Needle to the Skin Again Injecting Rust and Cinnamon

Potential Health Complications of Injection Drug Use

Many, if  non  all, of  the  things  that  can  go  wrong during the procedure of preparing and injecting drugs fall into one of three categories: drug-related, technique-related, and hygiene- related mishaps. Because we're forced to use blackmarket, unregulated drugs, we don't have control over the quality or purity of the substances we apply.  While we may not be able to exercise much almost the actual drugs we use, we can work to ameliorate our injection technique and hygiene which tin can take far-ranging furnishings on our wellness.

There are numerous and potentially very serious health complications associated with injecting illicit drugs, from injection-related injuries like tracking and bruising, to bacterial and fungal infections, from communicable diseases, to drug overdoses and other medical emergencies. This section of the manual describes some of the medical and health problems that tin result from injecting drugs and offers suggestions for how to prevent them. Overdose prevention and survival are addressed in chapter four.

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Dingy HITS

A "dirty hit" is a general term for a shot that makes someone ill or causes an abscess as a result of being contaminated with infection-causing microbes or toxic substances. Dirty hits can be caused by any number of things, such equally:

• contaminants in the water you used to dissolve your drugs;

• bacteria, fungi, or other microbes from erstwhile cottons;
• chemicals in a cigarette filter that was used to filter a shot;
• adulterants or contaminants in the drugs themselves; or
• non properly cleaning the pare prior to injection.

BACTEREMIA (bacteria in the claret)

Bacteremia is when  bacteria entersthe claret- stream that tin be caused by injecting with contaminated water, re-using onetime cottons, or declining to clean the skin prior to injection.

Early on symptoms include chills, fever, and extreme fatigue. If you feel these symptoms, seek medical attention. Bacteremiacan be fatal!

ENDOCARDITIS

Endocarditis is an infection of the centre valves  that is caused by leaner, fungi, and other infection-causing microbes that enter the bloodstream during injection and build upwardly effectually the valves of the eye, weakening them likewise as other parts of the heart musculus. Endocarditis can eventually cause a heart murmur, every bit well as fever, chest pains, fainting spells, shortness of breath, and heart palpitations besides every bit congestive center failure. Early on signs include influenza-like symptoms. It tin be treated with antibiotics or antifungal agents if detected early, just requires several weeks, or months, of IV antibiotics and/or centre valve replacement surgery if not detected early. Endocarditis can be fatal if it goes untreated.

TETANUS

Tetanus is a bacterial infection that occurs when tetanus spores enter a wound and release tetanus bacteria, usually after a scab has already formed. The bacteria so enter the bloodstream and cause an infection, which is characterized past musculus spasms or rigidity, especially in the neck and jaw (tetanus is normally called "lockjaw"). Tetanus is fatal if non treated.

Tetanus spores live in the soil and on rust, which is why a tetanus shot is recommended if you step on an erstwhile nail or other rusty object. Most local health departments offering free tetanus boosters, which volition protect you from tetanus for five years, so y'all should r get one. If your needle, syringe, or other injection equipment is contaminated with tetanus spores due to dirt or rust, you could infect yourself. Skin-poppers and muscle- poppers are especially susceptible to tetanus infection and should always use new, sterile equipment.

NECROTIZING FASCIITIS (Flesh-Eating  Disease)

Necrotizing fasciitis is a bacterial infection usually known equally "flesh-eating disease" that enters the body through cleaved skin and then affects the surrounding tissue and nearby muscle. It tin can exist transmitted past the substitution of blood during needle sharing, and has been traced to "black tar" heroin on the Due west Coast.

Symptoms of necrotizing fasciitis include increasing redness and swelling and extreme pain at the wound or injection site accompanied by a fever. This may wait a few dissimilar ways, the mankind around the site of infection will be very ruby, swollen, with severe pain, and possible fever. . Over the course of days the pare tin turn from red-purple to blue-gray and the pare could break down within 3-five days. Since this infection is fatal, early treatment with antibiotics is crucial to survival, although fifty-fifty appropriate therapy does not preclude death in all cases. Wounds must exist kept impeccably clean.

E'er using new, sterile injection equipment; never sharing injection equipment; thoroughly washing your hands and make clean- ing the skin prior to injection; and preparing your drugs on  a clean surface will all help prevent necrotizing fasciitis infections.

WOUND BOTULISM

Wound botulism is caused by a bacteria that produces a toxin on the peel where a puncture wound is fabricated and that somewhen stops your breathing by paralyzing your muscles. Cases accept been associated with the subcutaneous injection of "black tar" heroin on the West Coast. The source of the botulism could be the drug itself, a cut in the drug, dingy injection equipment, or contamination during the preparation process. Wound botulism can be prevented in the same ways as necrotizing fasciitis–by post-obit excellent sterile technique when preparing and injecting your drugs.

Symptoms of wound botulism include droopy eyelids, blurred or double vision, and a dry, sore pharynx which may progress into difficulty speaking and swallowing, a weakness of the neck, arms, and legs, and difficulty animate.

If untreated, wound botulism will cause death past paralyzing the muscles used for breathing. Early handling for wound botulism is essential. If you  experience  whatever  of the  symptoms  listed  in a higher place,  seek   medical   attention   immediately. Treatment normally involves an antibiotic regimen and the draining of any abscesses or infected wounds.

HEPATITIS

Hepatitis is an inflammation of the liver that tin can exist caused by certain toxic drugs, alcohol, or street drugs (iatrogenic or chemically-induced hepatitis); or that is the event of infection with a hepatitis virus (viral hepatitis). While there are numerous types of hepatitis viruses, hepatitis-B and hepatitis-C are the 2 that most oft affect people who inject drugs, with hepatitis-A coming in third.

General symptoms of hepatitis include fatigue, loss of appetite, nausea, balmy fever, and muscle aches, and if you smoke cigarettes, you may discover that they taste unpleasant. More than severe symptoms of hepatitis include nighttime (tea-colored) urine, light-colored stools, and jaundice (a yellowing of the peel and the whites of the eyes).

HEPATITIS A ( "HAV") is excreted in feces (shit) and spread by fecal-oral contact (feces-to-hand- to-mouth contact). Hepatitis A can be spread from contaminated food, h2o, hands, and eating utensils, for instance, by a restaurant worker who didn't wash their hands after using the bath and who and then prepared food. At that place have also been outbreaks in places similar encampments where people may not take admission to running water for handwashing.  Unlike hepatitis B and  C, hepatitis A is not transmitted by blood-to- blood contact that occurs when needles or other drug injection equipment is shared, and is not generally spread through sexual contact unless rimming (oral-anal contact) is involved.

Hepatitis A disease resembles the flu and tin concluding from four to six weeks. It causes an astute (short-term) infection merely and never develops into a chronic condition similar hepatitis B or  C. You develop antibodies to hepatitis A after y'all've been infected with it, so your chances of ever getting it once again are slight. A hepatitis A vaccine is available and is . a two-shot regimen, with the second injection taken 6 to 12 months afterward the first.

HEPATITIS B ( "HBV") is spread through blood-to-blood contact of the kind that occurs when injection equipment is shared; contact with infected body fluids like semen, claret, vaginal fluids s; and from a parent to their babe at birth. Hepatitis B infection tin be acute (short-term) and/or chronic (long-term); chronic HBV can cause serious liver damage, including cirrhosis (scarring), liver cancer, and death from liver failure. Hepatitis B is much more infectious than HIV, which means it is spread much more hands. Information technology is ane of the nigh of import reasons people who inject should avert sharing injection equipment of whatever kind.

A vaccine that will protect you confronting hepatitis B if you're exposed to it is available, and all people who inject drugs should think most getting it . The vaccine involves a series of three intramuscular injections, with the 2nd shot being administered 30 days afterwards the beginning, and the tertiary shot being administered 4 to 6 months after the second. The vaccine is safety and effective. If

you've had hepatitis B in the past, you've developed antibodies to it and will not catch hepatitis B once again in the time to come and do not need the vaccine. Y'all tin can get your blood tested to encounter if yous've ever been exposed to the hepatitis B virus, and go the vaccine at your doctor, local Department of Health,, or even your syringe service programme.

HEPATITIS C (formerly known as "not-A, non-B" hepatitis and also referred to as "HCV") is spread through blood- to-claret contact and is very infectious, which means you can acquire it quite easily if exposed to it. There are oral and blood tests available that notice whether or not you have antibodies to the hepatitis C virus in your blood, which, if positive, should exist confirmed with a 2nd test.  .  The just mode to test whether or non yous accept the actual virus in your blood is by getting a confirmatory exam which shows whether you have a electric current infection or not.  In that location is as yet no vaccine for hepatitis C, and antibodies are not protective—that is, they don't make you allowed to re-infection as with HBV. Currently, there is only prevention by fugitive blood-to-blood contact with use of sterile injection equipment, by non sharing injection equipment, and through safer sex.

Hepatitis C can either be chronic but asymptomatic (without symptoms, which means you barely even find you take information technology), or chronic-active, which means disease will develop over a long period of time–several years or perhaps even decades.  Up to a quarter of people who become infected with HCV will clear the virus on their own and not develop chronic hepatitis C.  This does not mean you're immune, or that y'all'll be able to clear it if you're re-infected.  People with active hepatitis C may take elevated liver office tests (LF Ts), fatigue, and jaundice, and agile illness tin consequence in cirrhosis, liver cancer, and ultimately liver failure, all of which can be fatal. The hepatitis C virus tin be cleared from the body with medication,  and over fourth dimension, the liver may exist able to regenerate itself.  Regular testing helps to prevent hepatitis C from going unnoticed.   Hepatitis C is a serious wellness take a chance for people who inject drugs, many of whom take been exposed to the virus at  some signal in their  lives.

In the past hepatitis C treatment was largely ineffective and had serious side effects.  Since 2013, there have been highly effective, all-oral, cures for hepatitis C.  Hepatitis C treatment can, and should, exist available to anybody.  Nonetheless, it may be difficult to access treatment based on where you live, your medical coverage, and your liver impairment.

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Human being Immunodeficiency Virus (HIV) is the virus believed to cause AIDS (Acquired Immune Deficiency Syndrome), an immune system disorder that causes the body to lose its ability to ward off infection and fight disease. HIV can be spread through the commutation of certain fluids (if they incorporate the virus).  These fluids are: semen (including pre-cum), vaginal,  and rectal fluids (during unprotected sex);  blood (via childbirth, the sharing of drug injection equipment or adventitious needlesticks); and breastmilk.

Claret-to-claret contact is 1 of the most efficient ways of transmitting HIV from one individual to some other, and the sharing or re-use of drug injection equipment is extremely risky in terms of HIV manual. It is important to point out that injection drug use itself does not cause HIV; rather, HIV is transmitted (like hepatitis and other viruses) when infected blood from i private is left in a needle, syringe, cooker, cotton, or water and injected into the bloodstream or body of a second individual who uses those aforementioned works. HIV from injecting drugs is therefore 100% preventable as long as you lot e'er use your own sterile works and never share them with anyone.

Full general symptoms of early HIV infection (before long later the point of transmission) may include a low-class fever and fatigue. The longer a person has HIV and does non receive medication,, the more probable they are to develop i of the many bacterial, fungal, or viral infections, cancers, neurological disorders, or other weather that affect people with HIV and AIDS.  There are numerous medication regimens including one pill version that tin can continue the HIV virus undetectable in the trunk HIV virus in the body and then that yous tin can live a regular lifespan.

 In July 2012, the Food and Drug Assistants (FDA) approved the use of tenofovir + emtricitabine (TDF/FTC), commonly known as Truvada, for HIV PrEP (Pre-Exposure Prophylaxis)  in adults who are at high risk for becoming HIV infected.  An uninfected person who might go exposed to the virus is provided a prescription for antiretroviral medications to prevent from becoming infected with HIV.   PrEP Eligibility includes: people who inject drugs and who share injection equipment, individuals who use stimulant drugs associated with high-run a risk behaviors, such as methamphetamine, and individuals who trade sex for money, drugs or housing.  PrEP is only for clients with a documented negative HIV test result.  HIV and STI testing, also as blood tests to bank check on the liver, are repeated every three months. PEP (Post-Exposure Prophylaxis) is an option for individuals who have come up in contact with fluids that may contain the HIV virus within the past 72 hours. Like to PrEP, it is a course of antiretrovirals, but information technology is only taken for the calendar month following the exposure.

INJECTION – RELATED INJURIES

TRACKING AND BRUISING

Track marks are the scars that appear along the veins of someone who injects frequently and repeatedly uses the same  injection sites.

How a bruise is formed

Bruising occurs when claret leaks out from the vein under the skin in the process of injecting. Damage to the veins, including tracking and bruising, can be minimized or prevented altogether by practicing the following safer injection guidelines. (These are especially important for those individuals who are worried nearly family unit, friends, an employer, or someone else finding out about their drug apply. Rail marks are i of the most visible signs that you use.)

• Apply a new, sterile needle for every injection. Re-using needles, even once will cause them to dull.  Slow needles will crusade trauma to the veins and surrounding tissue, crusade a much larger puncture wound, and increase bleeding at the site.
• Apply the highest gauge (thinnest) needle you can notice to make the smallest puncture wound possible.
• Alternate and rotate your injection sites. E'er try to inject at least one inch "up" from your previous injection site (for your arms, this means moving away from the hand and toward the shoulder, and for the legs, this would mean away from your feet and toward the hips).  Give your veins a chance to remainder in between injections. Stay away from veins that are ruddy or tender until they heal.
• Always inject in the direction of the trunk'south blood catamenia (toward the center).
• Use a soft, flexible, piece of cake-to-open up tourniquet and remove it after y'all've registered but before you inject to help prevent bruising.
• Employ emollient-rich or antibiotic creams on injection sites once they've closed or scabbed over. Aloe vera gel and vitamin E oil are commonly-available and can assist reduce the appearance of track marks.

VEIN COLLAPSE

Vein collapse occurs when veins shut up due to repeated injections into the same site, repeated local infections, or trauma to the veins and surrounding tissues. Using barbed or dull needles tin can precipitate vein collapse. You know you lot take a collapsed vein when yous can't draw blood from information technology or when the vein "disappears." Thrombosis is the formation of an obstruction of a blood vessel by
a blood jell. Don't utilise veins that do not bend when pushed as they may have claret clots that tin can break off and lodge in the lungs or other parts of the body and crusade serious harm.
You can avoid vein plummet by always rotating and alternate your injection sites and by injecting in the direction of the body'south claret flow (toward the eye). Using the same injection site over and over without letting the vein heal is one of the surest ways to crusade vein collapse. Also, insert your needle at a 15 to 45 degree angle with the bevel of the needle facing upwards. Taking oral vitamin C may assist your veins repair themselves and reduce bleeding and bruising. NEVER inject vitamin C, but eat it.

ABSCESSES

Abscesses begin with redness, swelling, and tenderness at an injection site and develop into an infection with a difficult, pus-filled core. Abscesses result from missed hits (injecting into the tissue surrounding the vein), injecting a solution with a lot of particles in it, not cleaning the injection site prior to injecting, re-using injection equipment, or peel-popping drugs like coke or speed that cause damage to muscle tissue and skin.
If you've just missed your shot and are worried about getting an abscess, ice the area immediately after and raise the injection site for at to the lowest degree 30 minutes, if you can. This will not forestall an abscess if one is developing, just volition help to ease the swelling. If any abscess does develop, switch from icing the area to heat.
If you notice a hard, warm lump developing at an injection site, apply warm compresses at least  three times a solar day to either make the abscess that is forming go abroad or come to a head (soften and fill with pus). If it comes to a head, you tin can get the abscess opened and drained at a hospital or clinic. If you experience fever, chills, extreme fatigue,  pain associated with an abscess, or a thin nighttime line moving from the abscess, seek medical attention immediately because y'all could have a blood infection. Pain in the groin or armpits (where your lymph nodes are)likewise means you most likely accept an infection for which you should seek medical treatment.

HOW AN ABSCESS IS FORMED

If you're unable or unwilling to seek medical care for an abscess, accept the following steps:

1. Clean the area with soap and water and dry it well  e sure to go on it as make clean and dry as possible at all times.
2. If the abscess is draining on its own (pus is coming out of it), let it continue to do so. Do not touch the abscess (except to clean information technology), squeeze information technology to extract the pus, stick your syringe into it, or inject to a higher place or below it.
3. Continue the surface area covered with sterile gauze you lot tin buy in a pharmacy, and change the dressing twice a day until the pus stops draining and at least once a day until the abscess is completely healed. Dressings that directly touch on the wound should be dampened with sterile saline (which y'all can too purchase at a drug store) and then covered with dry gauze and tape. Properly dressing an abscess will assistance keep it free from further infection and speed healing.
4. When removing the dressing, dampen the gauze that'south touching the wound so you don't pull off newly formed tissue.
5. Warm compresses and salt soaks volition encourage the abscess to bleed and promote healing. Practise non soak or apply a compress one time the wound is open or draining. Afterwards the abscess has drained and scabbed over, antibiotic creams and preparations like aloe vera gel can be helpful.
6. Let the area heal completely. If the abscess refuses to drain completely or pain and swelling persist, seek medical attention.

 If you exercise seek medical care to take your abscess drained, try to find a wound clinic where you can go your dressing inverse on a regular basis and make sure the abscess is healing properly. If in that location isn't a wound clinic available near you lot and y'all need your abscess drained, try a customs clinic or emergency room.. If y'all do seek care for your abscess at the emergency room or a community clinic, know in advance that the doctor may cut into your abscess and scoop the pus out with their (gloved) fingers, and that they should provide you with lidocaine to numb the expanse. If they practice not offer lidocaine, you are well within your rights to ask for it! Depending on what the infection is similar, you may also be prescribed antibiotics. Try to take the full course of medication. And call up, although at that place are certainly no guarantees when it comes to people'south views about injection drug use, you deserve compassionate treatment and are allowed to advocate for yourself.

EMBOLI

An embolism is something such as air, fat, impurities, clay, or other particles that can obstruct a blood vessel which results in the blockage of claret menstruum. Particles from injected pills that were not completely pulverized and clumps of bacteria are two examples of things that can cause emboli. Emboli tin can exist extremely serious, particularly if they travel through the claret vessels to the middle or lungs or society in the small capillaries of the fingers, eyes, or toes where severe apportionment impairment can occur. The chance of emboli can exist reduced past filtering out any particles in your shot

 TAKING Care TO YOUR HEALTH

Nosotros've got some tips for people who use drugs to access healthcare and abet for yourself with healthcare providers – cheque out Quality Healthcare Is Your Right resource .

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Source: https://harmreduction.org/issues/safer-drug-use/injection-safety-manual/potential-health-injections/

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