Infections from IV Drug Use
What do I need to know about infections from IV drug use? Drug abuse is associated with multiple health hazards, and the risks may be compounded when these drugs are used intravenously or via other needle routes of administration such as intramuscular or subcutaneous injection. Injecting drugs exposes the user to an increased risk of acquiring various infections and the transmission of certain blood-borne infections.
Some of the drugs commonly injected include:
Common infections that result from IV drug use are:
- Staph infections.
- Necrotizing fasciitis.
- Septic thrombophlebitis.
- Bacterial endocarditis.
- Hepatitis C.
There are many factors to consider when it comes to intravenous (IV) drug use and the development of infection. Bacterial infections may arise when germs that reside on the skin surface or on a contaminated needle are pushed through the skin deeper into the body and, in doing so, are able to bypass the normal barriers of entry or skin defenses that exist to protect us. Should the pathogenic (infection-causing bacteria) reach the blood vessels, it may result in widespread deep-tissue, vein or other vascular infection. IV drug users who inject subcutaneously – a practice known as “skin popping” – are also at greater risk of developing subcutaneous abscesses, infected blisters or pustules.1
Bloodborne infections, such as HIV and Hepatitis C, are also common when users share needles and other injecting paraphernalia.
For those IV drug users living in poor conditions (for example, on the streets or in squalid, drug den–type settings), the lack of hygiene, as well typically poor nutritional status and impaired immunity that results from intensive drug use, further contributes to the risk of acquiring other infections, such as tuberculosis.
A common type of injected drug are opioids, the most well-known of which is heroin. Other opioid medicines that IV drugs users frequently abuse are fentanyl, Talwin and buprenorphine, as well as the prescription painkillers oxycodone and hydrocodone (the latter two first crushed into a powder and then dissolved into a solution for injection). Ironically, such as in the case of buprenorphine, the very medication prescribed to manage opioid disorders are the ones abused by IV drug users.2
Opioid use is associated with physical effects, including:
Symptoms of an opioid overdose include:
- Slowed or stopped breathing.
- Pinpoint pupils.
- Loss of consciousness.
- Coma. 3
Stimulants are popular with IV drug users because they quickly deliver a strong feeling of euphoria, as well as increased energy, reduced appetite and a reduced need for sleep. Cocaine, methamphetamine and the prescription amphetamine-type stimulants (e.g., Adderall, Ritalin) are the most commonly injected. 4
Not all infections are the same. A few types of infections related to IV drug use include:
- Staph infections. One of the most common types of IV-drug-related infections, staphylococcus (staph) infections can manifest as a red bump or boil that may look like a pimple or a spider bite. The area may appear swollen, red and sore to the touch. If staph is allowed to spread to the lungs, it can produce symptoms of pneumonia, such as fever, chills, cough with yellow or green sputum and chest pain when breathing or coughing. The most common treatment for staph infection involves a round of intravenous antibiotics and wound drainage.5
- Abscesses. This type of infection is easy to recognize by its large, tender mass surrounded by inflamed pink flesh. The middle of the abscess is usually filled with pus, bacteria and debris. If the infection is allowed to spread, fever and feelings of nausea may develop. If the infection is serious enough, antibiotics may be prescribed.6 Though some abscesses will drain on their own, most need to be opened and drained by a physician, then packed to minimize bleeding. Large abscesses, when left intact, are slow to respond or resistant to antibiotic treatment.
- Cellulitis. Symptoms of this common skin infection include red streaking of the skin, pain, swelling, tenderness, swollen lymph nodes, leakage of yellow fluid from blisters and fever. Treatments for cellulitis include oral antibiotics and elevation of the affected areas. Severe cellulitis may require a hospital admission for intravenous antibiotics.7
- Necrotizing fasciitis. This is a serious, flesh-eating disease. Necrotizing, from the Latin “necro,” meaning “death,” occurs suddenly and without much warning. Bacteria enter and proliferate throughout planes of tissue beneath the skin, which becomes red, swollen and hot to the touch within 24 hours. Fever and chills, nausea, vomiting and diarrhea may also accompany this infection. When the bacteria spreads, the skin blackens as gangrene sets in. And if the infection is allowed to continue to spread, it may extend to the vital organs and can lead to death. Immediate treatment allows for the best chances of full recovery. Treatments may include surgery, antibiotics and hyperbaric oxygen therapy. In extreme cases, amputation is required.8
- Botulism. Botulism is a condition produced after exposure to a certain bacterial toxin. It is potentially deadly when left untreated, and is characterized by flaccid paralysis of muscles. Other symptoms of botulism include blurry vision, muscle weakness, dry mouth, difficulty swallowing, slurred speech, drooping eyelids and constipation. Severe botulism can result in respiratory failure. Botulism is treated using antitoxins to counteract the neurotoxins in the blood.9
- Tetanus. When the spores of the C. tetani bacteria enter the bloodstream through an open wound from an IV injection, tetanus may result. Symptoms include tension and spasms in the jaw (lockjaw), chest, neck and back. Generalized muscle spasms may result in a characteristic arching of the back called opisthotonos. These spasms may affect breathing, and muscle contractions can become very powerful and painful. Drooling, problems swallowing, fever and irritability are also symptoms of tetanus. Treatments include tetanus immunoglobulin, antibiotics, muscle relaxers, sedatives and bedrest.10
- Septic thrombophlebitis. Septic thrombophlebitis is a vascular, subcutaneous (under the skin) bacterial infection characterized by tender, swollen extremities. Symptoms include skin redness over a vein, swelling in one arm or leg, fever, chills and fatigue. Symptoms may worsen and include difficulty breathing, low blood pressure, rapid pulse, decreased or absent urination, confusion and even coma. Treatments for septic thrombophlebitis include antibiotics, non-steroidal anti-inflammatory drugs, bedrest, anticoagulants and surgery (if necessary) to remove the infected vein.11
- Bacterial endocarditis. Infection of the heart valve occurs when a bacterial infection spreads through the bloodstream and begins to colonize the heart muscle. Symptoms include unintentional weight loss, fatigue, fever, chills, back pain, abdominal pain, muscle aches and weakness, night sweats and stiff neck. The National Heart, Lung, and Blood Institute mentions intravenous drug use as a common cause of this serious health complication. Treatment for this disease includes intravenous antibiotics and possible heart surgery to repair or replace affected heart valves.12
- Hepatitis C. Hepatitis C is a viral infection that can be easily spread through sexual intercourse and IV drug use. It is a tricky disease to diagnose and treat because 80% of people who have it show no symptoms. However, some telltale signs and symptoms of this disease include extreme fatigue, itchy skin, sore muscles, dark urine and stomach pain that may be accompanied by bleeding, redness on the palms and feet and jaundice (yellowing of the skin or eyes). 13 Studies have shown that patients with both HCV and HIV are at increased risk for cirrhosis of the liver and early death.14 Combination therapy is a common treatment in the stabilization of HCV, including interferon, ribavirin and protease inhibitors.
- HIV. Infection with HIV (human immunodeficiency virus) can lead to the development of chronic autoimmune disease. The symptoms of a primary HIV infection are often first erroneously diagnosed as the flu: fever, chills, body aches, diarrhea, sore throat, nausea and vomiting. As the disease progresses, the person may develop persistent itchy and flakey skin, oral thrush (a fungal infection of the mouth), extreme malaise, shingles, short-term memory loss and unintentional weight loss. Since some people may be asymptomatic for as long as 10 years, it’s important to be tested and IV drug users should be tested regularly. Though there is no cure for HIV infection, many people live normal, active lives with proper treatment. These treatments include a cocktail of antiretroviral drugs taken daily to suppress the virus and its spread.15
IV drug use is a major public health problem. According to the World Drug Report published by the United Nations Office on Drugs and Crime (UNODC) for the year 2015, there were an estimated 12 million injection drug users worldwide. 16 People who inject drugs are considered the most marginalized among those who use drugs.
More than one and a half million people were estimated to be living with HIV during the year 2013, and of that number, IV drug users represent the majority.
Additionally, an estimated 6.3 million IV drug users were estimated to be living with Hepatitis C virus infection. Prevalence of Hepatitis C has been reported as high as 60% in certain countries.
Injection drug users are also at an increased risk of overdose-related deaths, opioids being the most commonly implicated drugs in these deaths.
An analysis of findings of the 2010 Global Burden of Disease study reported that IV drug use as a risk factor for HIV accounted for 2.1 million DALYs (Disability Adjusted Life Years: a measure of the burden of disease), and as a risk factor for Hepatitis C, accounted for 502,000 DALYs.17
According to a study published by the Division of Infectious Disease and Hospital Epidemiology, infectious diseases are a chief cause of death among IV drug users.18 The high rates of infection seen in this group are seen against a background of malnutrition, needle-sharing and homelessness.
Even if you’re able to use IV drugs now and live a productive, disease-free life, all that could change in an instant with your next injection. With the incredible health risks associated with IV drug use, it is important you get the help you need.
- Ebright, J.R. and Pieper, B. (2002). Skin and soft tissue infections in injection drug users. Infectious Disease Clinics of North America, 16(3), 697-712.
- Roy, E., Arruda, N., Bourgois, P. (2011). The Growing Popularity of Prescription Opioid Injection in Downtown Montreal: New Challenges for Harm Reduction. Substance Use & Misuse, 46(9), 1142-1150.
- National Institute on Drug Abuse. (2014). Prescription Drug Abuse: How do opioids affect the brain and body?
- National Institute on Drug Abuse. (2016). Commonly Abused Drugs Charts.
- Mayo Clinic. (2014). Diseases and Conditions: Staph Infections.
- Medline Plus. (2014). Skin abscess.
- Medline Plus. (2015). Cellulitis.
- Centers for Disease Control and Prevention. (2015). Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy.
- Centers for Disease Control and Prevention. (2014). Botulism.
- Centers for Disease Control and Prevention. (2013). Tetanus.
- UpToDate. (2016). Suppurative (septic) thrombophlebitis.
- National Heart, Lung, and Blood Institute. (2010). What Is Endocarditis?
- National Institute on Drug Abuse. (2000). Facts About Drug Abuse and Hepatitis C.
- Centers for Disease Control and Prevention. (2015). HIV and Injection Drug Use in the United States.
- AIDS.gov. (2015). Symptoms of HIV.
- United Nations Office on Drugs and Crime. (2015). World Drug Report 2015.
- Degenhardt, L. et al. (2013). Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. Lancet, 382(9904), 1564-1574.
- BioMed Central. (2008). Appropriateness of antibiotic treatment in intravenous drug users, a retrospective analysis.