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,
20 ■ Harm reduction ■ Legal status of drugs ■ Commonly misused drugs ■ Drug facilitated sexual assault ■ Further information sources
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, as with the anthrax outbreak amongst injecting drug users in Scotland in 2009, even rare complications can become clinically significant.
