Harm Reduction ⫸CASE STUDIES - It could happen to YOU!⫷

aussie101 said:

Ya needle exchanges in St Leonards and in the city. Injecting room in Kings Cross that helped me inject oxys before remarkably! They cant physically shoot it but do everything else for u which was a laugh. Free syringes have saved many people from shitty diseases and screwed veins. They even deliver here in Sydney lol!

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Yeh, they're good with that kind of thing here in Australia. Americans would shit if they knew we can ring for free delivery of sharps 24/7

I dont understand the US health system. ... places like Singapore where the addicts r too scared to seek medical help for abscess', out of fear of being dobbed in to the police, until it is too late like in earlier posts on here

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It's interesting to note that virtually every case study presented in this thread are either from the USA or Singapore. Go figure

djsim said:

Yeh, they're good with that kind of thing here in Australia. Americans would shit if they knew we can ring for free delivery of sharps 24/7



It's interesting to note that virtually every case study presented in this thread are either from the USA or Singapore. Go figure

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Wow! That's really amazing! You guys have really got that public health thing going on. Apparently us Americans don't need to take care of our fellow man

The sad thing is that I've seen several people change their minds on universal healthcare when they, or someone they know can't afford to go to the doctor. Just switching sides out of convenience

Completely off topic, but really cool:
Rich Germans demand higher taxes

This really just blew me away. I wish more of the world could be like this. Realizing you have more, and giving it away to those less fortunate.


To be on topic, I have a contribution (if that's ok). Instead of looking at missed shots/bacterial in the shot, it is related to diseases of intravenous drug users, which can also be a big risk (although hopefully no one here shares any equipment. equipment includes cookers as you'll see!).


Prevalence of HIV-1 resistant to antiretroviral drugs in 81 individuals newly infected by sexual contact or injecting drug use
Salomon, Horacio; Wainberg, Mark A; et. al. AIDS: 28 January 2000 - Volume 14 - Issue 2 - pp F17-F23

Results:

A high prevalence of PI and RT genotypic variants, associated with high-level resistance to antiretroviral drugs, was observed in individuals newly infected by injecting drug use (PI = 24%, RT = 24% ) or sexual transmission (PI = 12%, RT = 22% ). The PI mutations, L10I, V82A, and L90M, were found in 10.5, 3 and 4% of cases, respectively; whereas for RT, primary mutations at positions T215Y (zidovudine), M184V (lamivudine), T69D/A (zalcitabine), and K103N (multi-NNRTI) were present in 8, 5, 4, and 4% of subjects, respectively. Resistance to NRTI was demonstrated by phenotypic, genotypic, and line probe analyses. Transmission of multidrug (NRTI/NNRTI/PI) resistance in eight subjects (9.9% ) was confirmed by showing that source partners possessed viruses of similar genotype.

Full article is free here for those interested



Risk of Hepatitis C Virus Infection among Young Adult Injection Drug Users Who Share Injection Equipment
Lorna E Thorpe1,4, Lawrence J Ouellet1, Ronald Hershow1, Susan L Bailey1, Ian T Williams2, John Williamson3, Edgar R Monterroso3,5 and Richard S Garfein3
American Journal of Epidemiology Vol. 155, No. 7 : 645-653

Abstract:

Designing studies to examine hepatitis C virus (HCV) transmission via the shared use of drug injection paraphernalia other than syringes is difficult because of saturation levels of HCV infection in most samples of injection drug users (IDUs). The authors measured the incidence of HCV infection in a large cohort of young IDUs from Chicago, Illinois, and determined the risk of HCV seroconversion associated with specific forms of sharing injection paraphernalia. From 1997 to 1999, serum samples obtained from 702 IDUs aged 18–30 years were screened for HCV antibodies; prevalence was 27%. Seronegative participants were tested for HCV antibodies at baseline, at 6 months, and at 12 months. During 290 person-years of follow-up, 29 participants seroconverted (incidence: 10.0/100 person-years). The adjusted relative hazard of seroconversion, controlling for demographic and drug-use covariates, was highest for sharing "cookers" (relative hazard = 4.1, 95% confidence interval: 1.4, 11.8 ), followed by sharing cotton filters (relative hazard = 2.4, 95% confidence interval: 1.1, 5.0). Risks associated with syringe-sharing and sharing of rinse water were elevated but not significant. After adjustment for syringe-sharing, sharing cookers remained the strongest predictor of seroconversion (relative hazard = 3.5, 95% confidence interval: 1.3, 9.9 ). The authors conclude that sharing of injection equipment other than syringes may be an important cause of HCV transmission between IDUs.

After seeing the pic of the ms contin injection I'll never do that shit again. Did it twice without reading up on it, thank god nothing went wrong (just a yellow bruise the second time I did it). A friend who's been injecting MS Contin 100's for the past two years with no problem convinced me to let him boot me with it twice. Not only did the really weird rush make me feel like my body was gonna explode, but that fucking pic just did it for me. Never ever again.

http://smj.sma.org.sg/5001/5001a4.pdf

Captain Heroin see this article (Im not sure how to add it yet as im still working all this out,

Journal of Clinical Pathology 1972;25:876-881; doi:10.1136/jcp.25.10.876
Copyright © 1972 by the BMJ Publishing Group Ltd & Association of Clinical Pathologists.
Starch and talc emboli in drug addicts' lungs
D. Lamb, G. Roberts1

Department of Pathology, St George's Hospital Medical School, London
Department of Forensic Medicine, St George's Hospital Medical School, London

The lungs of eight drug addicts dying as a consequence of their habit have been examined. All showed the presence of small amounts of talc emboli and five the presence of starch emboli. Talc was invariably associated with a marked foreign body reaction which was insignificant in association with starch. Animal experiments showed very rapid (90% in 24 hours) removal of maize starch emboli; such rapid removal in man would explain the lack of a foreign body response. Quantitation of the amount of starch present in lungs from two of the cases gave values of 1·5 and 5·2 g. The higher amount could have been a contributory factor in the sudden death of the addict. The amounts of talc seen were not sufficient to be of clinical significance.

Captain.Heroin said:

You may have seen people use "Swim" off of this website, but we don't use "swim" here at BL. It simply does not protect you, it doesn't fool anyone, and is just an eye sore.

Even if it's not you, you can say it's you here. It doesn't really matter.


Do you have any literature that supports this? I haven't heard anything like that.


The gear I was getting was good quality, but this was over a year ago. The duration of IV use might have been longer than I remember, but I mostly stuck to snorting and not IV use. I preferred the 8 hour duration.

I also did small shots of H when I was using - I only used enough to get a good effect, not so much I'm doped up, drooling on myself, and nodding out. That may also have something to do why it only lasted 4 hours.

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Ok mate thanks for letting me know that, and your right it is a little stupid to use swim i guess.

Yeah I have a mate that uses really small shots and he generally needs to have a shot more often than me when we used. I know ur right with the whole snorting lasts longer. lol i try not to use so much that im drooling on myself too, but i prefer to feel like im on a cloud more than needing to worry about having additional shots. Although there is that saying, i think it goes 'a few more holes in your arm is always better than being in one hole in the ground'. Having lost a best mate recently that saying really rings true with me, although I am now clean and trying to keep it that way.

Mafila said:

After seeing the pic of the ms contin injection I'll never do that shit again. Did it twice without reading up on it, thank god nothing went wrong (just a yellow bruise the second time I did it). A friend who's been injecting MS Contin 100's for the past two years with no problem convinced me to let him boot me with it twice. Not only did the really weird rush make me feel like my body was gonna explode, but that fucking pic just did it for me. Never ever again.

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I know what u mean, I had a shot of that ms contin shit once and i had pins and needles in my head and organs. It was the shittiest come on i ever had, and afterwards i never wanted to use it again. The studies and pictures here really reinforce that...

I wanted to add this article:

http://smj.sma.org.sg/5001/5001a4.pdf

It seems like a good informative article and quite nasty (i dont think i have seen it yet in this thread). Perhaps someone else can add the article if they know how to do it...

This is a very good thread, thanks djsim

This is definitely in interesting thread and eye opener for many. What I'm interested in is if anyone knows of case studies involving repetative insufflation of substances. I know that it is notgood for you bit I would like to read real life examples and results. Yes I do sniff subutex daily although it is probably somewhere around .5mg and sometimes less. It's really all I need to get by without the discomfort of minor withdrawl. Plus it helps with my anxiety and insomnia.

aussie101 said:

I wanted to add this article:

http://smj.sma.org.sg/5001/5001a4.pdf

It seems like a good informative article and quite nasty (i dont think i have seen it yet in this thread). Perhaps someone else can add the article if they know how to do it...

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Cool, thanks for that. I'll add it when I get the time to format/edit it.
Another harm-related case study from Singapore... fancy that Like I said recently, it's funny how the places with the most stringent laws regarding drugs have the most health-related issues, isn't it?
It doesn't take a genius to figure out laws will never eradicate drugs, no matter how stiff the penalty.

GolfR32 said:

This is definitely in interesting thread and eye opener for many. What I'm interested in is if anyone knows of case studies involving repetative insufflation of substances. I know that it is notgood for you bit I would like to read real life examples and results. Yes I do sniff subutex daily although it is probably somewhere around .5mg and sometimes less. It's really all I need to get by without the discomfort of minor withdrawl. Plus it helps with my anxiety and insomnia.

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I have seen a couple of studies relating to the inactive ingredients in subutex being bad for the lungs whether iv'd or inhaled (apparently inhaling cornstarch can lead to asthma and breathing problems). Not sure about other permanent probs from insufflating it tho..

djsim said:

Cool, thanks for that. I'll add it when I get the time to format/edit it.
Another harm-related case study from Singapore... fancy that Like I said recently, it's funny how the places with the most stringent laws regarding drugs have the most health-related issues, isn't it?
It doesn't take a genius to figure out laws will never eradicate drugs, no matter how stiff the penalty.

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Good stuff, thanks Dj.
Harm reduction is always going to be the best method of controlling drugs use and problems that arise from it. World governments could legalize and tax drugs then use the proceeds to fund better programs for drugs users. Some politicians are meat heads (most of them in fact). I read this that sounds like Obama's admin are on 'a better' course though:

http://online.wsj.com/article/SB124225891527617397.html

djsim said:

Severe Upper Limb Complications from Parenteral Abuse of Subutex®
[/LIST]

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Was totally going to post this when I saw this thread! Great, great thread idea! I just hope it preserves a limb or two!

aussie101 said:

I wanted to add this article:

http://smj.sma.org.sg/5001/5001a4.pdf

It seems like a good informative article and quite nasty (i dont think i have seen it yet in this thread). Perhaps someone else can add the article if they know how to do it...

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Added. Thanks for the heads up.
By all means, if anyone else like aussie101 has studies/articles which should be here either post them or give me the link/DOI.
Pictoral based accounts written in laymans terms are generally prefered.

Infective endocarditis secondary to intravenous Subutex abuse
Chong E, Poh K K, Shen L, Yeh I B, Chai P -- Singapore Med 2009; 50 (1) : 34

The synopses of 12 cases of Subutex endocarditis are summarised in Table I. Patient 1 was a 28-year-old woman who had been abusing Subutex and Dormicum for three months. She presented with pneumonia and septic shock. She developed multiple pulmonary septic emboli (Fig. 1). Echocardiogram showed large tricuspid vegetation. Blood culture grew Staphylococcus aureus. She was treated with two weeks of intravenous (IV) gentamycin and eight weeks of IV cloxacillin. Despite completing the antibiotic regimen, she continued to experience septic symptoms. Repeat echocardiogram showed an impaired left ventricular systolic function, persistent vegetation and severe tricuspid valve destruction with resultant severe regurgitation. She underwent surgical vegetation excision and tricuspid valve replacement. She recovered after three months of hospitalisation.

Patient 2 was a 45-year-old man who had been abusing Subutex for six months. He injected Subutex powder into his arm veins in order to seek "a high". He was admitted to the vascular surgery unit for acute left arm ischaemia secondary to brachial artery thrombosis after Subutex injection (Fig. 2). He was found to have heart murmur and persistent fever for one week. Echocardiogram showed tricuspid valve vegetation. Blood culture grew Staphylococcus aureus. He was treated with two weeks of low molecular weight heparin (Clexane) for the upper limb ischaemia and six weeks of IV cloxacillin. He recovered from the illness without surgical intervention for the arm ischaemia.

Patient 3 was a 36-year-old man who had been injecting Subutex, and occasionally Dormicum, for one year. He presented with symptoms of fever, chills, rigors and weight loss for one month. A diagnosis of pyrexia of unknown origin (PUO) was made. Blood culture grew Staphylococcus aureus. Echocardiogram showed tricuspid valve vegetation. He was treated with IV cloxacillin and gentamycin for two weeks and further cloxacillin for a total of six weeks. He absconded from the hospital after being found guilty for injecting diazepam (Valium) powder in the ward.

Patient 4 was a 30-year-old man who bought and sold Subutex on the black market. This trade brought him extra money. He had been abusing Subutex for two years. He cut the 8 mg Subutex tablet into four portions and injected the crushed powder intravenously after mixing it with water. He was admitted for sepsis. He developed infective endocarditis involving both the mitral and tricuspid valves (Figs. 3a&c). There was no patent foramen ovale demonstrated in the echocardiogram. He had pulmonary septic emboli and disseminated intravascular coagulation (DIVC). He was treated with IV cloxacillin and IV gentamicin. Concurrently, he developed hepatitis C glomerulonephritis. He underwent a total of 60 days of IV antibiotic treatment in the hospital. He recovered from infective endocarditis, with residual tricuspid valve perforation and severe regurgitation.

Patient 5 was a 35-year-old man who was admitted to medical intensive care unit (MICU) for severe septic shock secondary to pneumonia and empyema. He had severe jaundice and was found positive for hepatitis C serology. Echocardiography showed vegetation in the tricuspid valves. Blood culture grew Staphylococcus aureus. He was treated with IV gentamicin and cloxacillin. Oral rifampicin was added on two weeks later. He required chest tube insertion for empyema drainage. He complained of severe low back pain. Magnetic resonance (MR) imaging of the spine showed discitis secondary to septic emboli (Fig. 4). He developed a few delirium episodes secondary to drug abuse in the ward. He received IV antibiotics for a total of 88 days and recovered from the illness.

Patient 6 was a 49-year-old man who had been abusing Subutex and Dormicum for two years. He was admitted for sepsis with PUO. Echocardiogram showed large tricuspid valve vegetation (Figs. 5a&c). Blood culture grew Staphylococcus aureus. He continued to have fever and chills. Subsequent blood culture grew Methicillin-resistant Staphalococcus aureus (MRSA). After interrogation, he admitted injecting Subutex in the ward. He developed hospital-acquired MRSA septicaemia. He was treated with four weeks of IV vancomycin and oral rifampicin but without success. He underwent tricuspid valve excision and bioprosthetic valve replacement. He was also a hepatitis C carrier. He continued to abuse Subutex post discharge. Two months later, he was admitted to the orthopaedic unit presenting with severe low back pain. MR imaging of the spine showed discitis. Blood culture grew MRSA colony. Repeat echocardiogram showed very large vegetation on the prosthetic tricuspid valves with significant obstruction. He was given another course of IV vancomycin, gentamycin, clindamycin and oral rifampicin. He failed to respond to the medical therapy and developed heart failure and septic shock. He underwent open heart vegetation excision (Figs. 5d&f), and died two days postoperation.

Patient 7 was a 31-year-old man who had been abusing Subutex and Dormicum for two years. He presented with an altered mental status. He was diagnosed to have septic encephalopathy secondary to multiple brain septic emboli (Fig. 6). His blood culture grew group G Streptococcus viridans. His long line tip culture grew Acinetobacter baumanii. He had positive toxoplasmosis antibodies and positive hepatitis C serology. Echocardiogram showed tricuspid valve vegetations and large abscess cavity. He developed septic shock with DIVC. He required inotropic support, and was treated with IV penicillin and gentamycin for four weeks. The patient then absconded from the hospital, and returned eight months later, presenting with persistent fever and chills. He continued to inject himself with Subutex and shared needles with other addicts. He had recurrent tricuspid valve endocarditis with multiple organisms isolated from the blood cultures that included Streptococcus mitis, Prevotella spp. and Acinetobacter spp. He was found stealing needles and injecting himself in the ward. He absconded from hospital after five weeks of antibiotics treatment.

Patient 8 was a 25-year-old man who abused Subutex for a few months. He presented with fever, breathlessness and lower limb swelling. Blood culture grew Pseudomonas spp. and Staphylococcus aureus. Echocardiogram showed mitral valve and tricuspid valve vegetations. Computed tomography of the thorax showed multiple pulmonary septic emboli. He was treated with IV cloxacillin, gentamycin and rifampicin. He failed to improve after antibiotic therapy and developed haemodynamic compromise after development of acute severe mitral regurgitation due to chordal rupture. He underwent emergency mitral valve replacement surgery and tricuspid vegetation debridement. He was treated with a prolonged course of IV antibiotics and stayed in hospital for six months. He recovered after surgery. Unfortunately, he was readmitted 12 months later for severe spontaneous intracranial haemorrhage due to warfarin overanticoagulation. He died during that admission.

Patient 9 was a 22-year-old man who abused both Subutex and Dormicum. He presented with prolonged fever. Echocardiogram showed large tricuspid valve vegetation. He was treated with IV cloxacillin after identification of positive Staphylococcus aureus growth on blood culture. He was non-compliant with treatment. He discharged himself against medical advice three times during the entire treatment period. His condition deteriorated. Echocardiogram one month later showed multiple enlarging tricuspid valve vegetations, severe tricuspid regurgitation, and impaired left ventricular ejection fraction from 65% to 45%. He developed pulmonary septic embolic, septic shock, brain abscess, seizures and kidney abscess. He was infected with hepatitis C, and developed hepatitis C-associated mesangial proliferative glomerulonephritis. Patient died from septic shock and multiorgan failure.

Patient 10 was a 35-year-old man who had a history of congenital bicuspid aortic valve with moderate aortic regurgitation. He had been abusing Subutex for months, despite warnings given by doctors regarding the high risk of infective endocarditis. He presented with fever, confusion and right hemiparesis for three days. He developed severe septic shock with multiple brain septic emboli. He was intubated and managed in the intensive care unit. He developed acute heart and renal failures. Transoesophageal echocardiogram revealed large aortic valve vegetations with severe aortic regurgitation (Figs. 7a&c). Blood culture grew Staphylococcus aureus and Corynebacterium spp. He underwent emergency aortic valve excision and replacement (Fig. 7d). He recovered from the infection, and had a fairly good functional return after two months of outpatient rehabilitation. Unfortunately, he continued to abuse Subutex and was readmitted 18 months later for prosthetic valve endocarditis and septic shock. He underwent prosthetic valve excision and died during the admission.

Patient 11 was a 24-year-old man who had been abusing Subutex for three months. He developed prolonged fever and chills for one month. He did not seek medical treatment. He was found collapsed at home by family members. He was intubated at the emegency department and transferred to the MICU. He presented with severe septic shock. His temperature was 41°C and blood pressure was 80/60 mmHg. Clinical examination revealed Osler’s nodes, splinter haemorrhage and a loud pansystolic murmur. Echocardiogram revealed large tricuspid valve vegetations. Blood culture grew Staphylococcus aureus. He was treated with IV cloxacillin and gentamycin, and later on converted to vancomycin and imipenum. He was given inotropic support with an intraaortic balloon counterpulsation pump. Despite intensive treatment, he continued to deteriorate and died on the fourth day after admission.

Patient 12 was a 23-year-old woman who had learnt to inject Subutex from her friends and had been abusing Subutex for three months. She presented with fever, chills and rigors for three weeks’ duration. Chest radiograph showed multiple pulmonary consolidations and abscess cavities. Echocardiogram showed tricuspid valve vegetation. Blood culture grew Staphylococcus aureus. She recovered after treatment with six weeks of IV cloxacillin.

We interviewed the patients and identified some of the reasons for abusing Subutex via IV injection:

(1) More rapid onset of action: euphoric response within 30 seconds with the IV route, compared to 10-20 minutes with the sublingual route.
(2) False belief that IV Subutex can enhance erection and sexual function.
(3) Combination usage with benzodiazepines, especially Dormicum and Erimin (Nimetazepam) in order to enhance euphoric effect.
(4) Psychological addiction to the habit of injecting drugs: habitual injection abuser.
(5) Peer pressure: especially among the Malay drug abusers. They tend to group together to inject drugs and share needles.
(6) To reduce cost: injection route often requires a smaller dosage compared to the sublingual route. Subutex tablets can be crushed into powder and dissolved in hot water. The insulin needle was used to inject the suspension into the veins of upper limbs. Occasionally, the patients injected blood vessels in the groin (femoral arteries was referred as "the highway") and neck. Few patients would clean the injection sites with soap and water.



Fig. 2 Photograph shows the gangrenous left hand secondary to acute ischaemia in a 45-year-old man (patient 2) who developed acute left brachial artery thrombosis at the injection site .

Fig. 4 Sagittal T2-W (left) and STIR (right) MR images show spinal abscess/discitis (arrows) in a 35-year-old man (patient 5) who presented with back pain.

Fig. 5(d) Photograph shows the excised tricuspid valve vegetation measuring 35 mm ×19 mm.
Fig. 5(e) Photograph shows the infected prosthetic tricuspid valve ring with abscess.
Fig. 5(f) Photograph shows the excised prosthetic tricuspid valve and large vegetation.

This thread is great BTW......how exactly are you finding such great case reports? I have access to Pubmed and all that via school but I am more versed in searching or literature and studies vs. case reports. Is there a way to specify you want case reports only? God I need to be studying for a test right now, but this thread is so great and informative!

Wow. Some of those people were really sick. I mean, it's terrible (and incredibly stupid of them) to wait so long before seeking treatment. Not to mention checking yourself out when you have sepsis and infections that are still very active (and i'm sure that he could feel!). Unfortunately, I feel like its partially the worry of getting in trouble.

djsim said:

Cool, thanks for that. I'll add it when I get the time to format/edit it.
Another harm-related case study from Singapore... fancy that Like I said recently, it's funny how the places with the most stringent laws regarding drugs have the most health-related issues, isn't it?
It doesn't take a genius to figure out laws will never eradicate drugs, no matter how stiff the penalty.

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Do you have any sources for this? I don't disbelieve you, I'm genuinely curious and looking for any studies that might show how big the difference is in health quality between harm-reduction sites and those that don't offer any HR services.

Sturnam said:

Do you have any sources for this? I don't disbelieve you, I'm genuinely curious and looking for any studies that might show how big the difference is in health quality between harm-reduction sites and those that don't offer any HR services.

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What do u mean dude? DjSim was referring to countries with stiff drug laws causing problems for drug addicts. You are asking about harm reduction sites? If you want evidence for countries that don't offer any harm minimization, and only prosecute drug addicts being an issue, just look over all the studies here and the countries that the people come from.

As for harm reduction internet sites I'd say it is fairly difficult to find studies relating to how they help people due to the wide distribution of people using the sites themselves.

aussie101 said:

What do u mean dude? DjSim was referring to countries with stiff drug laws causing problems for drug addicts. You are asking about harm reduction sites? If you want evidence for countries that don't offer any harm minimization, and only prosecute drug addicts being an issue, just look over all the studies here and the countries that the people come from.

As for harm reduction internet sites I'd say it is fairly difficult to find studies relating to how they help people due to the wide distribution of people using the sites themselves.

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Oops, I meant countries. Or I was just using the word "sites" badly when I meant different countries.

As for the second point, just because a country puts out or publishes a lot of case reports on addicts in HR-absent countries doesn't necessarily mean they have the most drug related deaths or complications. It mostly means that they have people willing and able to write about it, and then the means to send it in and get it accepted into an English-speaking, well accepted journal.

Besides, the fact is that I would probably guess the same thing. Harsher laws = increased health problems due to the fear of getting caught, not caring about themselves, and also not being able to afford it. None-the-less, I'm looking for some numbers of maybe two comparable large cities, and then their hospital admission rates for drug-related injuries. Ideally, there'd be a higher incidence of admissions and subsequent complications for those cities that did not have the HR procedures implemented.

Captain.Heroin said:

Oh wow, I guess I was wrong. That's cool.

I could tell that you weren't IVing from the fact it's 23G. No one would choose a 23G for IV purposes.

Just curious, what's the smallest gauge they have there? The smallest gauge here at the SEP I go to is a 28 (they one time had 30's and 29's but not many of them, and I don't think they regularly stock them).



With the way our current health care system is, the government profits off of companies profiting off of people dying from their products. And, the government has a dual-invested interest in keeping the population level down.

This is why US citizens will never see nationalized health care - people are making WAY too much money to stop the killing machine.

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That health care bill did just pass in the house recently, we may have hope (I realize this post is a few months old, and you may already know this, just throwin it out there) Now we just have to wait what happens in the senate. A bunch of right wingers are saying its "dead on arrival" but I think they may just be in denial.