Intravenous drug users

Infection with one or more strains of viral hepatitis often causes acute inflammation of the liver, while chronic infection with hepatitis B or C can lead to cirrhosis. Hepatitis B and C are common in intravenous drug users and can also be transmitted through sexual contact, but many cases of hepatitis C are idiopathic.5,6 Hepatitis C is a more common cause of cirrhosis than hepatitis B in the United States while hepatitis B is more common in the rest of the world.7 See Chapter 21 on viral hepatitis for a complete discussion of infectious hepatitis. 

Intravenous drug users using unsterilized needles Workers involved with non-human primates Food service handlers Patients with clotting factor disorders Individuals residing in health care institutions Hepatitis B and Hepatitis D Men having sex with other men Individuals with multiple heterosexual partners Intravenous drug users using unsterilized needles Recipients of blood products... 

Prior to routine screening of blood products in the early 1990s, the primary route of transmission of the HCV was blood transfusions, when the risk was 0.02% per unit transfused. Since then, the risk has decreased significantly (0.001% per unit transfused).13 Today, intravenous drug users utilizing contaminated paraphernalia are responsible for most HCV transmission. Other populations at risk for acquiring HCV are listed in Table 21-1. Approximately 10% of the individuals infected with HCV have no identifiable risk factors. 

The most likely modes of transmitting the HDV are similar to those of HBV, including intravenous drug users using unsterilized needles and recipients of contaminated blood products. Sexual and perinatal transmission are rare for HDV.16 Individuals at greatest risk of acquiring HDV are similar to those seen in HBV (Table 21-1). 

Infective endocarditis (IE) is a serious infection affecting the lining and valves of the heart. While this disease is mostly associated with infection of the heart valves, the septal defects may become involved as well. Infections also occur in patients with prosthetic or mechanical devices, such as mechanical heart valves or who are intravenous drug users (IVDUs). Bacteria is the primary cause of IE however, fungi and atypical organisms also can be responsible pathogens. 

IVDUs intravenous drug users MIC minimum inhibitory concentration... 

Castells X, Casas M, Vildal X, Bosch R, Roncero C, Ramos-Quiroga JA Capella D (2007) Efficacy of central nervous system stimulant treatment for cocaine dependence a systematic review and meta-analysis of randomized controlled clinical trials. Addiction, 102, 1871-87 Chaisson RE, Bacchetti P, Osmond D, Brodie B, Sande MA Moss AR (1989). Cocaine use and HIV infection in intravenous drug users in San Francisco. Journal of the American Medical Association, 261, 561-5 Chapleo CB Walter DS (1997). The bupre-norphine-naloxone combination product. Research and Clinical Forums, 19, 55-8 Cheskin LJ, Fudala PJ Johnson RE (1994). A controlled comparison of buprenorphine and clonidine for acute detoxification from opioids. Drug and Alcohol Dependence, 36, 115-21... 

Connell PH (1958). Amphetamine Psychosis. Institute of Psychiatry Maudsley Monograph No. 5. London Oxford University Press Conner KR, Pinquart M Duberstein PR (2008). Meta-analysis of depression and substance use and impairment among intravenous drug users (IDUs). Addiction, 103, 524-34... 

Metzer DS, Woody GE, McLellan AT, O Brien CP, Druley P, Navaline H, De Phillipis D, Stolley P Abrutyn E (1993). Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment an eighteen month prospective follow-up. Journal of the Acquired Immune Deficiency Syndrome, 6, 1049-56... 

Robertson, J.R., Skidmore, C.A., and Roberts, J.J.K. (1988) HIV infection in intravenous drug users A follow-up study indicating changes in risktaking behaviour , British Journal of Addiction, 83 387-91. 

Typically, patients or intravenous drug users who receive intravenous morphine experience a pleasant floating sensation with lessened anxiety and distress. However, dysphoria, an unpleasant state characterized by restlessness and malaise, may sometimes occur. 

Apart from infectious bloodborne diseases, reactions associated with toxic and semi-toxic additives, unknown purity levels, and the possibility of overdose, intravenous drug users also have to weigh the possibility of fatal bacterial infections. 

Methamphetamine also changes the level of some commonly used legal medications. With the high levels of HIV and AIDS that are seen in intravenous drug users, many will be on anti-HIV medication. Methamphetamine increases the blood level of some anti-HIV medications, which could cause serious side effects. Also, many users of methamphetamine suffer from psychiatric problems, including depression. Methamphetamine increases the blood levels of a class of commonly used antidepressants known as tricyclic antidepressants, which, when taken at high levels, can cause respiratory depression and even death. 

Cherubin, C. E., and J. D. Sapira. The medical complications of drug addiction and the medical assessment of the intravenous drug user Twenty five years later. Animals of Internal Medicine 119 (1993) 1017-1028. 

Haemmig RB, Tschacher W. Effects of high-dose heroin versus morphine in intravenous drug users a randomised double-blind crossover study. J Psychoactive Drugs 2001 33(2) 105-10. 

In a prospective study of 54 patients taking antiretroviral drugs who also took methadone and a further 154 patients who did not take methadone there were similar clinical, virological, and immunological outcomes after 12 months (52). These results support the usefulness of methadone in the management of intravenous drug users with HIV infection. 

Foodborne botulism accounts for approximately 1,000 cases per year worldwide, of which approximately 30 occur in the United States. Home processed foods account for 94% of U.S. cases. Infantile botulism, a form of the disease in which C. botulinum spores are ingested by infants due to food contamination, occurs in approximately 60 children per year in the United States, more than half of which are in California. Wound botulism, typically involving intravenous drug users who either inject drugs intravenously or in the subcutaneous tissue (a practice known as skin-popping ), is reported one to three times per year in the United States. It can also occur in other types of contaminated wounds such as a severe crush injury or other areas of contaminated avascular tissue. Botulism due to intestinal colonization by C. botulinum is extremely rare only seven cases have been reported in the literature (CDC, 1998). 

MargoHck JB, Mimoz A, VlaliovD, SolomonL, AstemborsM J, Colm S, Nelson KE (1992) Changes in T-lymphocyte subsets in intravenous drug users widi HIV-1 infecdon. JAMA 267 1631—1636. 

Silini, E., Bono, F., Cividini, A., Cerino, A., Maccabrnni, A., TinelU, C., Bruno, S., Bellobuono, A., Mondelli, M.U. Molecular epidemiology of hepatitis C virus infection among intravenous drug users. J. Hepatol. 1995 22 691-695... 

Froner GA, Rutherford GW, Rokeach M. Injection of sodium hypochlorite by intravenous drug users. JAMA 1987 258(3) 325. 

The question of whether intravenous drug users should be supplied with clean syringes free of charge as a way of preventing the spread of infection with human immunodeficiency virus (HIV) The continuing debate on whether marijuana should be available as a prescription drug... 

Wound botulism, a relatively rare form of the disease, results from the production of toxin by organisms that multiply in a contaminated wound. Wounds associated with botulism may not appear obviously infected (38). Before 1980, wound botulism was most likely associated with complicated wounds, such as extensive crush injuries, compound fractures and other wounds associated with avascular areas. Since 1980, most cases have occurred in illicit drug users, including intravenous drug users with contaminated needle puncture sites or drug users with nasal and sinus wounds secondary to chronic cocaine sniffing (38). In 2001, there were 23 reported cases of wound botulism in the United States, with one death (39). 

Kao J, Chen P, Lai M, Chen D. Hepatitis D virus genotypes in intravenous drug users in Taiwan Decreasing prevalence and lack of correlation with hepatitis B virus genotypes. J Cfin Microbiol 2002 40 3047-9. 

Meandzija B, O Connor PG, Fitzgerald B, Rounsaville BJ, Kosten TR (1994) HIV infection and cocaine use in methadone maintained and untreated intravenous drug users. Drug Alcohol Depend 36 109-113... 

INTRAVENOUS DRUG USERS METHODOLOGICAL ISSUES IN NATURAL HISTORY RESEARCH. Peter Hartsock, Dr.P.H., and Sander G. Genser, M.D., M.P.H., eds. 

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