Drugs may be swallowed, smoked, inhaled through the nose as a powder (snorted), or injected. When drugs are injected, their effects may occur more quickly, be stronger, or both.
Drugs may be injected into a vein (intravenously), a muscle (intramuscularly), or under the skin (subcutaneously). Veins in the arms are typically used for intravenous injections, but if these areas become too scarred and damaged, some people inject drugs into other veins, including those of the thigh, neck, armpit or feet.
(See also Drug Use and Abuse.)
Complications of Injection Drug Use
Injecting a drug has more risks than other methods of use. People are exposed not only to the effects of the drug but also to problems related to injection itself, such as the following:
Adulterants: Adulterants are substances that are added to a drug to alter its physical qualities. They are usually added, without the user’s knowledge, to reduce costs or to make the drug easier to use. Thus, users do not know what they are injecting. In street drugs such as heroin and
Fillers: Some people crush tablets of prescription drugs, dissolve them, and inject the solution intravenously. These people are injecting the fillers that tablets commonly contain (such as cellulose, talc, and cornstarch). Fillers can become trapped in the lungs, causing inflammation. Fillers can also damage heart valves, increasing the risk of infection there (endocarditis).
Bacteria and viruses: Injecting drugs with unsterilized needles, particularly needles used by someone else, can introduce bacteria and viruses into the body. As a result, abscesses may develop near the injection site, or bacteria or viruses may travel through the bloodstream to other parts of the body, such as the lungs, heart, brain, liver, or bones, and cause infection. Infection of the heart valves (endocarditis) is a common serious consequence of injecting drugs contaminated with bacteria or using dirty needles. Injecting drug users can develop botulism and tetanus infection through the injection site. Sharing needles can spread serious infections, such as hepatitis B and C and human immunodeficiency virus (HIV) infection.
Injuries due to needle use: Drug abuser’s elbow (myositis ossificans) is caused by repeated, inept needle punctures. The muscle around the elbow is replaced with scar tissue. Subcutaneous injections (those given under the skin, also called skin popping) can cause skin sores. Intravenous injections lead to scarring of veins (track marks), which makes the veins more and more difficult to inject and impairs blood flow.
Diagnosis of Injection Drug Use
A doctor's evaluation
Sometimes self-reporting
Sometimes injection drug use is diagnosed when people go to a health care practitioner because they want help stopping use of the drug. Other people try to hide their drug use.
Practitioners may suspect problems with drug use when they notice changes in mood or behavior in a person. They may then do a thorough physical examination. Signs of drug abuse may be apparent. For example, repeatedly injecting drugs intravenously produces track marks. Track marks are lines of tiny, dark dots (needle punctures) surrounded by an area of darkened or discolored skin. Injecting drugs under the skin causes circular scars or ulcers. People who inject drugs may claim other reasons for the marks, such as frequent blood donations, bug bites, or other injuries.
Health care practitioners also use other methods (such as questionnaires) to identify abuse of some drugs and other substances and to determine the extent of drug use and its effects. Urine and sometimes blood tests may be done to check for the presence of drugs.
If a drug use problem is identified, especially if the drugs are injected, people are thoroughly evaluated for hepatitis, HIV infection, and other infections common in people who use these drugs.
ST. MARY'S HOSPITAL MEDICAL SCHOOL/SCIENCE PHOTO LIBRARY
Treatment of Injection Drug Use
Counseling
Prevention and treatment of infectious complications
Treatment of complications is the same as that for similar complications with other causes. For example, abscesses may be drained, and antibiotics may be used to treat infections.
Because sharing needles is a common cause of HIV infection and hepatitis, a harm-reduction movement was started. Its purpose is to reduce the harm of drug use in users who cannot stop. Thus, users are provided clean needles and syringes so they do not reuse others’ needles. This strategy helps reduce the spread (and the cost to society) of HIV infection and hepatitis.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
National Institute on Drug Abuse (NIDA): Federal agency that supports scientific research into drug use and its consequences and supplies information about commonly used drugs, research priorities and progress, clinical resources, and grant and funding opportunities.
Substance Abuse and Mental Health Services Administration (SAMHSA): US Department of Health agency that leads public health efforts to improve behavioral health and provides resources, including treatment locators, toll-free helplines, practitioner training tools, statistics, and publications on a variety of substance-related topics.
