Emerging and Underrecognized Complications of Illicit Drug Use

Wurcel, Alysse G.; Merchant, Elisabeth A.; Clark, Roger; Stone, David R.

doi:10.1093/cid/civ689

Cited by 45 publications

(22 citation statements)

References 62 publications

(64 reference statements)

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“…People who use prescription opioids nonmedically are sometimes also injecting drugs, which is critical from a public health standpoint, because of harms associated with injections such as venous scarring and infectious diseases [12, 13]. …”

Section: Introductionmentioning

confidence: 99%

“…NMPOU has been linked to numerous adverse health-related consequences, largely due to its depressogenic effects on numerous biological systems, including the central nervous system causing somnolence or even unconsciousness and suppressing respiratory activity, and bowel and lower GI tract (e.g., opioid induced constipation). People who use prescription opioids nonmedically are sometimes also injecting drugs, which is critical from a public health standpoint, because of harms associated with injections such as venous scarring and infectious diseases [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs

Dahlman

Kral

Wenger

et al. 2017

Subst Abuse Treat Prev Policy

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BackgroundPeople who inject drugs (PWID) often have poor health and lack access to health care. The aim of this study was to examine whether PWID engage in self-treatment through nonmedical prescription opioid use (NMPOU). We describe the prevalence and features of self-reported physical pain and its association with NMPOU.MethodsPWID (N = 702) in San Francisco, California (age 18+) were recruited to complete interviewer administered surveys between 2011 and 2013. Multivariate logistic regression analysis was conducted to examine the associations among self-reported pain dimensions (past 24-h average pain, pain interference with functional domains) and NMPOU, controlling for age, sex, psychiatric illness, opioid substitution treatment, homelessness, street heroin use and unmet healthcare needs.ResultsAlmost half of the sample reported pain, based on self-reported measures in the 24 h before their interview. The most common pain locations were to their back and lower extremities. Past 24-h NMPOU was common (14.7%) and associated with past 24 h average pain intensity on a 10 point self-rating scale (adjusted odds ratio [AOR] = 2.15, 95% confidence interval [CI] 1.21–3.80), and past 24 h pain interference with general activity (AOR 1.82 [95% CI 1.04–3.21]), walking ability (AOR 2.52 [95% CI 1.37–4.63]), physical ability (AOR 2.01 [95% CI 1.16–3.45]), sleep (AOR 1.98 [95% CI 1.13–3.48]) and enjoyment of life (AOR 1.79 [95% CI 1.02–3.15]).ConclusionBoth pain and NMPOU are common among PWID, and highly correlated in this study. These findings suggest that greater efforts are needed to direct preventive health and services toward this population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs

Dahlman

Kral

Wenger

et al. 2017

Subst Abuse Treat Prev Policy

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“…Alpha toxins cause vasoconstriction and induce platelet aggregation, resulting in decreased blood flow which maintains the ischemic necrotic process. Theta toxins, which induce cell lysis, further contribute to the spread of infection to the surrounding tissue [7].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Gas Gangrene in Intravenous Heroin Addict

Pavlekic

Ječmenica

Alempijević

2021

Open Access Maced J Med Sci

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BACKGROUND: Gas gangrene is a clostridium infection primarily of muscle tissue, most commonly caused by C. perfringens. Clinical diagnosis is usually made by local inspection of the wound: the infected tissue shows characteristic signs of tissue inflammation with blistered changes. The disease can starts suddenly, 4-6 hours after the injury, but most commonly the incubation period lasts 2-4 days. Without proper medical intervention, death occurs in 4-24 hours after the development of the first symptoms, but even with timely and adequate therapy, the lethality is very high (around 12%). Due to its fulminant course, in all cases with fatal outcomes, a forensic autopsy is an obligatory procedure. However, discovering the entrance gate and source of infection is not an easy task, especially in the absence of a traumatic injury. CASE PRESENTATION: Male, 27 years old, an intravenous heroin addict for about 10 years, injured his left leg in a traffic accident. He only visited the doctor after 5 days. Upon examination, it was determined that there were no externally visible injuries and no fracture, and he was given a splint immobilization for an ankle luxation. Twelve days after the accident (or 7 days after the immobilization) his mother found him unconscious. CONCLUSION: From medicolegal aspects, it’s important to have in mind even the less frequent paths of infection, in order to give an expert professional opinion on origin and cause of death.

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“…Necrosis of the extremities is another lethal complication seen in IV illicit drugs. 20 Vasculitis associated with cocaine reported in various studies are; urticarial vasculitis, retiform purpura, Henoch Schonlein purpura, Raynaud's phenomenon and Churg-Strauss Vasculitis. 10,17,20,21,22 Urticaria is a common skin manifestation observed in heroin addicts in the past studies.…”

Section: Table-iv Distribution Of Patient According To Mode Of Drug Intakementioning

confidence: 99%

Frequency of cutaneous manifestations in drug abuse patients.

Rafiq¹,

Mehdi²,

Shafi³

2021

TPMJ

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Objective: Drug abuse and drug addiction cases have been increased immensely in last few decades in Pakistan. This study was conducted to assess the frequency of cutaneous manifestations in drug abuse patients. Study Design: Cross Sectional study. Settings: Dermatology Department of a DHQ Teaching Hospital/Sahiwal Medical College, Sahiwal and Central Jail Hospital, Sahiwal. Period: November 2019 to June 2020. Material & Methods: 50 patients with drug abuse irrespective of age and gender were selected. Skin manifestations based on history and examination recorded on predesigned proforma. Laboratory investigations and skin biopsies were performed to confirm diagnoses in doubtful cases. Results: A total of 50 male patients with age above 16 years were enrolled. Single drug addiction was noticed in 62% (n=31) and polydrug abuse was observed in 38% (n=19). Regarding mode of drug intake, single and multiple modes of drug administration were seen in equal number 50% (n=25) each. Major bulk of skin manifestations were chronic including skin scars 66% (n=33), xerosis 60% (n=30), hyperpigmentation 58% (n=29), oral mucosal changes 94% (n=47) and facial skin changes 60% (n=30). Acute along with chronic skin changes were observed in 30% (n=15) mainly including injection marks 30% (n=15), vascular changes 12% (n=6) and infections 8% (n=4). Conclusion: Skin scars, xerosis, hyperpigmentation and oral mucosal changes are the common skin changes observed among drug abusers. Thus, physicians need to be aware of skin signs of drug abuse for timely recognition of substance abuse disorders and effective management.

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Emerging and Underrecognized Complications of Illicit Drug Use

Cited by 45 publications

References 62 publications

Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs

Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs

An Unusual Case of Gas Gangrene in Intravenous Heroin Addict

Frequency of cutaneous manifestations in drug abuse patients.

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