Intravenous drug user
"Frankfurter
Tunnel" bei i.v.-Drogenabusus: Faktitieller intravenöser Drogen-Injektionszugang in der Leiste nach repetitiven Injektionen in die V. femoralis. In der Umgebung um diese Retraktion der Cutis in die Tiefe zahlreiche entzündlich vergrößerte Lymphknoten.
Femoral vein
thrombophlebitis and septic pulmonary embolism from intravenous drug use. Left femoral vein thrombosis extending to the external iliac, common iliac and inferior cava vein. Note the prominent vessel wall enhancement and endoluminal gas bubbles indicating septic thrombophlebitis.
Femoral vein
thrombophlebitis and septic pulmonary embolism from intravenous drug use. Left femoral vein thrombosis extending to the external iliac, common iliac and inferior cava vein. Note the prominent vessel wall enhancement and endoluminal gas bubbles indicating septic thrombophlebitis.
Intravenous drug users (IVDU) (also known as intravenous drug abusers (IVDA)) are patients who self-inject recreational drugs, most commonly heroin, although many other agents are frequently injected, including cocaine, prescription opioids and methamphetamine.
Terminology
Intravenous drug users form part of a larger population of persons who use drugs (PWUD) .
Clinical presentation
Intravenous drug users may present due to a variety of complications :
- at/close to the injection site
- vascular
- soft tissue infections
- tissue necrosis
- factitious intravenous drug injection site (tunnel of Frankfurt)
- remote from the injection site
- infections
- specific: infective endocarditis, HIV/AIDS, hepatitis B/C, pulmonary septic emboli, osteomyelitis, etc.
- non-specific: sepsis
- infections
- chronic disease: multiple comorbidities are common
- vascular: serial venous thromboembolism, venous ulcers, peripheral vascular disease (PVD)
- limb amputation: due to vascular insufficiency, infections, personal neglect
- skin: chronic pruritus, soft tissue/wound infections, lower limb ulcers
- GI: nausea, constipation
- hepatic: viral hepatitis, cirrhosis, hepatocellular carcinoma
- pulmonary: early COPD, poorly-controlled asthma, TB, pneumonia
- dental : caries, dental abscesses, multiple extractions
- GU: STIs, poor fertility, erectile dysfunction
- pregnancy: multiple issues, including unplanned pregnancy, IUGR, fetal addiction syndromes, prematurity, maternal death
- related to the drug and/or excipients
- non-specific
- overdose
- allergic reactions including anaphylaxis
- ARDS
- specific
- hypogonadism in heroin use
- non-specific
- violent traumatic injuries
- mental illness: high prevalence, both due to, and as a cause, of IVDU
- depression
- general anxiety disorder
- post-traumatic stress disorder (PTSD)
- self-harm and suicide
- severe psychiatric disease: drug-induced psychosis, schizophrenia, bipolar disorder, personality disorders
- alcohol, other substance addiction
Intravenous drug users are also at increased risk of disease due to often having other risk factors for disease, including long term tobacco use, chronic alcohol excess, malnutrition, poor living conditions, etc. e.g. pneumonia .
Siehe auch:
Assoziationen und Differentialdiagnosen zu i.v.-Drogenmissbrauch: