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Health Issues for Injection Drug Users
Street Works Street WorksCommon Health Problems of IDUs
1) Skin
2) Infectious Diseases
3) Cardiopulmonary
4) Overdose/Withdrawal
5) Other

Skin Problems

Abscesses/ Cellulitis
• Can be from mixing their drugs with something dirty, licking the site or needle before injecting, not cleaning properly before injecting.
• Often people treat themselves
• Starts out as a red, often raised area, which is warm to touch-should see a doctor as can be very serious if not treated.

Necrotizing Faciitis
• Does not respond to only antibiotics, surgery is needed,
• Starts with pain and redness then progresses into black crusty tissue that smells bad,
• Progresses VERY fast.
• Track Marks
• Scarring on the skin from frequent injections, using alcohol wipes AFTER injecting.
• Some look like heavy scars/ little dots/red scabs.
• There are several things that one can use to reduce scarring i.e. vitamin E cream, Eucarin cream, Prep H

We usually suggest that people use wipes before injecting, use the smallest gauge needle as possible, a new needle every time, and to rotate sites, keeping skin clean and moisturized.

Just because a person has track marks does not mean that they are presently using. Some track marks may stay for a while and some may never go away.

Infectious Diseases

Hepatitis C
• Between 60-80% of IDUs are infected with Hepatitis C
• 6 different genotypes- genotype #1b is the most common in IDUs and also the least responsive to therapy
• Can lead to cirrhosis and liver cancer (excessive drinking can increase chances of liver cancer)
• Many of our clients are not on therapy
• New evidence shows Hep C could be sexually transmitted with certain risk factors

HIV/AIDS
• In 1997 7% of Streetworks clients were infected
• IDUs have a greater risk of contracting HIV because drug use can cloud judgment and lead to unsafe practices, as well as other barriers.
• Person may be working as a prostitute to pay for drugs. Dates may pay more to not use a condom.
• May not be in a relationship where they can, or want to, ask partner to wear a condom

HIV and Hep C Coinfection
• Often go hand in hand because of lifestyle choices/route of infection
• Progress of one disease can affect the progress of another
• Those who are coinfected are three times more likely to develop cirrhosis
• Hep C increases opportunistic infections of HIV
• Those who are coinfected are 6x as likely to die from liver disease than non-coinfected individuals.

With liver damage drug metabolism is impaired and can led to toxicity.

Why treat?
Each disease has a worse prognosis when co-infected.

Why not to treat?
• Hep C might not be at the stage where it is affecting the liver
• The side effects of HIV meds are more pronounced with co-infection
• Risk of liver toxicity is greater because one’s liver is already compromised


Cardiopulmonary

Chalk Lung (pulmonary talcosis)
• Talc used to bind together medications
• Talc deposited in lungs -> body recognizes the talc as a foreign substance and begins reacting.
• Scar tissue results in the lungs; lung area is decreased leading to less oxygen in body.
• Presents with similar symptoms as COPD- often misdiagnosed as asthma
• Prevented by filtering and not doing shakers.

Infective Endocarditis
• Can be serious- can lead to blot clots in the lung
• Right-sided IE is more common in IDUs
• Usually caused by a germ, staphyloccocus aureus.
• Signs and symptoms include- usually high fever with breathing problems i.e. cough, chest pain, coughing blood, difficulty breathing, and swollen feet.
• Diagnosis is through blood cultures
• Treatment is IV antibiotics- may be in the hospital for weeks.

Embolism
• Can be serious as can cause stroke, heart attack, clot in the lungs,
• We encourage people to not inject into their neck, mix drugs in blood, and filter.


STDs

• Pose a threat to both the person and the community if untreated/undetected- can affect person’s physical and emotional health (infertility, pain, financial loss)
• Cannot live or reproduce on inanimate objects such as toilet seats, utensils, or swimming pools (except for parasites)

Many STDs have no symptoms
• Some symptoms may be:
• Redness, swelling and/or discharge
• A burning sensation
• Itching
• Sores, rashes, or bumps
• 80% of men have symptoms and 20% do not- so they may not know they have an STD and might pass it on
• No cost for STD testing at STD clinic
• Condoms are best for preventing STDs, but are not 100% effective
• If sores or warts are located on area not covered by condom there is no protection.
• Bacteria and fungi can be treated with meds whereas viruses can only be managed.

Types of STDs IDUs might be at risk of getting:
• Viruses- HIV/AIDS, Hep B, Hep C, warts, herpes
• Fungi- yeast infections
• Parasites- crabs, scabies
• Bacteria- gonorrhea, chlamydia, syphilis

Please see the STD book for more detailed information.

Addictions & Dual Diagnosis
• The idea of dual diagnosis suggests two distinct problems in one person (Health Canada, 1995).
• Several different services are needed to address the issue.
• Psychiatric disorders most often seen with drug use are major depression, schizophrenia, and bipolar disorder.

Smith & Seymour (2001) outlined 4 patterns of dual diagnosis:
1) Pre-existing mental illness in which “…the person has a clearly defined mental illness and then gets involved in drugs.”
2) Potential for mental illness when a “…person starts to use…drugs, the effects of those substances activate or accelerate the development of an underlying mental disturbance.
Addictions and Dual Diagnosis (cont’d)
3) Permanent drug induced mental illness.
“ There is not a pre-existing problem, but as a result of years of use…the user develops a chronic psychiatric because the toxic effects of the drug permanently imbalance the brain chemistry.”
Addictions and Dual Diagnosis (cont’d)
4) ‘Temporary’ drug induced mental illness.
“… occurs when the drug itself or withdrawal from the drug causes transient depression, temporary psychosis or other apparent mental illness.”
- Sometimes if a person treats their mental illness, their use of drugs may decrease or stop altogether.

Overdose
Many addicts also use other types of drugs or alcohol so overdose may be of a mixed type.
• DON’T PANIC
• Monitor closely
• May need NARCAN/emergency measures
• Many will sleep off an overdose

3 types of overdoses:
• Voluntary-take too much purposely
• Involuntary-may be stronger than usual or may use a different dealer, lower tolerance
• Accidental-liver may not work as well because person may be immuno-suppressed or have liver problems (i.e. hepatitis)
• In 1999 in Edmonton there were 70 unintentional overdoses.
• In San Francisco, 25% of overdoses occurred within 7 days of discharge from jail or deter.
• Some people recover from their overdoses and others may die.

Opiates:
Slow, shallow breathing
Lack of judgment
Pinpoint pupils
Hypoventilation
High blood pressure
Sleeping/nodding

Stimulants:
Rapid, irregular heart beat
Feelings of anxiety/ hard to breathe
Cardiac arrest (heart attack)
Stroke
Brain seizure
Blackouts/paranoia
Respiratory failure

Withdrawal
Can occur with the reduction or discontinued use of a substance of abuse
2 types:
• Voluntary-some may intentionally stop using themselves
• Involuntary-may be placed in jail or hospital and have to stop using abruptly, or if their supply ends

Opiates:
Vomiting
Sore bones/cramping
Diarrhea
Sweating
Dry heaving
Craving sweets
Visual changes when pupils open up to normal

Stimulants:
Irritability
Depression
Restlessness
Crying
Unable to sleep at first and then “crash”

Suggest eating better, sleeping more, and maybe even see a doctor
If people don’t get the drugs they need they become “dope sick”. Many people will self medicate and do whatever it takes to treat the withdrawl.

Most people know their own bodies and know when they are withdrawing.

Be aware if T3 use- codeine only is best.

Cotton Fever (aka Acute Febrile Syndrome)
• Caused by a piece of cotton caught in the bloodstream-> from filtering with cotton or by boiling down filters to get out the extra drugs
• Also could be caused by a germ.
• Rigors, nausea and vomiting, body ache, high fever
• Self-limiting, usually within a couple of hours
• Onset is usually between 10-20 minutes after injecting-temp is usually b/t 38.5-40.3 C.
• Treatment to treat symptoms only. Blood culture to find out if there is infection.
 
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