Emerging and Underrecognized Complications of Illicit Drug Use

More specifically, the report indicates that 61 per cent of heroin samples contained ,000 species of bacteria and fungi. Injections of liquids are given intravenously with the assistance of a syringe connected to a needle. Injected medications can be injected intravenously, intramuscularly, or subcutaneously. According to the World Health Organization (WHO), narcotics cause various forms of pain. If a person who has a history of drug use presents with a sepsis-like syndrome with no growth in blood cultures, there are other illicit drug complications to consider. “Cotton fever” is a syndrome first characterized in 1975, which includes fevers and leukocytosis in the absence of positive blood cultures 30.

Skin and Soft-Tissue Infections and Manifestations

Research has shown the number of Americans who reported using heroin in the last year has been increasing each year since 2007. In addition to heroin, other common IV drugs include Talwin, fentanyl, buprenorphine and hydrocodone. Track marks are the scars that appear along the veins of someone who injects frequently and repeatedly uses the same  injection sites. If untreated, wound botulism will cause death by paralyzing the muscles used for breathing. If you  experience  any  of the  symptoms  listed  above,  seek   medical   attention   immediately. Treatment usually involves an antibiotic regimen and the draining of any abscesses or infected wounds.

What Is Intravenous Drug Use?

Osteomyelitis is defined as bone inflammation caused by an infectious process and may be acute or chronic 17. It is often difficult to diagnose in the acute setting and can rapidly progress to a destructive process leading to significant long-term disability and pain. Multimodal imaging plays a key role in facilitating prompt diagnosis and treatment, and early imaging should be performed in PWID presenting with signs or symptoms suspicious for osteomyelitis 17, 18. Osteomyelitis due to haematogenous spread tends to result in a slow, insidious progression of symptoms whereas osteomyelitis from iv drug users complications direct local extension presents with more pronounced and aggressive local manifestations.

Health Risks of IV Drug Use

CDC’s infectious disease programs work to implement evidence-based prevention programs in school and community settings, and to stop the spread of infectious diseases like hepatitis C, hepatitis B, and HIV among people who inject drugs. Access to comprehensive prevention services is essential for all persons who inject drugs. Arterial pseudoaneurysms have a characteristic appearance on ultrasound which demonstrates an anechoic collection adjacent to the artery containing turbulent flow which appears as the “yin-yang sign” (Fig. 17) on Doppler ultrasound 28.

Oftentimes, Substance Use Disorders and Problem Gambling Go Hand in Hand

These dangers are part of the economic constraints, low cultural level, or peer-pressure situation that can lead to intravenous drug use and cause a variety of pathologies, including DVT 29-31. The prevalence of intravenous drug use has increased in the past decade and it represents an important risk factor for deep vein thrombosis. Peer pressure and poverty in high-risk groups such as sex workers, females, and young adults raise the risk of intravenous drug use, which expresses itself in the form of venous thromboembolism eventually.

Persons Who Inject Drugs (PWID)

AIDS cases in the United States were attributed to injected drug use, according to UCSF’s Center for AIDS Prevention Studies. Altered mental status is common in PWUD presenting to the emergency room and often leads to concern about possible meningitis or encephalitis. In addition to central nervous infections, healthcare providers should consider other causes of altered mental status, including stroke, movement disorders, and seizures caused by illicit drug use or withdrawal syndromes. Upon further questioning, the patient endorsed that several days before he had lost control of a needle while injecting into his right femoral vein. He subsequently visited an urgent care clinic for inflammation at the injection site; a targeted ultrasound did not show any retained fragments.

• Hepatitis causes inflammation in the liver, which can have serious side effects.
• For example, an article in the British Journal for Dermatology reports that 89 per cent of seized injected narcotics had pathogens present, and 68 per cent of heroin from the streets contained multiple types of pathogens.
• He is a freelance medical writer specializing in creating content to improve public awareness of health topics.
• Since this infection is fatal, early treatment with antibiotics is crucial to survival, although even appropriate therapy does not prevent death in all cases.
• All patients suspected of having DVT who were IVDU tested positive for DVT on Doppler ultrasound scans, according to research findings, including 109 patients who had DVT examinations.

This infection typically develops when germs or bacteria enter the body and travel through the bloodstream to the heart. Those with damaged or artificial heart valves may be at a higher risk of developing endocarditis. Those who regularly inject drugs are at a higher risk of developing an infection at the injection site.

Fig. 14.

Skin infections present classically with swelling, erythema, warmth, and tenderness. Appearances in intravenous drug users can be atypical, because the skin, venous, and lymphatic systems are damaged by frequent trauma and consequent low-grade infection. This may result in lymphoedema, lymphadenopathy, hyperpigmentation, and scarring. Chronic IV drug use can be confirmed by observing track marks due to repeated injections into subcutaneous veins. Track marks are a linear area of tiny, dark punctate lesions (needle punctures) surrounded by an area of darkened or discolored skin due to chronic inflammation.

The use of drugs is frequently linked to the modern life, geographical location, and demographic characteristics of each population 20. In addition to having higher morbidity, intravenous drug abusers have been proven to have a much higher death rate than the general population 21. Intravenous drug users (IVDU) are people who inject non-medical and controlled medical drugs (and may have substance use disorder) for non-medical purposes. Frequently injected drugs include heroin, cocaine, prescription opioids and methamphetamine 6. Treatment may be also complicated because IVDU patients with upper extremity infections may delay presentation to the ER because of other personal or social factors. A study conducted by Gonnella et al.13 found that late presentations to the hospital tend to increase the mean length of stay required, which led to increased costs per hospitalization.

Harm Reduction Methods for Intravenous Drug Use

Furthermore, many users crush tablets of one or more drugs for use as an injectable solution, and when doing so, they also inject the drug’s adjuvants, which carry health risks independent of the ones from the active ingredient from which they seek pleasure 24. Opioids are the most used intravenous drugs; in fact, heroin is the most prevalent drug among intravenous drug users 25. MRI is, therefore, the imaging modality of choice for the acute Substance abuse diagnosis, similar to osteomyelitis elsewhere in the body. MRI protocols typically include sagittal T1, T2, STIR and contrast-enhanced imaging of the affected segment of the spine in addition to axial T2 and contrast-enhanced imaging at levels noted to be abnormal on initial sagittal sequences 20. MRI demonstrates high signal intensity in the intervertebral disc space on T2 images with corresponding low signal on T1 (Fig. 13). Hyperintensity may also be seen on high B value diffusion-weighted imaging in the acute phase.