As we know, IV or intravenous drug use is by far the most dangerous way to use drugs. IV drug use is dangerous because it is the quickest way for drugs to be absorbed into the blood stream, it is the most powerful in its effect, it is the easiest way to overdose— as potency of illicit drugs are never consistent, it can quickly lead to major health problems at the injection site, and IV drug use spreads infectious diseases.
The Process of IV Drug Use
Not only does IV drug use require some knowledge and skillful practice in being able to properly dissolve drugs into liquid, draw the mixture up into the syringe, tie off the area to mitigate blood flow, find a vein, and correctly insert the syringe into that vein, but also you must know to draw blood up into the syringe before injecting yourself.
It is extremely easy to mess up injections by missing the vein, or messing up one of the many steps in the injection process. This can lead to the impure mixture of drugs and liquid being pushed into muscular tissue, which results in a sharp burning pain, or will lead to the mixture pooling up under the skin— this can cause an abscess and infection that can easily become so serious that it could result in a necessary amputation of the affected limb.
Complications of IV Drug Use
Intravenous drug use can cause a variety of complications, ranging from mild to severe complications. All of these complications can be exacerbated by continued IV drug use.
Common complications of IV drug use:
- endocarditis [an infection on the inner lining of your heart’s chambers and valves]
- skin and soft tissue infections
- septic phlebitis [inflamed and infected vein(s)— can be in superficial or deep veins]
- thrombophlebitis [vein inflammation due to one or more blood clots]
- central nervous system infection [effects the brain and spinal cord]
- botulism [bacteria introduced in the body forms a toxin that attacks the body’s nerves]
- “Roth Spots” [retinal hemorrhages— white spots in your vision]
- non-cardiogenic pulmonary edema [fluid leaks from the capillaries in your lung’s air sacs]
- adult respiratory distress syndrome (ARDS) [your lungs fill with fluid and inflammatory white blood cells]
- gas gangrene [can result in tissue death]
types of central nervous system infections include…
a. brain abscesses
b. bacterial and fungal meningitis
c. vertebral osteomyelitis/discitis
d. epidural abscesses
e. other extensive central nervous system complications
Some of the most common complications from intravenous drug use causes are track marks, collapsed veins, cellulitis, and swelling of the feet, ankles and legs. These are just some of the complications that can arise from IV drug use, however, there is a laundry list of complications caused by intravenous drug use. Many of these conditions can be fatal. Depending on what the cut or filler used in the illicit drug being injected, there is also a list of complications that can arise due to those specific chemicals.
IV Drug Use and Infectious Diseases
Sharing needles is a massive issue in the overall impact of intravenous drug use. Because of needle-sharing, infectious diseases are passed around to IV drug users.
The most common infectious diseases that needle-sharing result in, include:
- Hepatitis C
- Hepatitis B
- other blood borne bacterial, fungal, and viral infectious agents
It is estimated that out of the worldwide population of IV drug users, 13.5% are HIV positive and 52% have Hepatitis C (Martínez-Romo). If you contract an infectious disease, that disease will also make you more likely to experience more serious complications from IV drug use. For example, “Those with HIV are at risk of toxoplasmosis and cryptococcal meningitis as well as CNS lymphoma” due to complications from intravenous drug use (Martínez-Romo).
What is Harm Reduction?
“Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users ‘where they’re at,’ addressing conditions of use along with the use itself” (Winkelstein).
Buying Syringes Without a Prescription
Increasing accessibility to clean (unused) syringes is a harm reduction measure. Access to clean syringes helps to curb the transmission of infectious diseases, and can prevent some complications associated with intravenous drug use. “Most drug users report that the scarcity of injection equipment is an important reason for sharing. Rather than obtaining sterile syringes and needles from pharmacists, health care professionals, or public health departments, they get their injection equipment from street sellers and shooting galleries” (National Research Council).
Pharmacies, depending on the state they’re in, allow anyone to purchase insulin syringes without a prescription. In fact, 27 states in the U.S. have a law authorizing retailers to sell syringes without a prescription, and do not have a law prohibiting the sale of syringes to people who inject drugs. 21 states in the U.S. and the District of Columbia, do not have a law prohibiting the sale of syringes without a prescription, and no law prohibiting the sale of syringes specifically to people who inject drugs. The remaining 2 states, Tennessee and Delaware, do have a law that prohibits the sale of syringes without a prescription or prohibits the sale of syringes to people who inject drugs (CDC). Pharmacies that allow the sale of syringes without a prescription usually have a limit on how many needles you can buy at one time, which is commonly 10 needles.
This allows for drug addicts to purchase clean syringes that they can then use for IV drug use. While this practice seems to be enabling, we believe the harm reduction aspect is hard to overlook. Addicts have a way of doing what they want to do, no matter the regulations set in place. Most would agree that it’s better to allow the purchase of clean syringes as opposed to an addict being forced to use a dirty needle, or a shared needle.
How are Tennessee and Delaware Doing?
Tennessee and Delaware are the only two states that prohibit the sale of syringes without a prescription or prohibits the sale of syringes to people who inject drugs.
In Tennessee, out of the seven-hundred and fifteen new HIV cases recorded in just 2016, 14.7% of those cases were attributed to IV drug use. “In 2015, an estimated 16,425 persons were living with a diagnosed HIV infection in Tennessee…”; almost a quarter of those persons contracted HIV due to IV drug use (NIDA). For Hepatitis C, based on the U.S. percentage of people who contract Hepatitis C from IV drug use, out of the 150 new cases of Hepatitis C in Tennessee in 2016, 102 of those cases were people who contracted the disease from IV drug use. Keep in mind that “Actual acute cases estimated to be 13.9 times the number of reported cases in any year” (NIDA).
For high school students in Tennessee, “…about 5 percent of the high school population statewide, reported some lifetime history of injection drug use. This figure is substantially higher than the U.S. average rate of about 2 percent in the same year” (Tennessee Department of Mental Health & Substance Abuse Services). If these high school students continue to abuse substance by way of intravenous drug use, they have a much greater chance of contracting diseases and suffering complications into their adulthood. The CDC reported that from 2006-2012, “Increases in Hepatitis C Virus Infection Related to Injection Drug Use Among Persons Aged ≤30 Years” were seen in Tennessee…Adolescents and young adults (aged ≤30 years) from nonurban areas account for the majority of cases, with approximately 73% citing injection drug use as the principal risk factor” (Suryaprasad).
In Delaware, in just 2015, “…an estimated 3,230 persons were living with a diagnosed HIV infection in Delaware…” which over half of these people contracted the disease due to IV drug use. “In Delaware, there are an estimated 6,400 persons living with Hepatitis C (2013-2016 annual average)” (NIDA). Based on the U.S. percentage of people who contracted Hepatitis C from IV drug use, over 4,390 out of the 6,400 people in Delaware with Hepatitis C got the disease from intravenous drug use. This is 68.6% of people living with Hepatitis C, who contracted the disease specifically from IV drug use.
In Delaware’s 2017 Delaware State Epidemiological Profile: Substance Abuse and Related Issues report, the state only mentioned intravenous drug use in their “national overview” section, writing that “Drug users that inject heroin or other drugs risk spreading infectious disease. Intravenous drug use has been linked to HIV/AIDS and Hepatitis C. Many communities and states have enacted needle-exchange programs that allow drug users to drop off used needles and receive either free or reduced cost needles. In addition, many of these programs provide resources about substance abuse treatment, infectious disease control, and other health information.” In the report, Delaware declined to mention their own lack of policies in place to reduce the spread of infectious diseases and curb complications associated with IV drug use in regards to their law prohibiting the sale of clean syringes at pharmacies state-wide.
Delaware mentions that other communities and states have enacted needle-exchange programs, which was their inspiration for starting needle exchange programs in their state, authorized by Title 29, Section 7993 of the Delaware Code. While these needle exchange programs are great harm reduction practices, addicts who do not have access to these needle exchange program sites, cannot find out where these sites are, or are not close in location to a site, will still suffer from unsafe practices due to the state’s prohibition of syringe sales without a prescription.
Other Harm Reduction Measures
Syringe Service Programs (SSPs) exist as another harm reduction measure. These programs essentially provide clean syringes to drug addicts, and provide receptacles for the proper disposal of used needles. The goal in SSPs is to reduce harm and save lives by giving access sterile medical equipment. Syringe Service Programs (SSPs) are also known as: syringe access programs (SAPs), needle exchange programs (NEPs), syringe exchange programs (SEPs), needle and syringe programs (NSPs), or clean needle programs (CNPs). “The hostility of legislators to needle and syringe exchanges is illustrated by a series of congressional bans on the use of federal funds for exchange programs. Since 1988, Congress has passed at least seven statutes that contain provisions prohibiting or restricting the use of federal funds for needle exchange programs and activities” resulting in Syringe Service Programs relying on state, municipal, or charitable funding to operate (National Research Council).
Another initiative based around harm reduction is the emergence of safe injection sites. Safe injection sites are facilities that provide clean and sterile supplies for drug addicts to use in the presence of trained professionals. These trained professionals are present to revive someone if they have overdosed, answer questions for safe injection practices, and can provide information for hospitals or doctors for any IV drug use complications. The staff members of the facility do not directly assist in the IV drug use process.
These safe injection sites serve as a safe space for addicts to use clean supplies, properly sterilize the area of injection, and have access to useful information about programs targeted to help them stop their drug use. Safe injection sites can also be called: supervised consumption services (SCS), supervised injection sites (SIS), overdose prevention centers, safe or supervised injection facilities (SIFs), and drug consumptions rooms (DCRs). The American Medical Association states that “Studies from other countries have shown that supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance use disorders without increasing drug trafficking or crime in the areas where the facilities are located.”
We believe that allowing the purchase of clean syringes is an important measure for harm reduction. We support harm reduction practices, as they help communities stay as safe as possible and can guide more addicts and alcoholics into seeking the appropriate addiction treatment for their substance use disorder. “Numerous medical and professional organizations have studied syringe exchange and concluded that it does not encourage drug use. Rather, it is a highly effective way to prevent the spread of HIV and helps link drug users with drug treatment, medical care, counseling, and other social services” (“Needle Exchange Program”).
In addition, needle exchange programs are responsible for drastically decreasing the spread of infectious diseases; “Researchers from the University of Pennsylvania ran an eight year study of the Philadelphia needle exchange program. Within the eight years, the rate of new HIV infections dropped from 6.8% to less than 0.05% per year” (“Needle Exchange Program”). Most IV drug users cite the reason of lack of accessibility to needle exchange programs as their reason for not partaking, which is why allowing the purchase of clean syringes in pharmacies across each state is further helping reduce the harms associated with intravenous drug use.
If you or someone you know is struggling with an addiction, please reach out to us at (877)-RECOVERY or (877)-732-6837. Our team of addiction specialists make themselves available to take your call 24 hours a day, 7 days a week. Because We Care.
CDC. “Laws Related to the Retail Sale of Syringes/Needles | Policy and Programs | Division of Viral Hepatitis | CDC.” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, www.cdc.gov/hepatitis/policy/RetailSaleOfSyringes.htm
Martínez-Romo, Miguel. “Injection Drug Use Complications.” Emergency Medicine Education, EmDocs, 8 Jan. 2018, www.emdocs.net/injection-drug-use-complications/
National Institute on Drug Abuse. “Tennessee Opioid Summary.” NIDA, National Institutes of Health, 29 Mar. 2019, www.drugabuse.gov/opioid-summaries-by-state/tennessee-opioid-summary
National Research Council (US) and Institute of Medicine (US) Panel on Needle Exchange and Bleach Distribution Programs. Proceedings Workshop on Needle Exchange and Bleach Distribution Programs. Washington (DC): National Academies Press (US); 1994. Law and Policy. Available from: https://www.ncbi.nlm.nih.gov/books/NBK236633/
NIDA. “Delaware Opioid Summary.” National Institute on Drug Abuse, National Institutes of Health, May 2019, www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/delaware-opioid-summary
Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006–2012. Clin Infect Dis 2014;59:1411–9
Tennessee Department of Mental Health and Substance Abuse Services. “Tennessee Epidemiological Profile of Alcohol and Drug Misuse and Abuse.” Substance Use in Tennessee: A State Epidemiological Profile, Tennessee Department of Mental Health & Substance Abuse Services, 2016, preprod.tn.gov/content/dam/tn/mentalhealth/documents/Tennessee_Epidemiological_Profile_of_Alcohol_and_Drug_Misuse_and_Abuse.pdf
Winkelstein, Emily. Guide to Developing and Managing Syringe AccesS PROGRAMS. Harm Reduction Coalition, 2010, harmreduction.org/wp-content/uploads/2011/12/SAP.pdf