Injecting Drug Use Follow-up

Updated: Mar 31, 2016
  • Author: Gloria J Baciewicz, MD; Chief Editor: Eduardo Dunayevich, MD  more...
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Local problems associated with injecting drug use include abscess, cellulitis, septic thrombophlebitis, local induration, necrotizing fascitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (eg, broken needle parts) in local areas. The most common causative organisms reported are Staphylococcus aureus or Staphylococcus epidermidis, streptococci, and gram-negative bacilli.

Systemic problems associated with injecting drug use are HIV infection, hepatitis B or C, pneumonia or lung abscess from septic emboli to the lung, acute and subacute bacterial endocarditis, group A beta-hemolytic streptococcal septicemia, osteomyelitis, septic arthritis, candidal and other fungal infections, tetanus, clostridial myonecrosis, malaria, and amyloidosis. The endocarditis that occurs in individuals who inject drugs involves the right-sided heart valves; a recent review found no explanation for this predilection. [14] A rare case of needle embolization to the lung has been reported.


Patient Education

Chemical dependency treatment provides education and skills training regarding abstinence from drug use. For those individuals who are not yet able to abstain from injecting drug use, harm reduction approaches are used to educate about methods of safer injection, including the use of clean needles, sterile injection techniques, and safe disposal of needles. [15] Such outreach approaches are effective in promoting behavior change and slowing the spread of HIV and other infections. [16, 17]

Informal needle exchange programs in the United States began as early as the 1970s. In 1988, the New York City Health Department began the first government-sponsored needle exchange program in the United States. Usually, needle exchange programs operate by exchanging the used needles for an equal number of clean needles and syringes. Needle exchange programs may make referrals for chemical dependency treatment and medical treatment and may participate in other public health initiatives, such as distributing condoms and arranging HIV testing.

In some areas, needles and syringes are available for purchase from a pharmacy without a prescription. Those who purchase needles and syringes from pharmacies are less likely to participate in high-risk activities, such as using the services of crack houses or shooting galleries.

Several countries have developed harm reduction programs with different methods, including the introduction of syringe vending machines [18] and safe injecting areas or rooms.

Programs that distribute injectable naloxone to individuals for use in suspected overdose situations have been implemented in many larger US cities.

To reduce risks associated with injecting drug use, clinicians and public health workers must raise awareness of the health consequences and risks of injection, make contact with the target population by improving access and outreach, provide the means to change risky behavior, and gain political and community support for the measures introduced.

For excellent patient education resources, see eMedicineHealth's patient education articles Drug Dependence and Abuse, Narcotic Abuse, and Substance Abuse.