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.
- 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.
- 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.
- 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.
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.
- 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.
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.
- 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.
- 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.