Substance abuse is perpetuated in many ways. Drugs are ingested, snorted, smoked, or injected. Injected drugs are liquids put into the body with a needle and syringe.
The drugs are either injected into a vein (intravenous or IV), the muscle (intramuscular) or just under the skin (subcutaneous). The World Health Organization (WHO) reports that as many as 16 million people around the world inject drugs.
Injected drugs include:
- Prescription medications
With the exception of marijuana, almost all drugs can be injected, although heroin is likely the most common. Drugs that come in a tablet form, such as prescription medications, are first crushed into a powder and then dissolved in a liquid such as water before injecting. IV drug use is generally the most popular method of injected drug abuse and creates many health risks and concerns.
Many prescription medications are based on a time-release format and crushing them to dissolve and inject intravenously bypasses this built-in safety feature. When you take IV drugs, you are sending them directly into the bloodstream and rapidly across the blood-brain barrier. Results are often instantaneous and users feel the drug’s effects almost immediately.
For example, the average length of time for an IV drug to take effect is between 15 and 30 seconds, as opposed to the three to five minutes snorting the same drug takes, as published by Rutgers University. IV drug users therefore may easily overdose, taking in more drugs than the body can handle at once. Additionally, many drugs are often cut with other agents or additives, which may create a dangerous interaction in the body when crushed and injected.
In a drug overdose, the drug reaches toxic levels, overwhelming the brain and body.
Overdose symptoms will vary depending on the type and amount of drug taken, but generally include the following:
- Nausea and/or vomiting
- Difference in pupil size or reactivity
- Tremors or convulsions
- Trouble breathing
- Irregular heart rate
- Increased blood pressure
- Changes in body temperature
- Violence or hostility
If you suspect a drug overdose, seek immediate medical attention, as it is a medical emergency. It is also helpful if you can identify the type of drug taken so that health care professionals may attempt to reverse the drug’s effects. Drug overdose is the leading cause of injury death in America, killing 120 people each day, as reported by the Centers for Disease Control and Prevention, or CDC. IV drug use increases the risk for a potentially fatal overdose.
Long-Term Health Risks
In addition to the potential for a life-threatening overdose, IV drug abuse also increases the risks for developing several infectious diseases, including the human immunodeficiency virus, HIV, which leads to acquired immune deficiency syndrome, or AIDS for which there is currently no accepted cure. The University of California at San Francisco’s (UCSF) Center for AIDS Prevention Studies estimated that as many as 36 percent of cumulative AIDS cases in the United States were caused by injected drug use.
HIV is passed through the exchange of blood and/or bodily fluids, and many IV drug users share needles, helping to spread the disease. Sharing IV drug paraphernalia can also lead to the transmission and spread of other diseases including hepatitis B (HBV) and hepatitis C (HCV), each of which affect the liver and may lead to liver failure, liver cancer, cirrhosis of the liver, or permanent scarring.
IV drug use may account for as many as 60 percent of hepatitis C cases in the United States, according to UCSF.
Skin infections are also common in IV drug users, and abusers may not know exactly what is in the drug they are injecting. For instance, one study reported in the British Journal for Dermatology discovered that in confiscated injected drugs, 89 percent of them were contaminated with pathogens and 68 percent of the street drug heroin contained multiple or various pathogens. Pathogens cause disease and the presence of these bacteria or fungi may lead IV drug users to develop skin abscesses or infections.
Lack of proper sterilization techniques when using needles and syringes to inject drugs may also increase the risks for bacterial infections and diseases. Chronic IV drug use also creates vascular scarring, or “track marks,” which is a permanent and visible side effect of needle drug abuse.
Additional potential health risks with prolonged IV drug abuse include:
- Endocarditis: an inflammation in the lining of the heart that may damage heart vessels, causing potentially life-threatening complications
- Chronic venous insufficiency (CVI): blood flow to the heart from the legs is obstructed (Research in Nursing & Health reported that 87.7 percent of IV drug users were symptomatic)
- Thrombosis: clot formation in the veins causing damage or blockage
- Musculoskeletal infections: infections in the bone, such as ostiomyelitis or joint infections, including septic arthritis
- Substance abuse disorder or addiction
IV drug use may also indirectly cause tuberculosis (TB) or sexually transmitted diseases (STDs). Side effects and health risks will vary depending on the type of drug abused as well. For example, central nervous system depressants, like heroin, may decrease heart rate, respiration, blood pressure, and body temperatures to dangerous levels and cause lasting damage to the respiratory and cardiovascular organs.
Heart disease, respiratory issues, liver and kidney failure, seizures, collapsed veins, insomnia, and a weakened immune system are just some of the potential physical health risks for chronic drug abuse.
Substance abuse takes a psychological toll on the body as well. It may lead to depression, memory loss, confusion, irritability, hostility, paranoia, increased risk-taking behavior, impulsivity, aggression, inability to feel pleasure, emotional numbness, hallucinations, and impaired cognition and judgment.
IV drug users may be more prone to developing a substance abuse disorder than those using other methods to abuse drugs. Chronic drug abuse leads to the development of a tolerance to the drug, wherein your brain and body become used to the dosage, requiring more and more to be taken each time in order to obtain the same results.
Continuous episodes of increasing drug dosage may also lead your brain to become dependent on the drug in order to feel normal. Drug dependence can rapidly devolve into a substance abuse disorder, or addiction.
Considered a chronic and relapsing brain disease, addiction is identified by compulsory drug-seeking behavior despite negative social, emotional, and physical consequences. Warning signs for addiction include a drop in school or work production as well as a failure to uphold family obligations.
Addicts may become socially isolated and spend more time using and recovering from the drug’s effects. Recreational and social activities previously enjoyed are skipped or stopped altogether. Addiction is a highly treatable disease; specialized treatment including behavioral therapies, support groups, and sometimes medications are often necessary to facilitate recovery.
Community Outreach and Harm-Reduction Programs
Many states, cities and counties employ community outreach programs to help manage drug addiction and substance abuse. Often found in urban areas, community outreach centers may provide educational opportunities, drug screenings, referrals and transportation to outside services, on-site outpatient services, HIV testing and counseling, intervention services, family and peer support groups, parenting classes, and prevention education.
For instance, harm-reduction seeks to provide clean and sterile needles, through needle and syringe exchange programs (NES), for IV drug users in order to reduce the amount of infections and diseases that are spread via the sharing of dirty needles.
This is a controversial practice in the United States, although NES is more widely accepted in other countries. There are currently 200 NES programs in the United States, and NPR reports that NES programs have reduced HIV infections to about 150 a year out of the 150,000 injection drug users in New York City alone, down from 13,000 infected at the peak of the drug-related HIV epidemic.
Opioid Replacement Therapy
Opioid replacement therapy is often used in order to combat heroin dependency. Methadone is a longer-acting opioid thought to be less potent than heroin. Federally funded methadone clinics dispense methadone to heroin abusers to combat the uncomfortable withdrawal symptoms that stopping heroin can induce. Methadone is typically dispensed in liquid oral form that does not produce the same euphoric or high effects and blocks opioid receptors from receiving other opioids including heroin.
The goal is usually to detox from heroin completely, although methadone maintenance is also used as a form of harm reduction to keep addicts from returning to the dangers of injecting street drugs. This is not without risk factors, however, as methadone is still a narcotic and does carry the risks of addiction and dependency as well.
Newer medications, like forms of buprenorphine, were approved by the U.S. Food and Drug Administration (FDA) for prescription in a doctor’s office through the Drug Abuse Treatment Act (DATA) of 2000. These drugs may even prove more effective and contain fewer potential risks than methadone.
Buprenorphine is a partial opioid agonist, meaning that it activates opioid sites but not in the same manner as more potent opioids and does not create a high. Buprenorphine also has a ceiling effect, in which it plateaus after a certain point, thus decreasing the potential for abuse. Buprenorphine is prescribed in two main forms: Suboxone and Subutex. Suboxone also contains the opioid antagonist naloxone that blocks opioid receptors, almost completely preventing other opioids from taking effect, while Subutex is strictly buprenorphine.
Substance Abuse Treatment
The best way to prevent potential health concerns related to IV drug use is to enter into a specialized substance abuse treatment facility focused on long-term recovery and abstinence. Chronic IV drug use may require a detox protocol first. Detox is the process of purging toxins from the body and can include the use of medications in order to help stabilize the brain and body. Withdrawal symptoms are often managed with the use of medications during detox.
Once physical stabilization is accomplished, substance abuse disorders are treated with behavioral therapies and counseling sessions in order to focus on the emotional aspects of addiction. Emotional, social and environmental triggers must be identified in order to learn how to cope with and manage them when returning to everyday life. Cognitive Behavioral Therapy seeks to modify negative thoughts and elevate feelings of self-worth and self-esteem.
IV drug users often neglect physical appearances, and health and treatment plans often encourage healthy lifestyle changes, including a balanced diet and fitness regime. Peer support groups as well as family counseling and educational opportunities are further components of a successful substance abuse disorder recovery plan.
The National Alliance on Mental Illness (NAMI) estimates that about half of drug users also suffer from a mental illness as well. This is considered a dual diagnosis and specialized integrated treatment offers the highest success rates. Dual diagnosis treatment models manage both disorders simultaneously, treating each condition as a primary disorder. Teams of medical professionals work together to employ evidence-based treatment plans.
Successful treatment is not the same for everyone and evidence-based treatment plans take personal preferences as well as scientific research and clinical expertise into account. Duration of treatment will vary as well depending on several factors, including genetics, environmental aspects, length of time abusing substances, previous treatment, and physical and psychological dependence.
Dual diagnosis treatment centers provide comprehensive care and treatment models designed to prevent or reduce the severity and duration of relapse with proven strategies and highly trained professionals. Recovery is a real and attainable goal. Our admission coordinators are standing by to give you more information and to answer your questions. Call 844-675-1221 now.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton