Maintaining vein vitality and identifying injection infections.
The length of time injecting drugs is a predictor of a greater number of drug classes ever used. It is also a predictor of changes in the bodily sites of injection, with a clear progression from the cubital fossa (crook of the arm) to the forearm, and other sites including the hand, the foot and leg, the neck and groin. It is evident that the use of more injection sites is associated with a greater number of injection-related health problems.
Wound and vein care
It is difficult to accurately determine the number of people who inject drugs that have mild to severe complications from injecting drug use – in particular poor vein integrity and injecting-related wounds.
An individual’s vascular health, and the complications associated with wounds from injecting of drugs is directly related to:
the length of use and frequency of an individual’s use,
the type of drug used,
their general health and wellbeing,
the level of hygiene and the cleanliness of the injecting environment
The injection of pill particulates (small insoluble particles), the organic matter, and other residuals in a opiate or amphetamine solutions, can result in poor vascular health – including:
phlebitis,
abscesses,
blocked blood vessels (leading to deep vein thrombosis, varicose ulcers and gangrene)
endocarditis localized vein collapse.
The long-term care required by health services and the attributable costs for those patients (for example) with ulcers, abscesses and open wound sis significant. Some wounds take many months to many years to heal. A timeline extended by the persistent use of drugs and poor general health.
Although injecting drugs per se results in injection-related problems, the injection of oral preparations and amphetamines exacerbates these harms. Methadone syrup, benzodiazepine liquids, and methamphetamine are independently associated with higher levels of injection-related poor health. These include more injection-related vascular problems, poorer general health, higher levels of psychological distress, and higher levels of needle sharing. Particularly significant scarring and bruising of injection sites, and difficulty injecting (indicating vascular scarring) are also well associated to these drugs.
What seems to work
Washing hands thoroughly prior to injecting preparation and the injection of that drug in a clean environment impacts markedly on vein maintenance and health. Equally, alternating the site of injection between the cubital fossa (crook of the arm) and limiting the frequency of injection all improve the health and integrity of veins over time.
For wounds, cleaning hands, a general clean environment, and having fresh clean wound dressings are as essential to reducing the length of time they take to heal. As is the timely access to a GP or pharmacist for medical advice. The safe disposal of used wound dressings and the cleaning of hands after dressing open wounds is vital to reducing the timeline to restoring tissue health.
Filters save limbs, save lives facstheet
An easy to read, visually descriptive wheel filter factsheet can be downloaded for printing: Sterile Filters Factsheet. The Quadrant Approach. C2017
References:
Binswanger I, Kral A, Bluthenthal R., et al. 2000. High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clinical Infectious Disease: 30(3):579 – 581.
Bassetti and Battegay. 2004. Staphylococcus aureus infections in injection drug users: risk factors and prevention strategies. Infection. 32:163-169.
Caflisch C, Wang J, Zbinden R. 1999. The role of syringe filters in harm reduction among injection drug users. American Journal of Public Health. 89(8): 1252
Kluytmans J, van Belkum A, Verbrugh H (July 1997). Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms and associated risk. Clinical Microbiology Review,10 (3): 505–20.
Longtin, Y; Sax, H; Allegranzi, B; Schneider, F & Pittet, D. (2011). Hand hygiene. New England Journal of Medicine, 364:e24.
Ministry of Health.(2002).Guidelines for the control of methicillin-resistant Staphylococcus aureus in New Zealand. Ministry of Health: Wellington.
Scott, J., Bond, C., Kennedy, E & Winfield, A. (1997).Investigation into the Effectiveness of Filters for use by Intravenous Drug Users.The Robert Gordon University, School of Pharmacy, Aberdeen &University of Aberdeen, Department of General Practice.
Scott, J. 2005. Laboratory Study of the Effectiveness of Filters used by Heroin Injectors. Journal of Substance Use. 10:5.
Scott, J. 2008. Safety, Risks and Outcomes from the Use of Injecting Paraphernalia.Scottish Government Social Research.
Vlahov, D., Sullivan, M., Astemborski, J &Nelson, K. (1992).Bacterial infections and skin cleaning prior to injection among intravenous drug users.Public Health Rep. 107(5):595-8.