Legal Prescription

ALRT's Exploration of Addiction, Law, and Medicine

Month: October 2019

Collateral Health Effects of Heroin Use

By Travis Murray

[The following blog post is written by a licensed pharmacist in Pennsylvania. This post is intended to illustrate diseases and medical conditions in which intravenous drug abuse (IVDA) is considered to be a risk factor. This post is not an exhaustive list of the health complications associated with IVDA nor is it intended to be used as medical advice to diagnose, treat, cure, or prevent disease.]

Overdose from intravenous heroin and fentanyl use can result in death. However, overdose is not the only harmful or even lethal effect of administering illicit drugs intravenously. Contaminated needles and impure substances can result in other deadly health effects. These health effects can also have substantial economic and potential legal consequences as well. The following is a list of serious risks and complications of illicit intravenous drug use, including HIV/AIDS, hepatitis C, and endocarditis. 

  1. Human Immunodeficiency Virus (HIV) Transmission

HIV is the virus that is responsible for acquired-immunodeficiency syndrome (AIDS). The virus can be transmitted from needles that were previously used on an HIV-positive person. AIDS weakens the body’s immune system to the point that the body is unable to fight off most infections. If AIDS is left untreated, patients can succumb to life-threatening opportunistic infections such as: toxoplasmosis, cytomegalovirus infection, and cryptococcal meningitis. In an effort intended to dissuade HIV-positive people from spreading the virus, 26 states have criminalized behavior that can lead to HIV exposure. 

  1. Hepatitis C (HCV)

Hepatitis C virus (HCV) can spread from a contaminated needle containing the virus from another person. Hepatitis C can result in liver disease that can cause ascites and cirrhosis. Infected people can experience severe distended abdomens, jaundice, and fluid retention that can worsen heart, lung, and kidney function. Cirrhosis can permanently destroy liver cells. Alcohol and some opioids are also harmful to the liver and can worsen liver disease. If left untreated, hepatitis C can lead to liver failure and the need for a liver transplant. There is no vaccine for hepatitis C like there is for hepatitis A and B, but there is now a cure for hepatitis C, with treatment costing tens of thousands of dollars. 

  1. Methicillin-Resistant Staphylococcus aureus (MRSA) Infections

MRSA is a drug-resistant bacteria which can lead to serious and life-threatening illness if the bacteria enters the bloodstream. MRSA can lead to bacteremia and endocarditis, which is an infection of the endocardium in the heart. The bacteria can colonize in the heart valves and severely weaken the heart, sometimes permanently, resulting in heart failure. The bacteria can spread to other part of the body and lead to sepsis and septic shock, a life-threatening condition. MRSA can only be treated with a few antibiotics, and even these antibiotics are dwindling in their efficacy. MRSA can also cause severe skin and soft tissue infections resulting in painful, swollen, and pus-filled abscesses. MRSA is only one of countless blood-borne bacteria, viruses, fungi, and parasites that can lead to severe infection. 

  1. Poisoning

Heroin is a Schedule I substance and is not approved for any therapeutic use in the United States. Heroin is not commercially produced with the same purity and potency standards because it is not regulated as an approved food or drug. Without regulation, heroin that is purchased could really be any substance at all. Heroin products are likely adulterated and contain toxins that can damage blood vessels and organs. Heroin may contain fentanyl, an opioid more potent than heroin. This presents complications for health care providers because users cannot accurately state what substances are inside of them and numerous and expensive tests may be necessary to correctly identify the poison and additives. 

  1. Collapsed Veins

Illicit drugs are not administered by trained medical professionals. Poor technique, dull needles, and frequent injections can result in collapsed veins which make injections into the vein to deliver the drug impossible. Users often rotate injection sites in the event of a collapsed vein to the other arm, behind the knee, hands, feet, and groin area. Eventually, all veins may become collapsed. Scarring also makes it difficult to find veins. This presents a serious medical issue if the user needs medical treatment that requires intravenous delivery of fluids or medications. 

  1. Constipation

All opioids are associated with constipation, whether they are administered by mouth or intravenously. While constipation may seem relatively minor in comparison to other complications of opioid-use, it can become quite severe if left untreated. Impaction can cause extreme abdominal pain and cramping and may lead to perforations of the intestine and severe abdominal infections. If impaction does not respond to laxative therapy, surgery may be necessary. 

  1. Dental Disease, Malnutrition, and Diabetes 

Heroin use is associated with poor dietary intake which can lack essential macronutrients and essential vitamins and minerals. Heroin increases the desire for simple sugars, which can increase the risk for dental decay and the lack of fiber can worsen constipation. High sugar diets also increases the risk for diabetes. Diabetes weaken the immune system by decreasing circulation throughout the body and is considered to be an additional risk factor for poor wound healing and worse outcomes from MRSA, especially when the infection is on the feet. Severe diabetes, if not properly managed, can result in numerous health problems, including: kidney disease, vision loss, heart disease, nerve pain, and infections. 

  1. Health and Safety of Others

Intravenous drug use can have consequences on others as well. For example, contaminated needles have the potential to infect others who use the same needle. Improperly disposed of needles can infect other people that come in contact with needles, especially if left in public places. Public concern is high on ensuring that used needles are disposed of properly, as a South Carolina jury awarded $4.6 million to a woman who was punctured by a hypodermic needle in a Target parking lot in 2014. Needles should never be shared and should be disposed of in a sharps container. If you do not own a sharps container, used needles can be: placed in a thick empty plastic laundry detergent container, filled no more than three-quarters full, labeled “DO NOT RECYCLE – CONTAINS SHARPS”, and placed in the regular trash with the lid taped closed. 

If you are exposed to a used needle, the wound should be cleaned with soap and water and seek medical attention immediately. For more information from the Addiction Legal Research Team regarding how to prevent the misuse and abuse of prescription opioid medications, see 10 Ways to Reduce the Risk of Opioid Misuse and Abuse. For an article exploring safe injection sites, see Safe Injection Site Fights to Call Philadelphia Home. 

October Advocate of the Month: Keegan Wicks

By J. Alexander Short

[Each month, the Addiction Legal Resource Team at Penn State’s Dickinson Law recognizes an exceptional individual for their contributions to the addiction treatment community. The individual recognized as Advocate of the Month for the month of October is Keegan Wicks. Formerly involved with the RASE Project, Keegan Wicks is now a Project Coordinator for Faces & Voices of Recovery, a national advocacy organization fighting for the rights of those affected by addiction. We are thankful for inspiration from our honored advocates and from Dickinson Law’s Inside Entrepreneurship Blog. To learn about our past month’s advocate, see here.]

Before I had the pleasure of speaking with Keegan Wicks, I knew about him. People spoke of him and did so with high regard. Whether at local symposia on the current opioid crisis, in the local Opioid Intervention Court, or during discussions with fellow law students, his name continued to echo in my life. His involvement with the RASE Project, a local recovery organization, led to his invitation to speak on a panel on the opioid crisis at Penn State’s Dickinson Law in the fall of 2018. There, Keegan spoke eloquently and candidly about his experiences and how they led to his becoming involved with the world of treatment and recovery. Hearing his words made me hopeful about one of the most serious health crises of my generation – not an easy feat. This was my introduction to Keegan. He is a natural choice to feature as Advocate of the Month. 

When I spoke with Keegan, he introduced himself in a few ways. He told me he was a person who had a connected relationship with his family, he was an upstanding citizen, and he was someone who is actively involved with his employer. Keegan then stated he also happened to be a person in long-term recovery. Not long into our discussion, he explained how he never imagined he would be someone with a substance use disorder. He never planned for this, but it still happened. His story parallels so many I have read about in the past year. While we spoke, I noted how forthright and sincere he was about these traditionally sensitive subjects. Whether discussing the struggles he faced in his past or the hardships our society is facing in the current opioid crisis, Keegan’s tone remained consistent. Everything he said resonated a singular message: The battle against substance use disorder is a fight which cannot be fought alone. 

As our conversation twisted from one topic to another, Keegan consistently stressed the importance of family in his personal journey. “I wouldn’t have been able to maintain recovery without others in my life,” he stated without hesitation. Without family, it would have been nearly impossible for Keegan to overcome substance use disorder and all the struggles associated with it. However, despite all of the difficulties associated with these topics, Keegan remained stubbornly optimistic. He went on to say that “family was just such an important piece in [his] receiving the care [he] needed.” It took little time for it to become clear that the manner in which Keegan successfully overcame his battle with substance use disorder informs his current outlook to this day in countless ways. Now, Keegan is able and willing to give back to others struggling and participate in the recovery community. It is this calling that drives Keegan’s work.

Like I mentioned earlier, I first met Keegan and heard him speak at a conference at Penn State’s Dickinson Law in the fall of 2018. There, he spoke about his story. Since 2013, he actively worked in the recovery field through roles in advocacy, counseling, and management. The organizations with which he has been involved reads like an alphabet soup: CRAFT (Community Reinforcement And Family Training); the Workforce Development Steering Committee for the Pennsylvania Governor’s Office / Pennsylvania Department of Drug and Alcohol Programs (DDAP) Collaboration; the Recovery and Resiliency Steering Committee lead by the Pennsylvania Recovery Organizations Alliance (PRO-A); the Pennsylvania Mental Health Consumers’ Association (PMHCA); and the Office of Mental Health and Substance Abuse Service Mental Health Planning Council (OMHSAS MHPC). However, he primarily spoke about his work with the RASE Project, the advocacy organization which serves the needs of individuals in and seeking recovery in Central Pennsylvania. Specifically RASE is a Recovery Community Organization, meaning it is comprised entirely of staff and volunteers from the Recovery Community and it exists to serve the Recovery Community. The RASE Project allowed Keegan to become involved with the Central Pennsylvania community, but today he advocates on a larger scale. 

Keegan’s now focuses his energy fighting for the rights of individuals facing the same struggles he had to overcome in his life. Since June of 2019, he works with an organization known as Faces & Voices of Recovery. The organization’s mission reads as though Keegan himself authored it. Faces & Voices of Recovery is “dedicated to organizing and mobilizing the over 23 million Americans in recovery from addiction to alcohol and other drugs, our families, friends and allies into recovery community organizations and networks, to promote the right and resources to recover through advocacy, education and demonstrating the power and proof of long-term recovery.” At Faces & Voices of Recovery, Keegan advocates for people in recovery in a number of ways. Through his work there, Keegan focuses on the continued development of recovery organizations. Put simply, recovery organizations are organizations which help someone during the recovery process, oftentimes by pairing them with individuals who have already been through the process. In one project, he is working to coordinate and establish recovery community organizations in Florida run by members of the recovery community to assist those in recovery themselves. He noted that peer services like these are an essential component in developing a large-scale response to the current drug crisis in this country. Even when discussing this project, it doesn’t take long for Keegan to bring it back to family: “It’s really about going out into the community and educating people about the family dynamic.” However, Keegan recognized there are even more battles to fight.

One such battle is the overarching issue of stigma associated with substance use disorder. As Keegan spoke about stigma, it quickly became apparent how language is fundamental in educating people about substance use disorder as well as causing change in how institutions address it. Loaded language has the potential to identify people by their ailment, rather than their personhood. For instance, words like junkie or addict do harm to this cause and should be avoided. Instead, as Keegan explained, person-first language like ‘person in recovery’ or ‘person with substance use disorder’ refocuses the language in a far more positive manner. “Imagine if a doctor told you that your chlamydia test came back ‘dirty’,” Keegan said frankly, “and yet that language is regularly used in court proceedings everyday to describe positive drug screenings.” The need for careful language goes beyond everyday conversation and impacts legislation and policy.  

With equal conviction, Keegan discussed the importance of legislative advocacy for those affected by substance use disorder.  He discussed one such law which could impact the lives of anyone with a substance use disorder: 42 CFR Part 2. When enacted, these federal privacy protections were motivated by the understanding that individuals with substance use disorder may fear treatment due to stigma or the potential of prosecution. Currently, Keegan explained, there are efforts being made to align these protections with HIPAA, but there are large gaps in the law as it exists today that could harm individuals with substance use disorder. Check out a summary of the ongoing changes being made to these regulations here. 

The nature of most discussions about the opioid crisis or larger issues of addiction are naturally difficult to have. These topics cause people stress or discomfort. Even more often, people become exasperated about the colossal nature of the problem. Keegan is not like most people. Whether explaining his personal journey in recovery or detailing legislative developments of the past week, Keegan spoke with a contagious, unfettered optimism. It was hard not to feel refreshed and invigorated in my passion about this topic after speaking with him. 

In many ways, after our discussion, I understood why so many people spoke so highly of Keegan. In his demeanor and energy, he naturally shines a light onto topics so regularly tucked away into the shadows. Beyond that, Keegan puts in the hours each day to make the changes necessary to overcome a monumental crisis. Perhaps it is his history with recovery, his understanding of the magnitude of this crisis, or his work ethic that drives him. Whatever it is, Keegan continues his fight and is not looking back. 

Powered by WordPress & Theme by Anders Norén

Skip to toolbar