Drugs may be swallowed, smoked, inhaled through the nose as a powder (snorted), or injected. When drugs are injected, their effects may occur more quickly, be stronger, or both.
Drugs may be injected into a vein (intravenously), a muscle (intramuscularly), or under the skin (subcutaneously). Veins in the arms are typically used for intravenous injections, but if these areas become too scarred and damaged, some people inject drugs into other veins, including those of the thigh, neck, armpit or feet.
(See also Drug Use and Abuse Overview of Substance-Related Disorders Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people ... read more .)
Complications of Injection Drug Use
Injecting a drug has more risks than other methods of use. People are exposed not only to the effects of the drug but also to problems related to injection itself, such as the following:
Adulterants: Adulterants are substances that are added to a drug to alter its physical qualities. They are usually added, without the user’s knowledge, to reduce costs or to make the drug easier to use. Thus, users do not know what they are injecting. In street drugs such as heroin Opioids Opioids, a class of drugs derived from the opium poppy (including synthetic variations), are pain relievers with a high potential for misuse. Opioids are used to relieve pain, but they also... read more and cocaine Cocaine Cocaine is an addictive stimulant drug made from leaves of the coca plant. Cocaine is a strong stimulant that increases alertness, causes euphoria, and makes people feel powerful. High doses... read more , adulterants may also be added to enhance the drug's mind-altering properties or to substitute for the drug. Different adulterants (for example, amphetamine, dextromethorphan, fentanyl, ketamine, LSD) have been found as additives, each with their own effects, which sometimes makes it difficult to determine what someone has actually used. Also, adulterants may be potent and result in toxicity or overdose.
Fillers: Some people crush tablets of prescription drugs, dissolve them, and inject the solution intravenously. These people are injecting the fillers that tablets commonly contain (such as cellulose, talc, and cornstarch). Fillers can become trapped in the lungs, causing inflammation. Fillers can also damage heart valves, increasing the risk of infection there (endocarditis Infective Endocarditis Infective endocarditis is an infection of the lining of the heart (endocardium) and usually also of the heart valves. Infective endocarditis occurs when bacteria enter the bloodstream and travel... read more
).Bacteria and viruses: Injecting drugs with unsterilized needles, particularly needles used by someone else, can introduce bacteria and viruses into the body. As a result, abscesses may develop near the injection site, or bacteria or viruses may travel through the bloodstream to other parts of the body, such as the lungs, heart, brain, liver, or bones, and cause infection. Infection of the heart valves (endocarditis Infective Endocarditis Infective endocarditis is an infection of the lining of the heart (endocardium) and usually also of the heart valves. Infective endocarditis occurs when bacteria enter the bloodstream and travel... read more
) is a common serious consequence of injecting drugs contaminated with bacteria or using dirty needles. Injecting drug users can develop botulism and tetanus infection through the injection site. Sharing needles can spread serious infections, such as hepatitis Overview of Hepatitis Hepatitis is inflammation of the liver. (See also Overview of Acute Viral Hepatitis and Overview of Chronic Hepatitis.) Hepatitis is common throughout the world. Hepatitis can be Acute (short-lived) read more B and C and human immunodeficiency virus (HIV) infection Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and is treated with antiretroviral medications. If untreated, it can cause... read more 
.Injuries due to needle use: Drug abuser’s elbow (myositis ossificans) is caused by repeated, inept needle punctures. The muscle around the elbow is replaced with scar tissue. Subcutaneous injections (those given under the skin, also called skin popping) can cause skin sores. Intravenous injections lead to scarring of veins (track marks), which makes the veins more and more difficult to inject and impairs blood flow.
Diagnosis of Injection Drug Use
A doctor's evaluation
Sometimes self-reporting
Sometimes injection drug use is diagnosed when people go to a health care practitioner because they want help stopping use of the drug. Other people try to hide their drug use.
Practitioners may suspect problems with drug use when they notice changes in mood or behavior in a person. They may then do a thorough physical examination. Signs of drug abuse may be apparent. For example, repeatedly injecting drugs intravenously produces track marks. Track marks are lines of tiny, dark dots (needle punctures) surrounded by an area of darkened or discolored skin. Injecting drugs under the skin causes circular scars or ulcers. People who inject drugs may claim other reasons for the marks, such as frequent blood donations, bug bites, or other injuries.
Health care practitioners also use other methods (such as questionnaires) to identify abuse of some drugs and other substances and to determine the extent of drug use and its effects. Urine and sometimes blood tests may be done to check for the presence of drugs.
If a drug use problem is identified, especially if the drugs are injected, people are thoroughly evaluated for hepatitis Overview of Hepatitis Hepatitis is inflammation of the liver. (See also Overview of Acute Viral Hepatitis and Overview of Chronic Hepatitis.) Hepatitis is common throughout the world. Hepatitis can be Acute (short-lived) read more , HIV infection Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and is treated with antiretroviral medications. If untreated, it can cause... read more , and other infections common in people who use these drugs.
Treatment of Injection Drug Use
Counseling
Prevention and treatment of infectious complications
Specific treatment depends on the drug being used, but it typically involves counseling and sometimes involves use of other drugs (for example, methadone as a safer drug to replace heroin). Family support and support groups help people remain committed to stopping use of the drug.
Treatment of complications is the same as that for similar complications with other causes. For example, abscesses may be drained, and antibiotics may be used to treat infections.
Because sharing needles is a common cause of HIV infection Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and is treated with antiretroviral medications. If untreated, it can cause... read more and hepatitis Overview of Hepatitis Hepatitis is inflammation of the liver. (See also Overview of Acute Viral Hepatitis and Overview of Chronic Hepatitis.) Hepatitis is common throughout the world. Hepatitis can be Acute (short-lived) read more , a harm-reduction movement was started. Its purpose is to reduce the harm of drug use in users who cannot stop. Thus, users are provided clean needles and syringes so they do not reuse others’ needles. This strategy helps reduce the spread (and the cost to society) of HIV infection and hepatitis.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
National Institute on Drug Abuse (NIDA): Federal agency that supports scientific research into drug use and its consequences and supplies information about commonly used drugs, research priorities and progress, clinical resources, and grant and funding opportunities.
Substance Abuse and Mental Health Services Administration (SAMHSA): US Department of Health agency that leads public health efforts to improve behavioral health and provides resources, including treatment locators, toll-free helplines, practitioner training tools, statistics, and publications on a variety of substance-related topics.
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
cocaine |
GOPRELTO, NUMBRINO |
amphetamine |
Adzenys, Adzenys XR, Dyanavel XR, Evekeo |
dextromethorphan |
AeroTuss, Buckley's Cough Suppressant , Buckley's DM, Buckley's Mixture, Cough DM, Cough Suppressant , Delsym, Delsym Children's, Delsym Children's Cough Relief, Delsym Cough, Dexalone, ElixSure Cough, ElixSure Cough DM, Giltuss DM, PediaCare Children's Long Acting Cough, PediaCare Infants' Long-Acting Cough, PediaCare Long-Acting Cough , Robafen Cough, Robitussin, Robitussin Children's Cough, Robitussin Cough, Robitussin CoughGels, Robitussin Lingering Cold Long-Acting Cough, Robitussin Pediatric Cough, Scot-Tussin CF, Silphen DM, Theraflu Long Acting Cough Strip, Triaminic Long Acting Cough , Triaminic Long Acting Cough Strip, Tylenol Children's Simply Cough, Vicks DayQuil Cough, Vicks DayQuil Nature Fusion, Vicks Formula 44, Vicks Nature Fusion Cough, Zicam Concentrated Cough, Zicam Cough Max, Zicam Cough Nite |
fentanyl |
ABSTRAL, Actiq, Duragesic, Fentora, IONSYS, Lazanda, Onsolis, Sublimaze, SUBSYS |
ketamine |
Ketalar |
methadone |
Dolophine, Methadose |
