Intravenous drug user

Intravenous drug users (IVDU) are people who inject non-medical and controlled medical drugs (and may have substance use disorder) for non-medical purposes. Frequently injected drugs include heroin, cocaine, prescription opioids and methamphetamine ⁶. 

Terminology

More neutral terms such as people who inject drugs, drug user, or people with substance use disorder (SUD) are preferred ^5,6. Terms such as intravenous drug abusers, addict, junkie, etc. should not be used due to stigmatization, which affects people's willingness to seek treatment ⁵.

Epidemiology

Four out five people who inject drugs are men. More than 11 million people globally are estimated to inject drugs (c.2019), most commonly in Eastern Europe, Central Asia/Transcaucasia, and North America ⁶.

Clinical presentation

Intravenous drug users may present due to a variety of complications ⁴:

• at/close to the injection site

  • vascular

    • hemorrhage/hematoma

    • arterial

      • thromboembolism

      • aneurysm

    • venous

      • superficial thrombophlebitis

      • venous thromboembolism: DVT, PE

  • soft tissue infections

    • cellulitis

    • abscess

    • necrotizing fasciitis

  • tissue necrosis

• remote from the injection site

  • infections

    • specific: infective endocarditis, HIV/AIDS, hepatitis B/C, pulmonary septic emboli, osteomyelitis, etc.

    • non-specific: sepsis

• chronic disease: multiple comorbidities are common ⁴

  • 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, tuberculosis, pneumonia

  • dental : caries, dental abscess, multiple extractions

  • GU: STIs, poor fertility, erectile dysfunction

  • pregnancy: multiple issues, including unplanned pregnancy, intrauterine growth restriction, fetal addiction syndromes, prematurity, maternal death

• related to the drug and/or excipients

  • non-specific

    • fatal and non-fatal overdose

    • allergic reactions including anaphylaxis

    • ARDS

  • specific

    • hypogonadism in heroin use ²

• violent traumatic injuries

• ​​mental illness: high prevalence, both due to, and as a cause, of IVDU ²

  • depression

  • general anxiety disorder

  • post-traumatic stress disorder (PTSD) ⁴

  • 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 ².