ABSTRACT
Stigmata of intravenous drug use are commonly seen in association with injection site ulcer, abscess, deep vein thrombosis, venous ulcer and post-phlebitic limb (Figures 20.1-20.4). Severe complications requiring hospitalization, such as necrotizing fasciitis, may occur. Injectors may be very adept at gaining vascular access for the administration of drugs, and any clinician should
be aware of the wide variety of sites that may be used for injection (Figure 20.5). Infectious systemic complications occur less often, such as transmission of human immunodeficiency virus (HIV) and hepatitis, but in some areas of the world essentially all injection drug users are infected with the hepatitis C virus. In the case of anthrax the source of infection is believed by some to be the animal skins used to transport the heroin into Europe, but person-to-person spread occurs via the exchange of saliva or blood. Valvular infection, secondary to the injection of non-sterile material, can lead to valve destruction and some confusing medical symptoms, as when bacterial vegetations separate from the valve and circulate through the body. At the same time that the incidence of this complication seems to be decreasing, the rate for valvular infection with mixed organisms, many drug resistant, seems to be increasing. Other complications are so rare as to merit little attention, but occasionally, even rare complications can become clinically significant. In 2012 cases of anthrax were reported in a number of European countries. In March 2013, following the seventh anthrax related death in the UK, the North Inner City Drugs Task Force in Dublin issued an anthrax alert for heroin users and for front line staff who have contact with them.
