Intravenous drug user

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) ³.

Clinical presentation

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

• at/close to the injection site
  • vascular
    • haemorrhage/haematoma
    • arterial
      • thromboembolism
      • aneurysm
    • venous
      • superficial thrombophlebitis
      • venous thromboembolism: DVT, PE
  • soft tissue infections
    • cellulitis
    • abscess
    • necrotising 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, 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 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.