Managing Wound Care & Chronic Complications Associated With Sustained Injecting


This article contains images, videos and other media that shows real-life wounds, abscesses, ulcers and amputations associated with injecting throughout. Not for those with a nervous disposition to wounds and graphic media.

We are seeing more and more overdoses and skin/wound issues arising at the moment. This is mostly due to the increased drug use compounded by COVID-19 and reduced access to care services, wound management clinics at Doctors surgeries and increased waiting times at hospitals as waiting lists slowly back up with cases deemed “a lower priority”.

There needs to be less judgment and more education and quicker access to provisions within the injecting communities (heroin, steroids, methamphetamine and others). Not every person with substance addiction issues is addicted due to a poor choice. Reasons for use can be related to unmanaged mental illness, self-medication and family genetics, just to name a few.

Compassion is lacking for this group of folks. I have seen it firsthand. This topic hits close to home as I personally have experienced serious wound care issues in my own recovery. This problem is an epidemic and needs to be talked about more.


Main Issues With Injecting & Those Who Inject

Below are some of the main complications that occur when addicts chronically inject. Some are directly associated with injecting and others as a result of their addictive behaviours.

  • Causes necrosis (death of healthy tissue)
  • Damage to nerves
  • Damage to/risking injecting into arteries
  • Open wounds that then become infected
  • Reduced vascular (blood) circulation
  • Risk of loss of limbs (amputations)
  • Chronic neuropathic (nerve) pain associated with damaged nerves
  • Poor care of current and new wounds
  • No access to clean, sterile wound dressing supplies
  • Risk of sepsis (blood poisoning)
  • Risk of overdoses
  • Risk of pulmonary embolisms
  • Risk of deep vein thrombosis (DVT’s)
  • Risk of death

Substances & Related Wounds

Heroin

Abscesses are common in those who use heroin because the substance is not sterile and is often mixed with citric acid. Citric acid can also cause acid burns in the vessels or subcutaneous tissues, leading to necrosis (dead tissue).

Heroin can be smoked, snorted or injected. The stronger the addiction, the more apt the user is to inject the drug. Skin infections and injection site-type wounds are becoming more of the “norm.” Skin breakdown, abscess, infection, sepsis, deep vein thrombosis (DVT), and amputation are common.

Substance users inject in their arms, legs, hands, groin, “blood bank” (into veins beside bicep muscles in the upper arm), between fingers or toes, neck and even genitalia. Addicts most often begin with injecting into their arms as these provide the easiest to access. They then tend to move onto more riskier areas such as their groin or legs.

When a user cannot find a good site, the overriding urge to ensure that they get “a hit” is so strong they they will result to skin popping their drugs instead. Skin popping mean injecting the drug under their skin or into their muscle. We mention both as addicts are so desperate to get their hit that they won’t be fussy where it end up, as long as they get their hit. This means that the drug can build up under the skin and be absorbed into subcutaneous or muscular tissues.

Skin popping leads to other complications as with conventional injecting. Placing an unsterile, acidic substance under the skin can cause chemical burns, cause necrosis (death of surrounding tissue), damage to nerves, arteries and others.

Methamphetamine

People who use meth are known for having open sores on their bodies. This can happen if the user is smoking, snorting or injecting the drug. Open wounds or “pocks” are mostly caused by the hallucinations of what are referred to as “meth mites” or “crank bites” that meth users think are under their skin. It is common for meth users to feel anxious or like they are being eaten alive by insects. These open areas of the skin can then lead to infections and other risks associated with open wounds.


Krokodil

Krokodil is the street name for desomorphine. This isn’t a common substance in the UK, but one we thought we should include to cover all bases. This drug is injected and leads to necrotic skin.

Russian doctors first noticed wounds with a crocodile hide appearance in the early 2000’s. The drug was being made in the homes of Russians and Siberians. Krokodil causes skin necrosis and damages internal organs.

It has also been referred to as a “flesh-eating drug.” Bone infections and amputations are common. Krokodil has since spread to Europe and the United States (Utah, Illinois, Arizona, and Ohio).


Anabolic Steroids

Anabolic steroids are prescription-only medicines (POM’s) that are sometimes taken without medical advice to increase muscle mass and improve athletic performance.

If used in this way, they can cause serious side effects, including addiction.

Anabolic steroids are manufactured drugs that mimic the effects of the male hormone testosterone. They have limited medical uses and aren’t to be confused with corticosteroids, a different type of steroid drug that’s commonly prescribed for a variety of conditions and are designed and produced, specifically to be injected by medical professionals.


Learning The Basics Of Wound-care


Common Terms In Injecting Wound-care

What Is An Abscess?

An abscess is a painful collection of pus, usually caused by a bacterial infection. Abscesses can develop anywhere in the body.

Signs and symptoms include a smooth swelling under your skin, pain and tenderness in the affected area, warmth and redness in the affected area, a visible build-up of white or yellow pus under the skin in the affected area, a high temperature or chills.


What Is An Ulcer?

An ulcer is a long-lasting (chronic) sore that takes more than 2 weeks to heal. They can develop anywhere a user injects, they usually develop around areas with good vascular access (somewhere near to veins the addict was trying to inject into) these include on the inside/outside of the legs or arms.

The signs and symptoms of an ulcer include pain, itching, swelling, heat radiating from the affected area, radiating pain or shooting, burning pain (nerve pain), possible smelly discharge in the affected area, numbness or difficulty weight bearing if it’s on the legs. There may also be hardened or discoloured skin around the ulcer.

What Is An Amputation?

Amputations are the surgical removal of limbs or body parts. When wounds become a risk to the individuals life or that complications associated with the wound causes conditions such as sepsis (blood poisoning), amputation is often opted for to save the persons life. However, many amputations could be spared is the individual had sought treatment sooner, took better care of their wounds and ceased injecting. This however doesn’t always happen. People’s drive to inject can become an addiction in itself as they become “needle fixated” and continue to inject into the same areas, even though they already have abscesses or ulcers as their need/desire to inject overrides their understanding of the seriousness of their current situation and how continuing to inject could be playing a very real game of Russian roulette with their life.

What Is Slough?

Most of us have seen it, debrided it or even watched it change from wet (stringy, moist, yellow) to dry eschar (thick, leathery, black) in our wounds. Slough is necrotic tissue that needs to be removed from the wound for healing to take place. When referring to slough, some terms may be used interchangeably – fibrotic tissue or necrotic tissue most commonly. It is important to differentiate between wet necrotic tissue and dry necrotic tissue to formulate the best, evidenced-based wound care treatment plan.

What Is Biofilm?

Biofilms are usually composed of mixed strains of bacteria, fungi, yeasts, algae, microbes, and other cellular debris. A biofilm is formed when certain types of microorganisms adhere themselves to the wound surface. A viscous substance is then secreted which needs to be removed to allow proper healing to continue.


What Is Necrotic Tissue/Necrosis?

Necrotic tissue is dead or devitalised tissue. This tissue cannot be salvaged and must be removed to allow woundhealing to take place.


What Is Debridement?

Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic or by maggot therapy. This is done via your healthcare professional and should never be attempted without the proper training and equipment as you might only make things a lot worse.


Tips For Injecting With Wounds

It’s important that you follow the following tips and suggestions if you want to avoid becoming another photo like the ones above!

  • NEVER inject into a wound or near a wound, no matter how unwell you may feel or how desperate you are! This increases your risks of developing a new infection by transferring dirt or necrotic tissue as you puncture holes into dirty, infected skin which can then end up going into your bloodstream as you push the needle into the vein, causing sepsis.
  • Never use risky sites such as your groin, neck, face, fingers, toes or genitals.
  • Always use new, sterile, single use injecting equipment each and every time you use.
  • Never use anyone else’s injecting equipment as you may transfer any blood borne viruses they may have into your wounds, which you then may contract.
  • Where absolutely possible, alternate your injecting sites to avoid overuse of one vein/area in an attempt to minimise the damage to your body.
  • Always clean your sites before you inject as you may push bacteria or germs into your injecting sites, causing new wounds.
  • Use the smallest needle sizes/gauges possible.
  • Never pull back and forth on the syringe plunger in an attempt to get every last drop of drug. This can rupture your veins or cause further scar tissue.
  • If you cannot find the vein within 3 attempts, change the needle as it may be blocked. You do not want to push this blockage into your vein as it may cause a blockage in a vein or artery and can be fatal! Blunt needles also cause more damage.

Wound care 101

The tips below will help your wounds to heal, whilst minimising any risks that may occur from improper wound care.

  • If you have a miss or end up skin popping, always keep an eye on your injecting site for the following 7 days to see whether you may end up developing an infection, abscess or ulcer.
  • Change your dressings regularly as advised by your healthcare professional.
  • Never inject into an open wound you may already have, no matter how desperate you are!
  • If your wound is on a limb, ensure that you move your legs or arms regularly to keep blood flowing, prevent deep vein thrombosis and promotes healing.
  • Never leave any open wounds unattended. As soon as you notice a wound developing, it’s important that you “jump” on top of it and take good care of it straight away before it gets worse, which inevitably it will if left untreated.
  • When changing your dressings, de-briding and removing any biofilm or will help promote healing. You can do this with clean, running water in a shower or with special products designed for this task (shown below).
  • Wash your hand before and after touching any wounds with hot water and soap, or ideally antibacterial soap.
  • Visit your healthcare professional regularly to monitor any new or existing wounds.
  • If you are ever in doubt, speak to a healthcare professional or your nearest drug and alcohol service.
  • Don’t inject if possible, try smoking, snorting or other less invasive routes of administration.
Products used for the removal of slough and biofilm.
Second product designed for the removal of slough and biofilm.

Conclusion

It has been reported that one third of substance users will develop an injection-related abscess, sore or open wound within a one-year period at minimum. Education about substance use, skin issues and wound care is an important part of helping not only the user but also the health care professionals that are encountering this consequence of injecting more and more often.


When To Seek Professional Help?

The following guidelines are a generalised suggestions, however if you are ever unsure, play it safe and seek help. It’s better to be safe than sorry!

Seek professional help if:

  • The wound is open, smells or there is necrotic tissue (dead skin).
  • If the wound is bigger than 4 £1 coins in a square.
  • If you feel unwell, have a fever, sweating, feel sick, have a headache or any other possible symptoms of sepsis as it can be fatal within 60 minutes if not caught and treated quickly enough.
  • If you have any health conditions which may impede your ability to heal or make you more susceptible to infections.
  • If you are unable to look after the wound properly yourself.
  • Are unable to source or obtain the proper dressings and equipment needed to look after a wound.

You can find more information and contact NHS 111 by clicking here. You can also find out more information about leg ulcers here or about other types of wounds on the wounds-uk website here.

IF YOU ARE EVER IN DOUBT, REACH OUT BY CALLING 111, VISITING YOUR GP OR DOCTOR.

IF YOU FEEL UNWELL AFTER DEVELOPING A WOUND, CALL 999 OR YOUR EMERGENCY SERVICES NUMBER AND TELL THEM YOU HAVE SUSPECTED SEPSIS.


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Published by Drink ’n’ Drugs

Providing useful, relevant, up to date information and support for those suffering from active addiction or those who are in recovery.

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