Concerns of IV Drug Use

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Injection drug users routinely use syringes to inject drug solutions — either manufactured or self-prepared — into their bodies. Standard injection sites include the inside of forearms and inner sides of legs, wrists and hands, as well as the tops of feet, neck, groin and even underneath the tongue. Often, addicts will choose sites that won’t be easily visible to others; these signs of injection are known as “track marks.” While some people will inject straight into the bloodstream via veins, others will inject subcutaneously just underneath the skin.

one million
As of 2007, it was estimated there were around one million people injecting drugs in the United States.[1] Favored drugs of abuse for injection include:

  • Ketamine
  • Heroin
  • MDMA
  • Methamphetamine
  • Cocaine
  • Crushed prescription opioid pain relievers dissolved in water solutions

Health Hazards

There are health concerns with any substance abuse, but injection drug users face more than the typical risks associated with substance abuse. The biggest worry involved with injection drug use is the risk of contracting an infectious disease.

Hepatitis C

Hepatitis C (HCV) is a viral infection. Around 3.2 million people in the United States are infected with the HCV[2] and about 17,000 more are diagnosed every year.[3] Only around a quarter of individuals infected with hepatitis C show any symptoms in the acute phase of the virus.[4]

Most HCV infections are spread through unintentional exposure to the blood of another infected party. IV drug use is the number one method of transmission.[5] Substance abusers have a 50 percent risk of contracting the HCV within the first three years of starting to inject drugs.[6]

An alarming 75 percent of people infected with this virus will have cases that persist and develop into chronic HCV.[7] The most serious consequence of the HCV is the impact it has on the liver. Complications of the liver, like cirrhosis or cancer, occur in five to 15 percent of cases where HCV is the only infection.[8]

hep c

Fortunately, there is now a cure for some types of HCV. Previous methods of treatment included ribavirin and interferon, and now a daily pill named Harvoni promises a 96 percent cure rate for those individuals with genotype I HCV.[9] On the downside, it costs $95,000 for a mere 12 weeks of treatment — thus it is outside most people’s price ranges.[10]

HIV/AIDS

hiv

It is estimated that around three million injection drug users across the globe have the human immunodeficiency virus (HIV).[16] Around 50,000 new cases of HIV are seen in the United States alone each year.[17] The virus is passed from one person to the next through blood and other bodily fluids, including semen, vaginal fluids and breastmilk.

Dual diagnoses are a major problem among HIV-infected individuals. More than 90 percent of HIV-infected persons also have chronic HCV.[18] In 2005, an analysis of 478,488 people infected with HIV or AIDS showed that 24.6 percent of them had a history of IDU that could have resulted in their exposure to the virus.[19]

Other Issues

Infectious diseases get a lot of attention when it comes to injection drug use, but other complications arise all the time. Collapsed veins are one of them. Repeated injections at the same sites often cause veins to collapse in frequent IV drug users. This can also be caused by using faulty syringes with blunt needle tips or not injecting in the right manner.

Skin, bone and tissue infections are other problems caused by injection drug use. These bacterial infections may stem from a number of bacteria, but the most common is staphylococcus. The presence of this strain of bacteria is more commonly seen in injection drug users than the general population.[20]

A staph infection usually looks like a boil or insect bite, and most of these infections will need to be drained in conjunction with antibiotics to recover from the infection. Some frequently seen cases of skin infections in injection drug users include:

  • Cellulitis
  • Abscesses
  • Ulcers
  • Septic thrombophlebitis
  • Necrotizing fasciitis

Cellulitis and abscesses are a problem for 22 to 65 percent of addicts.[21] Tissue and musculoskeletal infections are common problems for drug abusers who inject, too. The Human T-lymphotrophic virus is known for being far more common among injection drug users, too. One study notes nine percent of participants had type I, 18 percent had type II, and 41 percent had type III, compared to only one percent of the general population.[22]

Drug abuse may also influence behavior and can cause addicts to fall into patterns of impulsive and unhealthy behavior, such as engaging in sexual acts with strangers — often unprotected. Injection drug users are also more likely to contract a sexually transmitted disease — as much as 60 percent of this population did in one study.[23]

Clearly, the most serious risk involved with injection drug use is overdose. As many as one to three percent of the injection drug-using population dies from an overdose every year.[24]

every year

Who Is at Risk?

Merely being an injection drug user may increase the threat of certain health woes, but among those who inject drugs, certain individuals are at an even higher risk. Those who do not practice safe injection methods obviously carry the highest risk factor. Some efforts to combat this have been introduced in a few nations. For example, Canada now offers addicts safe havens, known as “injection sites,” where they can go to safely inject their drug of choice with sterile equipment in a supervised setting without the risk of persecution. However, this trend has not caught on in the United States as of yet, but some syringe exchange programs are in place.

It isn’t just the risk of shared needles either. Sometimes disease is passed from one person to the next through the supply itself or the other pieces of equipment the substance was prepared on.

Certain demographics are also more likely to engage in injection drug use, thus upping their risk of adverse consequences. Needle sharing seems to be more common among women than men and in younger drug abusers.[25] One study showed that those who are under 30 and inject drugs are twice as likely to share needles than those over age 30.[26] This same demographic was additionally twice as likely to report having more than two sexual partners in the preceding six months.[27]

Young people also appear to be less likely to engage in protective factors. Case in point, only 10 percent in the same study had completed vaccinations for HBV.[28]

The likelihood of contracting certain infectious diseases may be linked to the age of onset for injection drug use, too. Among individuals who began these practices by the time they were 23 years old, 51.4 percent had HIV.[29] While this seems to imply a greater likelihood of HIV in younger IDUs, it is indicative only of those who fit the age of onset criteria. In contrast, 10 percent of people 25 and older in another study had HIV while only half as many under 25 did.[30]

The mentally ill may be at an increased risk of adverse effects stemming from injection drug use, too. This population is already afflicted with higher rates of substance abuse than the general population. Approximately 29 percent of all people with mental health disorders abuse drugs or alcohol.[31]

Then there are those substance abusers who do not inject drugs, but they abuse other substances that may act as gateways to injectable drugs and open the door to them down the road. Prescription opioid pain relievers are one such drug. A reported four in five injection drug users admitted to prior misuse of an opioid painkiller before they ever injected heroin.[32]

Untangling the Damage

Many question whether the damage caused by injection drug use can be undone. Sadly, in some cases, it cannot. Collapsed veins and skin infections may heal, but for the many who contract an infectious disease throughout the time they are engaging in injection drug use, they will live with these consequences for the rest of life.

Treating an injection drug user is no different from treating anyone else. Since these substance abusers are accustomed to a quick and euphoric high, the crash from such during detox may be more turbulent. Co-occurring conditions should always be treated in conjunction with an addiction. This doesn’t just include issues of mental health but also those of physical health. If an addict has an infectious disease such as hepatitis C, a quality facility will understand how to manage the symptoms of such during detox and follow-up treatment.

 

Citations

[1]Injection Drug Users.” (November 2011). Virginia Department of Health. Accessed June 9, 2015.

[2]Hepatitis C Fact Sheet.” (n.d.). Office of Population Affairs. Accessed June 9, 2015.

[3] Ibid.

[4]Management of Common Health Problems of Drug Users.” (n.d.). World Health Organization. Accessed June 10, 2015.

[5]Hepatitis C Infection.” (n.d.). Medicine Net. Accessed June 10, 2015.

[6] Gourlay, K. (2015 May 26). “Injection Drug Use Fuels Rise in Hepatitis C Cases.” NPR. Accessed June 10, 2015.

[7]Management of Common Health Problems of Drug Users.” (n.d.). World Health Organization. Accessed June 10, 2015.

[8] Ibid.

[9]96% Hep C Cure Rate for Harvoni in Those Coinfected with HIV.” (2015 March 3). AIDS Meds. Accessed June 10, 2015.

[10] Heitz, D. (2014 Oct 26). “Harvoni Takes the Sting Out of Hepatitis C Treatment.” Healthline. Accessed June 10, 2015.

[11]Viral Hepatitis – Statistics and Surveillance.” (n.d.). Centers for Disease Control and Prevention. Accessed June 10, 2015.

[12]Hepatitis B.” (n.d.). Viral Hepatitis Action Coalition. Accessed June 10, 2015.

[13]Management of Common Health Problems of Drug Users.” (n.d.). World Health Organization. Accessed June 10, 2015.

[14] Ibid.

[15]Medical Implications of Injection Drug Use.” (n.d.). Rutgers University. Accessed June 10, 2015.

[16] Mathers, B.M., Degenhardt, L., Phillips, B., Wiessing, L., Hickman, M., Strathdee, S., Wodak, A., Panda, S., Tyndall, M., Toufik, A. & Mattick, R.P. (2007). “Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review.” World Health Organization. Accessed June 10, 2015.

[17]New HIV Infections in the United States.” (n.d.). Centers for Disease Control and Prevention. Accessed June 10, 2015.

[18]Management of Common Health Problems of Drug Users.” (n.d.). World Health Organization. Accessed June 10, 2015.

[19]Medical Implications of Injection Drug Use.” (n.d.). Rutgers University. Accessed June 10, 2015.

[20] Bassetti, S. & Battlegay, M. (June 2004). “Staphylococcus aureus infections in injection drug users: risk factors and prevention strategies.” Journal of Infection. Accessed June 10, 2015.

[21] Del Giudice, P. (2004). “Cutaneous Complications of Intravenous Drug Abuse.” The British Journal of Dermatology. Accessed June 10, 2015.

[22] Kaushik, K.S., Kapila, K. & Praharaj, A.K. (n.d.). “Shooting up: the interface of microbial infections and drug abuse.” Journal of Medical Microbiology. Accessed June 10, 2015.

[23] Ibid.

[24] Milloy, M-J.S., Kerr, T., Tyndall, M., Montaner, J. & Wood, E. (2008 Oct 7). “Estimated Drug Overdose Deaths Averted by North America’s First Medically-Supervised Safer Injection Facility.” PLoS One. Accessed June 10, 2015.

[25]HIV/AIDS and Injection Drug Use.” (n.d.). DrugWarFacts. Accessed June 10, 2015.

[26] Seal, K.H., Edlin, B.R., Ochoa, K.C., Tulsky, J.P., Moss, A.R. & Hahn, J.A. (January 2000). “Risk of hepatitis B infection among young injection drug users in San Francisco: opportunities for intervention.” Western Journal of Medicine. Accessed June 10, 2015.

[27] Ibid.

[28] Ibid.

[29] Barrett, D., Hunt, N. & Stoicescu, C. (December 2013). “Injecting Drug Use Among Under-18s.” Harm Reduction International. Accessed June 10, 2015.

[30] Tassiopoulos, K., Bernstein, J. & Bernstein, E. (2013 Dec 13). “Age and sharing of needle injection equipment in a cohort of Massachusetts injection drug users: an observational study.” Addiction Science & Clinical Practice. Accessed June 10, 2015.

[31]Substance Abuse and Mental Health.” (n.d.). HelpGuide. Accessed June 9, 2015.

[32] Join Together Staff. (2011 July 25). “Prescription Drug Abuse Gateway to Injected Drugs, Study Suggests.” Partnership for Drug-Free Kids. Accessed June 10, 2015.

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