Complications from Injecting Drugs

Many injectable drugs are used for medical purposes. Some of these prescription drugs are used illegally, as are a variety of street drugs. Illegal and abused injectable drugs can include nearly any drug that can be produced in a liquid form. The user takes these drugs to experience a high by injecting them into veins or under the skin. Injecting drugs puts a user at risk for a variety of medical complications.

Transmitting Disease through Injection

Injections are the source of the greatest number and variety of medical complications from drug use. The most common complication, and the one with the most frequent fatal and disabling consequences, is transmitting disease through the use and sharing of dirty needles. Injecting drug users feel an intense desire to get high. They will inject drugs even if their needles and other injection equipment are not sterile. Injecting drug use can also affect a person's ability to exercise good judgment. Users are more likely to engage in risky behaviors, resulting in disease or even death.

Human Immunodeficiency Virus (HIV). The use of injected drugs is the second greatest risk factor for HIV (the first is sex between men). The majority of heterosexual HIV transmission occurs through injecting drug use. Injecting drug users transmit the virus directly through blood when they share used, unsterilized hypodermic needles and syringes, cotton, cookers (items such as a spoon or bottle top used to heat heroin prior to injection), rags, and water that has been contaminated with the infected blood of others. HIV may live in a needle contaminated with blood for up to four weeks. HIV is also transmitted when bodily fluids, including semen, saliva, and blood, are exchanged during sexual acts.

At least half of all new HIV infections in the United States are among people under age 25, with females making up 47 percent. According to one study, African Americans account for 56 percent of HIV cases reported among 13- to 24-year-olds. Because all needle-using drug abusers are considered at extremely high risk for HIV infection, HIV screening is performed routinely at most drug-treatment centers.

Hepatitis B and C. Hepatitis B and Hepatitis C, diseases of the liver, are the most common diseases caused by injecting drug use. Like HIV, hepatitis can also spread during sexual intercourse or other direct sharing of blood and bodily fluids. Hepatitis can cause hepatic fibrosis, the development of fibrous tissue in the liver, which can interfere with liver function. Hepatitis can also cause or worsen cirrhosis (scarring of the liver), although this is most often a result of chronic alcohol abuse. A vaccine is available to prevent hepatitis B. However, there is no vaccine for hepatitis C, and infection progresses more rapidly to liver damage in HIV-infected individuals. In fact, the majority of HIV-infected drug users also have hepatitis C.

Tetanus and Malaria. Between 70 and 90 percent of all cases of tetanus are among drug abusers. Tetanus most often occurs from injecting drugs under the skin, also known as "skin-popping." Malaria has been spreading in the United States among injecting drug users who have been to areas where malaria is common, such as Africa or Asia. The spread of both these diseases among needle-sharing drug abusers (particularly on the East Coast and in Chicago) is generally contained because of the quinine added to heroin. (Dealers add quinine to stretch the heroin's profitability.)

Complications to Heart and Blood Vessels. Endocarditis is an infection of tissues in the heart, usually a heart valve. This condition can prevent the free flow of blood through blood vessels, and can cause progressively worsening heart damage. Endocarditis can also cause severe heart-valve destruction that can be fatal if not treated. This disease can result from repeated injection of the infective agents into the blood system, usually from nonsterile needles.

Other Complications

There has been considerable concern over the hazards of cocaine, especially when it is self-administered into a vein. Chest pain is a very common effect of injecting cocaine. The physical conditions causing this pain place a cocaine user at significant risk for an acute coronary syndrome, a heart condition in which the heart muscle is deprived of oxygen, risking heart attack and damage.

People who inject amphetamines may experience inflamed and swollen arteries that can, in turn, lead to blood-vessel changes and tissue loss. This blockage of blood flow in the vessels of the brain may trigger a stroke. Intravenous users of amphetamines may also develop lung problems caused by materials that are included as cutting agents or as buffers and binding agents in drugs that come in pill form but are liquefied and injected. These substances do not dissolve, so particles may lodge in the lungs, causing damage. These same buffers and binding agents may also become lodged in various capillary systems, including the tiny blood vessels in the eye.

Bone infections (osteomyelitis) are a common complication of injecting drug use. Gangrene can develop from cutting off circulation to the limbs and may lead to amputation or death. Injecting drug use also contributes to reduced immune system functioning, making the user more susceptible to disease and related complications.

Occasionally drugs are accidentally injected into an artery (rather than into a vein or under the skin). This produces intense pain, swelling, cyanosis (blueness), and coldness of the part of the body injected. Injecting a drug into an artery creates a medical emergency and, if untreated, may produce gangrene of the fingers, hands, toes, or feet and result in loss of these parts.

Preventing Complications Among Injecting Drug Users

The best way to avoid complications from injecting drugs is to never start. Once a person becomes a user, the best course of action is to enroll in a drug treatment program. However, until a user stops, he or she should take certain precautions to keep personal risk at a minimum. For example, the user should use new, sterile syringes for each injection. Syringes, needles, water, or drug equipment should never be shared or reused. Needle exchange programs in some areas will exchange clean, sterile needles for used, dirty needles. The goal of these programs is to keep infection rates down by offering clean needles. When sterile syringes are not available, individuals should wash syringes and other equipment with bleach, even though this procedure is not as safe as using a new, sterile syringe. Toothbrushes, razors, and personal care items that might be contaminated with blood should not be shared. Injecting drug users and their partners should also practice safer sex such as using a condom or dental dam during every sex act.

see also Accidents and Injuries from Drugs; Cocaine; Heroin; Needle Exchange Programs; Substance Abuse and AIDS.