I’m Sick Man; Common Health Issues of People Who Use Drugs

1. I’m Sick Man; Common Health Issues of People Who Use Drugs Erica Schoen, RN, BScN Ashley Schwanke LPN Streetworks

2. Principles • Health Promotion – Help clients make better choices about their health, as well as to take control and improve their own health. • Primary Healthcare – Act as a point of entry into the healthcare system; Occurs at a very grassroots level; incorporates health promotion, disease prevention, and early diagnosis. • Harm Reduction – Reducing the harm associated with drug use; helping people stay safer and healthier. Streetworks

3. Common Health Problems of IDUs • Skin Infections • Abscess and Cellulitis • Tracking and Bruising • Vein Collapse (Picking a site) Artery vs Vein • Necrotizing Fasciitis • Chalk Lung • Cotton Fever • Embolism • Endocarditis • Septicemia • Overdose • Withdrawal • Levamisole • Multi drug use Streetworks

4. Skin Infections – Abscess (Boil) • Is a pocket of pus underneath the skin. • Begins as redness, swelling, and tenderness at the site. Develops into an infection with a hard, pus-filled core. • How one gets it – missed hits, dirty technique and or equipment, injecting a solution with lots of particles in it, poor hygiene Streetworks

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7. Abscess Treatment • Treatment – Warm compress, Lancing, Antibiotics • Unable to seek medical treatment – Self Care Streetworks

8. Abscess Prevention • To prevent getting an abscess always: • Wash your hands • Clean the site • New equipment • Always use filters • Sterile water – No puddles!! Streetworks

9. Cellulitis • Skin infection - a germ gets into the layers of the skin and spreads. • Usually forms after a boil, ulcer or injury. • The skin becomes very red, hot, tender and swollen. • Treatment – Antibiotics Streetworks

10. Tracking and Bruising • Track marks are scars that appear along the veins • Bruising can occur when blood leaks out from the vein under the skin • To prevent tracking and bruising always: • Use a new needle every time • Use the thinnest (highest gauge) needle you can find • Inject in the direction of blood flow – towards the heart • Use a tie!! • Put pressure on the site after you pull out - Do not use an Alcohol swab after. • It puts the lotion on its skin – Vitamin E cream Streetworks

11. Vein Collapse • This happens from repeated injection in that spot, frequent infections, or trauma to the site. • Avoid by rotating • Vitamin C – helps prevent bruising, bleeding, and helps heal • Pick your veins carefully. Streetworks

12. Pick a Site • Veins are bouncy! Spend time looking for it. • Practice finding veins • Get that vein to pop: Make a fist, Warm compress, Use a Tie . • Rotate! • Work from bottom up. • Save a vein for emergencies • Use safer sights- Do not inject into the jugular Streetworks

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14. Veins vs Arteries • Each one is a one way system but it is all connected • Veins take blood to the heart and lungs • Arteries take blood away from the heart and lungs • It is very dangerous to inject into an artery • When an artery is hit – plunger will push back quickly and the blood is different in color Streetworks

15. What to do if an artery has been hit • No injecting the drug • Pull out (That’s what she said) • Raise the limb where the needled poked • Press hard on the site for at least 5 minutes of until bleeding stops • If bleeding or swelling or if the leg or arm becomes very painful after 10 minutes go see a Dr. Streetworks

16. Necrotizing Faciitis (Flesh –Eating Disorder) • Bacterial infection • Enters the body through broken skin • Affects the surrounding tissue and nearby muscle. It spreads really quickly • S &S: fever, redness, swelling, extreme pain at the injection site or wound. • The flesh looks like it is beginning to decay and the area looks like it is being eaten away. • See a Dr immediately • Prevention is most important Streetworks

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18. Chalk Lung • Tiny pieces from drugs can be injected into the blood stream • Veins in your lungs are tiny and when pieces end up there the lungs scar and make it hard to breath! • Misdiagnosis • There is no cure Streetworks

19. Prevention: Chalk Lung • FILTERING • No Shakers • Eating pills Streetworks

20. Cotton Fever • Piece of the filter enters the blood stream • What it looks like – Fever, bone aches/pains, feeling of hot and cold at the same time, and shaking. • How to treat it – Rest, Food, Take some ASA or Acetaminophen • Usually gets better within an hr-2hrs. If it last longer it could be something more serious. Streetworks

21. Endocarditis (Heart infection) • Is an infection of the heart caused by bacteria. . • What it looks like – Fever, chills for a couple of days without any other reason, coughing, SOB, chest pain, feeling tired or weak, and weight loss. • Treatment with IV antibiotics and a hospital stay. • Long term problems • Prevention is the key – NO GERMS!! Streetworks

22. Septicemia (Blood infection) • Is a serious condition!! • Bacterial infection in the blood stream which travels to all parts of the body. • Symptoms include chills, fever, extreme fatigue and weakness. With severe infection the nervous system can be affected resulting in confusion, disorientation, seizures or a loss of consciousness. • This can be LIFE THREATENING!! • Treatment – You have to see a doctor • Don’t let any infections (Abscess) get out of control. Prevention – safer injection. Sterile equipment always and no sharing ever! Streetworks

23. Withdrawal Streetworks

24. Withdrawal • Misuse or overuse of opiates can cause physical dependence. • This means that a person feels the need for the drug to prevent symptoms of withdrawal. • Over time, greater amounts of the drug become necessary to produce the same effect. . Streetworks

25. Withdrawal • The time it takes to become physically dependent is different for everyone. • When the drugs are stopped, the body needs time to recover, and withdrawal symptoms result. Streetworks

26. Withdrawal • When it comes to withdrawal, every drug is different • Some drugs produce significant physical withdrawal (alcohol, opiates, and tranquilizers). • Some drugs produce little physical withdrawal, but more emotional withdrawal (cocaine, marijuana, and ecstasy). Streetworks

27. Emotional Withdrawal Symptoms • Anxiety • Restlessness • Irritability • Insomnia • Headaches • Poor concentration • Depression • Social isolation Streetworks

28. Physical Withdrawal Symptoms • Sweating • Racing heart • Palpitations • Muscle tension • Tightness in the chest • Difficulty breathing • Tremor • Nausea, vomiting, or diarrhea Streetworks

29. Dangerous Withdrawal Symptoms • Alcohol and tranquilizers produce the most dangerous physical withdrawal. • Suddenly stopping alcohol or tranquilizers can lead to seizures, strokes, or heart attacks. Streetworks

30. Withdrawal • Opioid withdrawal reactions are very uncomfortable but are not life threatening. • Symptoms include diarrhea, body aches and shakes, stomach cramps, puking, bone pain, sweating, loss of appetite, trouble sleeping, a fast heartbeat, and runny nose/eyes. • Withdrawal sets in about 6 hours after last use, peaks at 48-72 hrs but may continue to experience abstinence syndrome- including depression and cravings for months Streetworks

31. Overdose Streetworks

32. Overdose • One of the most serious health consequences with illicit drug use is the risk of overdose • If there is too much of a drug getting to the brain or other organs too fast, dangerous side effects can occur including: Streetworks

33. Opioid Overdose • Unconsciousness • Heart failure, • Respiratory distress (stopping breathing) • Seizures Any of these conditions could become deadly Streetworks

34. Overdose • Common causes of Overdose include: • Doing too much of a drug at once • Using too much over a short period • A lowered tolerance (often occurs after detox, hospital stay, jail) • Quality or purity of the drug Streetworks

35. Upper overdose (ie. Cocaine) • What is an cocaine overdose? • Not actually an “overdose” of cocaine • a cocaine reaction, even causing death can happen at any dose • Depends on personal factors of the user including weight, metabolism and health condition Streetworks

36. Common Symptoms of cocaine reactions • Severe anxiety, agitation, confusion, headache • Chest pain- lack of O2 to the heart • Rapid pulse/heartbeat • Changes in vision, balance, weakness in arms/legs, difficulty speaking • High blood pressure • Seizures or convulsions • Rise in body temperature Streetworks

37. Preventing Overdose • Ways to prevent overdoses include: • Knowing your dealer • Doing a tester and taking it extra slow • Using in a safe, comfortable environment • Having Narcan training to reverse an opioid overdose *Remember: your tolerance will be lower if you haven’t used in awhile Streetworks

38. Factors increasing the dangers of drug use • Environmental factors • Polypharmacy (mixing drugs with alcohol or other drugs) • Cutting agents Streetworks

39. 1) Environmental factors • The quality of any drug experience is determined not only by the drug itself (potency,purity factors for example) • Also depends on: • how the drug is administered • the environment in which it is taken • the mood or mindset at the time the drug is taken Streetworks

40. 2) Polypharmacy • Mixing drugs alcohol or other drugs • Can be very dangerous • One of the most common reasons for death from an overdose is mixing drugs-this makes the first drug much stronger and is often too much for the body to handle. Streetworks

41. Mixing Uppers and Down • Mixing an upper (ie. Cocaine) with a downer (heroin) makes your chance for OD’ing even greater- your body is trying to answer 2 different demands- Speeding up from the upper and slowing down from the opiate. Streetworks

42. Alcohol and Opiates (down) • Both alcohol and Down (morphine, codeine, heroin) depress the body and its functions • Using alcohol and opiates together increases: • the risk of unconsciousness • Chances that a person will stop breathing and • Death from OD Streetworks

43. Alcohol and Cocaine • Between 30-60% of individuals who use cocaine combine it with alcohol • The combo of alcohol and cocaine increases risk of illness and death from heart complications, liver toxicity and behaviors leading to personal injury • The risk of sudden death is 25X greater once alcohol is added while using cocaine (then using cocaine alone) Streetworks

44. Alcohol and Cocaine • Alcohol + Cocaine = • the formation of a third compound in the body: Cocaethylene Streetworks

45. Cocaethylene • Its effects are similar to those of cocaine, however this compound is far more toxic to the body then alcohol or cocaine use alone • The symptoms of a cocaine reaction can continue for some time after cocaine is last used Streetworks

46. Cocaethylene • The use of alcohol with cocaine increases the risk of convulsions and death then cocaine use alone • This formation of this compound continues for several hours- sudden deaths may occur 6-12 hours after cocaine use! Streetworks

47. 3) Cutting agents • The cutting of illegal drugs is common. • To increase value and acceptability of a drug, they may undergo processes such as: • Substitution - replacement of 1 drug with another • Dilution - addition of a substance to use less of the drug • Contamination - adding extra substance by accident and/or • Adulteration - purposely adding a substance with similar characteristics OR properties which increase the effects of the drug Streetworks

48. Cutting agents • Past cutting agents: • lactose, mannitol, niacinamide (match the appearance of cocaine) • Benzocaine, lidocaine, procaine (cause a localized numbing effect similar to cocaine) Streetworks

49. Cutting agents • In recent years, there has been an increase in the addition of more serious drugs including: • Acetaminophen (tylenol) • Caffeine • Atropine • Diltiazem • Ritalin • Levamisole Streetworks

50. Levamisole Streetworks