s; and from a parent to their infant at birth. Hepatitis B infection can be acute (short-term) and/or chronic (long-term); chronic HBV can cause serious liver damage, including cirrhosis (scarring), liver cancer, and death from liver failure. Hepatitis B is much more infectious than HIV, which means it is spread much more easily. It is one of the most important reasons people who inject should avoid sharing injection equipment of any kind. CT is required to assess for suspected abscess formation in deeper locations where ultrasound assessment is limited such as the retroperitoneum or deep pelvis 11.

Inadequate treatment of opioid withdrawal symptoms resulted in several participants reporting intravenous drug use while hospitalized. Often, participants reported that homelessness would lead to more careless injection drug use practices in the setting of an unstable drug injecting environment, pessimistic thoughts regarding future, and lack of available resources. This knowledge about safe injection practices was often passed from family members or other friends/acquaintances that injected drugs.

Practice guidelines for uncomplicated skin abscesses following incision and drainage recommend antibiotic therapy to decrease the risk of infection 49. Underlying tissue damage both locally and at distant sites would allow for adherence and propagation of bacteria. Increased medical management of uncomplicated SSTI among PWID would likely decrease rates of treatment failure and risk of progression to SBI. For participants with prior SBI hospitalization, adaptation of safer injection practices as a result of education and past experience were reported to occur yet did not lead to prevention of future SBI in this population. This may be related to limited knowledge and omission by healthcare providers surrounding the multiple potential amplifiers of bacterial infection risk during the injection process. Social-ecological models with respect to drug-related risk and harms emphasize the complex interplay between both behavioral and structural factors, with the need for a multi-level approach to harm reduction 31, 32.

Participants repeatedly reported poor vein health as a result of their history of injection drug use. Consequently, most participants reported needing multiple injection attempts per injection episode (MIPIE) in order to achieve a successful injection. HEPATITIS A ( “HAV”) is excreted in feces (shit) and spread by fecal-oral contact (feces-to-hand- to-mouth contact). Hepatitis A can be spread from contaminated food, water, hands, and eating utensils, for example, by a restaurant worker who didn’t wash their hands after using the bathroom and who then prepared food.

Human Immunodeficiency Virus (HIV)

Participants reported a basic understanding of prevention of blood-borne viral transmission but limited understanding of SBI risk. Participants described engagement in high risk injection behaviors prior to hospitalization with SBI. Qualitative analysis led to the proposal of an Ecosocial understanding of SBI risk, detailing the multi-level interplay between individuals and their social and physical environments in producing risk for negative health outcomes. Infectious complications are the most common reason for inpatient admission in PWID 7. Soft tissue infection due to intravenous injection with contaminated needles or subcutaneous/intramuscular injection may manifest as a range of disorders of varying severity which include cellulitis, abscess, myositis and necrotising fasciitis. These infections are often polymicrobial and Staphylococcus aureus and Streptococcus pyogenes are among the most common organisms 7.

CT or MRI may also be used for planning of endovascular or surgical intervention in complex cases and can concurrently assess for surrounding soft tissue infection. Injection drug use can result in harmful infectious and noninfectious effects to almost every organ system (Table 2). Also, vaccination to prevent hepatitis, influenza, pneumococcal infections, tetanus infection, and other infections should be offered to all appropriate patients. When a virus, bacteria or other germs are introduced and trapped beneath the skin, an abscess can form. Local infection in the skin results in the body’s immune system trying to defend itself from the infection by sending white blood cells to the infected area.