2 - Identify risks
What are the risks that Sam exposes himself to as a drug user who injects?
The greatest risk as a user who injects is overdose leading to morbidity (Damage) or mortality (Death), other serious risks and complications include:
• Addiction. Heroin is highly addictive. When an individual persists in use of Heroin or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. Addiction can create a huge list of biological, psychological and social distress including chronic disease, relationship problems, poverty and death from overdose.
• Blood borne viruses such as Hepatitis B and C and HIV, the virus that leads to AIDS. Blood borne viruses (BBV’S) are those viruses that are transmitted from the blood of one person to the blood of another person.
• Deep Vein Thrombosis is a blood clot in a deep vein. A clot inside a blood vessel is called thrombosis. Symptoms of Deep Vein Thrombosis (DTV) range from pain, swelling, redness, warmness, and swollen close (superficial veins) in the legs to no symptoms at all. DTV can clear itself but the most serious complication is when the thrombosis dislodges (embolises) and travels into the lungs becoming a life threatening pulmonary embolism (Blockage of the main artery in the lung).
• Phlebitis is an inflammation of a vein, usually in the legs. When phlebitis is associated with the formation of blood clots (thrombosis), usually in the deep veins of the legs, the condition is called thrombophlebitis. These clots can travel to the lungs, causing pulmonary embolisms that can be fatal. Similar to DTV.
• Ulcers and skin infections are common in IV drug users. Ulcers are generally shallow but have hard edges and arise from a combination of inflammation, foreign bodies and infection. Foreign bodies (toxic materials) in the drug can leak out of veins during the injection (extravasation), “Popping” is when a drug is injected into the fatty layer under the skin. Poor injection technique especially dealing with hygiene practice also increases the amount of bacteria on the skin at the injection site and inflammation.
• Abscesses are collections of pus. They are usually caused by infection with Staphylococcus aureus but in drug users they occasionally contain a mixture of aerobic bacteria (that require oxygen) and anaerobic bacteria (that do not require oxygen). These mixed abscesses often result in a foul odour.
• Cellulitis is a common bacterial infection of the skin, which can affect all ages. It usually affects a limb but can occur anywhere on the body. Symptoms and signs are usually localised to the affected area but patients can become generally unwell with fevers, chills and shakes (bacteraemia). Cellulitis is usually caused by Group A streptococci or Staphylococcus aureus.
• Ischaemic gangrene (dry gangrene) Occurs due to chronic impairment of blood flow. In most patients, the affected part is not infected. This type of gangrene presents clinically as tissue that is cold, black, and dry. In most cases, self-amputation eventually occurs. The pathological processes involved may include:
o Atherosclerosis: associated with peripheral artery disease, diabetes mellitus, smoking
o Thrombosis: associated with vasculitis, IV drug abuse, trauma, antiphospholipid syndrome, malignancy View image
o Vasospasm: associated with Raynaud's phenomenon, cocaine abusers.
• Septacemia refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms. Sepsis can originate anywhere bacteria can gain entry to the body; common sites include the genitourinary tract, the liver and its bile ducts, the gastrointestinal tract, and the lungs. Broken or ulcerated skin can also provide access to bacteria commonly present in the environment this is why IV drug users are so susceptible to this.
3 - Provide education for safer drug use
You have the opportunity to provide Sam with education on safer drug use. What advice do you need to give Sam? Discuss some a harm minimisation approaches that you will implement with Sam.
I would start off with revisiting information Sam should/may/may not know (as a seasoned user I’m guessing he’s heard a lot of it before but not necessarily), such as safer injecting sites and injection hygiene. The safest injecting sites are the sides of the arms and the inner elbow face. Injection must always travel with the flow of blood and not against it. Always use the smallest needle possible to prevent vein damage. NSP supplied syringes are designed to only be used once and so should be only used once. Needles will blunt easily when used with a hard spoon and when used repeatedly, and this can cause vein damage. Be sure to use the disinfectant swabs provided in the fit kit as many as you need, at least one to wipe injection site and another to hold down on site after injection. Never share fits with anyone even if you know for a fact they have ‘clean’ blood as this can spread infectious diseases like Hepatitis and HIV. Always have clean hands washed with soapy water before and after use and handling any of the equipment. Always dispose of used fits in the sharps container provided and dispose of container at exchange agency or other appropriate place. Some people like their filter to be wet before using it and I’ve seen people wet them in their mouth, I’d advice against this due to harmful bacteria ones mouth. I would also give Sam advice using proper bacterial wheel filters and info on the dangers of commonly used filters like cigarette butt filters, cotton wool or a piece of the swab. If sterile water is available always use it but remember they also should only be used once as bacteria will grow when left open.
Also I would encourage Sam to use different ROA’s to try and break his ‘ritual’ with using needles, for the mind and the body.
(copied directly from my latest assignment unit CHCAOD407D answered form a case sdtudy, but the info. is there)
