Drug injection

Last updated
Fragment of a hypodermic needle stuck inside the arm of an IV drug user (x-ray) Fragment of hypodermic needle stuck inside arm of IV drug user (x-ray).jpg
Fragment of a hypodermic needle stuck inside the arm of an IV drug user (x-ray)

Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body (usually intravenously, but also at an intramuscular or subcutaneous, location). Intravenous therapy, a form of drug injection, is universally practiced in modernized medical care. As of 2004, there were 13.2 million people worldwide who self-administered injection drugs outside of medical supervision,[ clarification needed ] of which 22% are from developed countries. [1]

Contents

A wide variety of drugs are injected, often opioids: these may include legally prescribed medicines and medication such as morphine, as well as stronger compounds often favored in recreational drug use, which are often illegal. Although there are various methods of taking drugs, injection is favoured by some people as the full effects of the drug are experienced very quickly, typically in five to ten seconds. It also bypasses first-pass metabolism in the liver, resulting in higher bioavailability and efficiency for many drugs (such as morphine or diacetylmorphine/heroin; roughly two-thirds of which is destroyed in the liver when consumed orally) than oral ingestion would. The effect is that the person gets a stronger (yet shorter-acting) effect from the same amount of the drug. Drug injection is therefore often related to substance dependence.

In recreational-use drug culture, preparation may include mixing the powdered drug with water to create an aqueous solution, and then the solution is injected. This act is often colloquially referred to as "slamming", "shooting up", "smashing", "banging", "pinning", or "jacking-up", often depending on the specific drug subculture in which the term is used (e.g. heroin, cocaine, or methamphetamine).

Risks

In addition to general problems associated with any IV drug administration (see risks of IV therapy), there are some specific problems associated with the injection of drugs by non-professionals, such as:

Methods

A clandestine kit containing materials to inject drugs, a bottle of a type of lean, promethazine, an antiemetic, and unidentified pills Clandinjectkit.JPG
A clandestine kit containing materials to inject drugs, a bottle of a type of lean, promethazine, an antiemetic, and unidentified pills

The drug—usually (but not always) in a powder or crystal form—is dissolved in water, normally in a spoon, tin, bottle cap, the bottom of a soda can, or another metal container. Cylindrical metal containers—sometimes called "cookers"—are provided by needle exchange programs. Users draw the required amount of water into a syringe and squirt this over the drugs. The solution is then mixed and heated from below if necessary. Heating is used mainly with heroin (though not always, depending on the type of heroin), [4] but is also often used with other drugs, especially crushed tablets. Cocaine HCl (powdered cocaine) dissolves quite easily without heat. Heroin prepared for the European market is insoluble in water and usually requires the addition of an acid such as citric acid or ascorbic acid (Vitamin C) powder to dissolve the drug. Due to the dangers from using lemon juice or vinegar to acidify the solution, packets of citric acid and Vitamin C powder are available at needle exchanges in Europe. In the U.S., vinegar and lemon juice are used to shoot crack cocaine. The acids convert the water-insoluble cocaine base in crack to a cocaine salt (cocaine acetate or cocaine citrate), which is water-soluble (like cocaine hydrochloride).

Once the drugs are dissolved, a small syringe (usually 0.5 or 1 cc) is used to draw the solution through a filter, usually cotton from a cigarette filter or cotton swab (cotton bud). "Tuberculin" syringes and types of syringes used to inject insulin are commonly used. Commonly used syringes usually have a built-in 28 gauge (or thereabouts) needle typically 1/2 or 5/8 inches long.

The preferred injection site is the crook of the elbow (i.e., the Median cubital vein), on the user's non-writing hand. Other users opt to use the Basilic vein; while it may be easier to "hit", caution must be exercised as two nerves run parallel to the vein, increasing the chance of nerve damage, as well as the chance of an arterial "nick". [5]

Regarding route of administration, much injection drug use, but not all, is intravenous injection, whereas some is subcutaneous injection or intramuscular injection (including skin popping, which often involves a depot injection).

Recreational drugs

Risks

Substances

Contraindicated substances

Hydroxyzine (brand name Atarax, and Vistaril) is contraindicated for subcutaneous, intra-articular, or subcutaneous administration. [6] [7]

Street drugs

Infections

Risks from drug injection are caused by a variety of factors, including unclean or unsafe injection practices such as blood flashing [8] and repeated injections at the same site. [9] Injection drug users that fail to adequately sanitize the skin or use clean injection products are at increased risk for cellulitis, abscesses, and thrombophlebitis; these infections can subsequently result in sepsis and bacteremia, which can be fatal if untreated. [9] Repetitive injections, especially those with unsafe practices, can result in additional medical concerns that include thrombosis formation and infectious endocarditis. [9] In rare cases osteomyelitis of the chest can be caused by IV drug use.

Additional risks from unsafe injection practices result primarily from sharing materials (needles, cookers, syringes) used in injection. [9] Blood-borne pathogens, such as HIV, Hepatitis B, and Hepatitis C are of particular concern among injection drug users who share supplies, and increase the likelihood of infection. [9] An added challenge, is that not only infected individuals know their positive status and continue to share supplies, placing other users at risk for infection as well. [9] 30-50% of adults will not experience acute Hepatitis B symptoms, and those that do experience lethargy, nausea, upper abdominal pain, muscle aches, or a darkening of urine will need to connect these symptoms to a possible infection to seek care and limit spreading of the virus. [9]

Of all the ways to ingest drugs, injection carries the most risks by far as it bypasses the body's natural filtering mechanisms against viruses, bacteria, and foreign objects. There will always be much less risk of overdose, disease, infections, and health problems with alternatives to injecting, such as smoking, insufflation (snorting or nasal ingestion), or swallowing.

Drug injection is also commonly a component in HIV-related syndemics. Fragments from injection of pills are known to clog the small blood vessels of the lungs, brain, and elsewhere, potentially causing pulmonary embolism (PE), stroke, or venous embolism. A small proportion of PE is due to the embolization of air, fat, and talc in the drugs of people who inject substances. More commonly, the inflammatory response to these foreign objects causes granulation tissue to form in the capillary beds, resulting in vasculitis, and, when it occurs in the pulmonary capillary bed, potentially pulmonary talcosis. Hitting arteries and nerves is dangerous, painful, and presents its own similar spectrum of problems.

The injection of talc from crushed pills has been associated with pulmonary talcosis in intravenous drug users. [10]

Harm reduction

A sterile and safe injection kit obtained from a needle exchange program Who needs a virtual world%3F.jpg
A sterile and safe injection kit obtained from a needle exchange program

Harm reduction is a public health approach that serves as an alternative to abstinence-only guidance. While it does not condone the use of illicit or illegal drugs, it does seek to reduce the harms, risks and dangers associated with illicit drug use, both for the person using illicit drugs and the wider community. Injection drug users that re-use drug delivery components put themselves and others at risk for diseases such as HIV, hepatitis B, and hepatitis C, as well as increase their chances of getting a serious infection. [11] [12] In 2015, the CDC performed an HIV Surveillance Report and attributed 2,392 (6%) of new HIV diagnoses to IV drug use in the US. [13]

A prominent method for addressing the issue of disease transmission among intravenous drug users are needle exchange programs (also known as syringe exchange programs, syringe service programs or needle-syringe programs), where people who inject drugs (PWID) can access sterile needles, syringes, and other paraphernalia. [12] [14] In addition to providing sterile devices used in drug injection, these programs often offer access to infectious disease testing, referrals for substance use or mental health treatment programs, and more. [12] The idea behind harm reduction approaches is to slow disease transmission, such as HIV/AIDS and hepatitis B and C, and promote public health by reducing the practice of sharing used needles.

In countries where harm reduction programs are limited or non-existent, it is quite common for an IV users to use a single needle repeatedly or share with other users. It is also quite uncommon for a sterilizing agent to be used on needles and syringes. This creates a high risk population for the spread of bloodborne pathogens.

A new approach to reduce harm to IV drug users was recently started in Southern Nevada in 2017. Trac-B Exchange - Southern Nevada Harm Reduction Program was approved in early 2017 to help reduce the spread of HIV in "People Who Inject Drugs". [15] In Nevada, the sharing of needles for drug injections has led to an increase in the spread of HIV and hepatitis B and C. In an effort to reduce the spread of blood borne pathogens, Southern Nevada installed vending machines to give access to sterile needles to those using them for drug injections. Individuals who use these vending machines are required to register with Trac-B and are allowed 2 boxes a week. The boxes contain sterile needles as well as other supplies necessary to reduce the risk of spreading blood borne pathogens. [16] This is a pilot program for increasing injection safety and, if successful, may expand to other areas of the United States. Although this is a new idea in the United States, it was tested in Europe over 20 years ago. In order to combat the AIDS epidemic that was spreading across Europe, France allowed pharmacies to dispense needles without a prescription and implemented needle exchange programs. In 1996, they began a pilot program of syringe vending machines, similar to a coin-operated vending machine. The first vending machines were placed in Marseille due to its high occurrence of AIDS caused by sharing of needles. The results of their study was published in 1999. They found that when the availability of syringes increased, more and more people began to purchase sterile needles. It also provided a discreet way for people to purchase needles without having to feel embarrassed going into a pharmacy. They theorized that with greater access to sterile needles, they would expect to see a reduction in bloodborne pathogen cases. [17]

Beyond just needle exchange programs, the other major harm reduction strategy for drug users are safe injecting facilities (SIFs). These provide a sterile environment for people who inject drugs to do so cleanly, and with sterile syringes which are forced to be thrown away after use so that no re-use occurs. The first of these facilities opened in Switzerland, but there are now over 100 globally including one in Vancouver - Canada, Sydney - Australia, and most recently, Melbourne - Australia.

Modifications

Particularly for intravenous administration, self-injection in the arm can be awkward, and some people modify a syringe for single-handed operation by removing the plunger and affixing a bulb such as from a large dropper or baby pacifier to the end of the barrel to in effect make it a large dropper with a needle affixed. This is therefore a variant of the common method of injection with a dropper with the hypodermic needle affixed, using a "collar" made of paper or other material to create a seal between the needle and dropper. Removing part of the plunger assembly by cutting off most of the shaft and thumb rest and affixing the bulb to the end of the barrel, thereby allowing the bulb to operate the plunger by suction, also does work in many cases.

An alternative to syringes in the 1970s was to use a glass medicine dropper, supposedly easier to manipulate with one hand. [18] A large hairpin was used to make a hole in the skin and the dropper containing the drug (usually heroin) was inserted and the bulb squeezed, releasing it into the tissues. [19] This method was also reported—by William S. Burroughs and other sources—for intravenous administration at least as far back as 1930.

Alternatives

The closest method to IV/overall injection use, in terms of rapid onset, optimal bioavailability, and reduced health risks for most drugs, tends to be rectal administration via concentrated liquid solution (also known as a suppository), usually consisting of only ~1-3ml of liquid (typically not exceeding 5-10ml) assuming the drug in question possesses sufficient water solubility. While oral morphine has a general bioavailability range is only 20-40%, properly administered rectal use of liquid morphine has an effective bioavailability of roughly 70%, or more than double the overall potency of oral morphine and more than two thirds that of IV use. Swallowing tends to be the safest and slowest method of ingesting drugs. It is safer as the body has a much greater chance to filter out impurities. As orally administered drugs take effect later, the effects tend to last longer as well, making oral administration a preferred method among dance and rave groups for drugs such as amphetamine and MDMA. People rarely take heroin orally, as it is converted to morphine in the stomach and its potency is reduced by more than 65% in the process. However, oral bioavailability of opioids is heavily dependent on the substance, dose, and patient in ways that are not yet understood. [20]

History

IV drug use is a relatively recent phenomenon arising from the invention of re-usable syringes and the synthesis of chemically pure morphine and cocaine.

It was noted that administering drugs intravenously strengthened their effect, and—since such drugs as heroin and cocaine were already being used to treat a wide variety of ailments—many patients were given injections of "hard" drugs for such ailments as alcoholism and depression.

Origin and early use

The hypodermic needle and syringe in its current form was invented by the French scientist Charles Pravaz in 1851, and became especially known during the wars of that and the subsequent decade. However, the first well-known attempt to inject drugs into the body was a 1667 attempt to inject a solution of opium into a dog, and some had suspected that parenteral administration of drugs may work better based on the practise of rubbing opium and other drugs into sores or cuts on the skin for the purpose of causing systemic absorption and the beginnings of scientific understanding of the functioning of the lungs.

During most of the 1850s, the previously held belief that opiate dependence and addiction (often called "the opium appetite", or, when relevant, the "morphine appetite" or "codeine appetite") was due to the drug's action on the digestive system—just like any hunger or thirst—caused doctors to opt to inject morphine rather than administer it orally, in the hope that addiction would not develop. Certainly, by c.1870 or earlier, it was manifest that this was not the case and the title of earliest morphine addict as the term is currently understood is often given to Pravaz' wife, although habituation through orally ingesting the drug was known before this time, including Friedrich Sertürner and his associates, followers, wife, and dog. To some extent, it was also believed early on that bypassing the lungs would prevent opium addiction, as well as habituation to tobacco. Ethanol in its usual form generally is not injected and can be very damaging by most routes of injection; in modern times, it is used as an alternative or potentiator of phenol (carbolic acid) in procedures to ablate damaged nerves.

In or shortly after 1851, the drugs which had been discovered and extracted from their plants of origin and refined into pure crystalline salts soluble in water included morphine (1804 or late 1803), codeine (1832), narcotine/noscapine (1803–1805?), papaverine (1814), cocaine (1855), caffeine (1819), quinine (1820), atropine (1831), scopolamine (aka hyoscine, aka laevo-duboisine) (1833?), hyoscyamine or laevo-atropine (1831), opium salts mixtures (c.1840s), chloral derivatives (1831 et seq.), ephedrine (1836?), nicotine (1828), and many others of all types, psychoactive and not. Morphine in particular was used much more widely after the invention of the hypodermic syringe, and the practise of local anaesthesia by infiltration was another step forward in medicine resulting from the hypodermic needle, discovered at around the same time that it was determined that cocaine produced useful numbing of the mucous membranes and eye.

A wide variety of drugs are injected. Among the most popular in many countries are morphine, heroin, cocaine, amphetamine, and methamphetamine. Prescription drugs—including tablets, capsules, and even liquids and suppositories—are also occasionally injected. This applies particularly to prescription opioids, since some opioid addicts already inject heroin. Injecting preparations which were not intended for this purpose is particularly dangerous because of the presence of excipients (fillers), which can cause blood clots. Injecting codeine into the bloodstream directly is dangerous because it causes a rapid histamine release, which can lead to potentially fatal anaphylaxis and pulmonary edema. Dihydrocodeine, hydrocodone, nicocodeine, and other codeine-based products carry similar risks. Codeine may instead be injected by the intramuscular or subcutaneous route. The effect will not be instant, but the dangerous and unpleasant massive histamine release from the intravenous injection of codeine is avoided. To minimize the amount of undissolved material in fluids prepared for injection, a filter of cotton or synthetic fiber is typically used, such as a cotton-swab tip or a small piece of cigarette filter.

Some manufacturers add the narcotic antagonist naloxone or the anticholinergics atropine and homatropine (in lower than therapeutic doses) to their pills to prevent injection. Unlike naloxone, atropine does indeed help morphine and other narcotics combat neuralgia. The atropine may very well not present a problem, and there is the possibility of atropine content reduction of soluble tablets by placing them on an ink blotter with a drop of water on top, then preparing a shot from the remainder of the pill. Canada and many other countries prohibit manufacturers from including secondary active ingredients for the above reason; their Talwin PX does not contain naloxone. However, as a narcotic agonist–antagonist, pentazocine and its relatives can cause withdrawal in those physically dependent upon narcotics.

See also

Related Research Articles

<span class="mw-page-title-main">Heroin</span> Opioid used as an analgesic and a recreational drug for its euphoric effects

Heroin, also known as diacetylmorphine and diamorphine among other names, is a morphinan opioid substance synthesized from the dried latex of the Papaver somniferum plant; it is mainly used as a recreational drug for its euphoric effects. Medical-grade diamorphine is used as a pure hydrochloride salt. Various white and brown powders sold illegally around the world as heroin are routinely diluted with cutting agents. Black tar heroin is a variable admixture of morphine derivatives—predominantly 6-MAM (6-monoacetylmorphine), which is the result of crude acetylation during clandestine production of street heroin. Heroin is used medically in several countries to relieve pain, such as during childbirth or a heart attack, as well as in opioid replacement therapy.

<span class="mw-page-title-main">Harm reduction</span> Public health policies which lessen negative aspects of problematic activities

Harm reduction, or harm minimization, refers to a range of intentional practices and public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.

<span class="mw-page-title-main">Intravenous therapy</span> Medication administered into a vein

Intravenous therapy is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrients for those who cannot, or will not—due to reduced mental states or otherwise—consume food or water by mouth. It may also be used to administer medications or other medical therapy such as blood products or electrolytes to correct electrolyte imbalances. Attempts at providing intravenous therapy have been recorded as early as the 1400s, but the practice did not become widespread until the 1900s after the development of techniques for safe, effective use.

<span class="mw-page-title-main">Needle and syringe programmes</span> Method of providing drug users with uninfected equipment

A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It is based on the philosophy of harm reduction that attempts to reduce the risk factors for blood-borne diseases such as HIV/AIDS and hepatitis.

<span class="mw-page-title-main">Hypodermic needle</span> Device to inject substances into the circulatory system

A hypodermic needle, one of a category of medical tools which enter the skin, called sharps, is a very thin, hollow tube with one sharp tip. It is commonly used with a syringe, a hand-operated device with a plunger, to inject substances into the body or extract fluids from the body. Large-bore hypodermic intervention is especially useful in catastrophic blood loss or treating shock.

<span class="mw-page-title-main">Blood-borne disease</span> Medical condition

A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious agents such as viruses. Three blood-borne pathogens in particular, all viruses, are cited as of primary concern to health workers by the CDC-NIOSH: HIV, hepatitis B (HVB), & hepatitis C (HVC).

<span class="mw-page-title-main">Subcutaneous administration</span> Insertion of medication under the skin

Subcutaneous administration is the insertion of medications beneath the skin either by injection or infusion.

Needle sharing is the practice of intravenous drug-users by which a needle or syringe is shared by multiple individuals to administer intravenous drugs such as heroin, steroids, and hormones. This is a primary vector for blood-borne diseases which can be transmitted through blood. People who inject drugs (PWID) are at an increased risk for Hepatitis C (HCV) and HIV due to needle sharing practices. From 1933 to 1943, malaria was spread between users in the New York City area by this method. Afterwards, the use of quinine as a cutting agent in drug mixes became more common. Harm reduction efforts including safe disposal of needles, supervised injection sites, and public education may help bring awareness on safer needle sharing practices.

<span class="mw-page-title-main">Injection (medicine)</span> Method of medication administration

An injection is the act of administering a liquid, especially a drug, into a person's body using a needle and a syringe. An injection is considered a form of parenteral drug administration; it does not involve absorption in the digestive tract. This allows the medication to be absorbed more rapidly and avoid the first pass effect. There are many types of injection, which are generally named after the body tissue the injection is administered into. This includes common injections such as subcutaneous, intramuscular, and intravenous injections, as well as less common injections such as intraperitoneal, intraosseous, intracardiac, intraarticular, and intracavernous injections.

<span class="mw-page-title-main">Oxymorphone</span> Opioid analgesic drug

Oxymorphone is a highly potent opioid analgesic indicated for treatment of severe pain. Pain relief after injection begins after about 5–10 minutes, after oral administration it begins after about 30 minutes, and lasts about 3–4 hours for immediate-release tablets and 12 hours for extended-release tablets. The elimination half-life of oxymorphone is much faster intravenously, and as such, the drug is most commonly used orally. Like oxycodone, which metabolizes to oxymorphone, oxymorphone has a high potential to be abused.

<span class="mw-page-title-main">Black tar heroin</span> Impure form of heroin

Black tar heroin, also known as black dragon, is a form of heroin that is sticky like tar or hard like coal. Its dark color is the result of crude processing methods that leave behind impurities. Despite its name, black tar heroin can also be dark orange or dark brown in appearance.

<span class="mw-page-title-main">Needlestick injury</span> Accidental puncture of skin causing contamination

A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick injury are generally negligible, these injuries can lead to transmission of blood-borne diseases, placing those exposed at increased risk of infection from disease-causing pathogens, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Among healthcare workers and laboratory personnel worldwide, more than 25 blood-borne virus infections have been reported to have been caused by needlestick injuries. In addition to needlestick injuries, transmission of these viruses can also occur as a result of contamination of the mucous membranes, such as those of the eyes, with blood or body fluids, but needlestick injuries make up more than 80% of all percutaneous exposure incidents in the United States. Various other occupations are also at increased risk of needlestick injury, including law enforcement, laborers, tattoo artists, food preparers, and agricultural workers.

<span class="mw-page-title-main">Chasing the dragon</span> Cantonese drug slang phrase

"Chasing the dragon" (CTD), or "foily" in Australian English, refers to inhaling the vapor of a powdered psychoactive drug off a heated sheet of aluminum foil. The moving vapor is chased after with a tube through which the user inhales. The "chasing" occurs as the user gingerly keeps the liquid moving in order to keep it from overheating and burning up too quickly, on a heat conducting material such as aluminium foil.

Skin popping is a route of administration of street drugs where they are injected or deposited under the skin. It is usually a depot injection, either subcutaneous or intradermal, and not an intramuscular injection. After deposition, the drug then diffuses slowly from the depot into the capillary networks, where it enters circulation. Skin popping is distinct from intravenous injection in that the latter deposits the drug directly into the bloodstream via a vein. Nonetheless, it is included with IV injection in the category of injection drug use because both involve injection, both are often done with the same drugs, and both carry many of the same risks. Higher-potency prescription opioids, such as morphine, fentanyl, or meperidine can be injected subcutaneously, as can cocaine. Skin popping increases the duration of the high one gets from drugs such as cocaine. The sites where skin popping with cocaine has been performed have an area of central pallor surrounded by bruising (ecchymosis). This pattern is due to the vasoconstrictive properties of cocaine acting locally at the injection site with hemorrhage occurring in the surrounding tissue. Skin popping puts one at risk for developing secondary amyloid associated (AA) amyloidosis. Tetanus has also been associated with skin-popping as has botulism.

Flashblood is an intravenous drug administration technique used by recreational drug users in which an individual injects himself with blood extracted from another drug user, most commonly one who has injected heroin. The purpose of the technique is to experience substance intoxication or to help combat symptoms of drug withdrawal. The practice was first documented in an announcement submitted by Sheryl A. McCurdy, et al., in an October 2005 issue of BMJ. First reported to be practiced in Dar es Salaam, Tanzania, the practice had spread to other areas in East Africa by 2010.

Low-threshold treatment programs are harm reduction-based health care centers targeted towards people who use substances. "Low-threshold" programs are programs that make minimal demands on the patient, offering services without attempting to control their intake of drugs, and providing counselling only if requested. Low-threshold programs may be contrasted with "high-threshold" programs, which require the user to accept a certain level of control and which demand that the patient accept counselling and cease all drug use as a precondition of support.

Responsible drug use seeks to maximize the benefits and minimize the risks associated with psychoactive drug use. For illegal psychoactive drugs that are not diverted prescription controlled substances, some critics believe that illegal recreational drug use is inherently irresponsible, due to the unpredictable and unmonitored strength and purity of the drugs and the risks of addiction, infection, and other side effects.

With an estimated 120,000 people living with HIV/AIDS, the HIV/AIDS epidemic in Colombia is consistent with the epidemic in much of Latin America as a whole, both in terms of prevalence of infection and characteristics of transmission and affected populations. Colombia has a relatively low rate of HIV infection at 0.4%. Certain groups, particularly men who have sex with men, bear the burden of significantly higher rates of infection than the general population. Colombia's health care system and conception of a "right to health", created by the T-760 decision of 2008, have revolutionized access to HIV treatment. Despite this, the quality of health insurance and treatment for HIV has often been disputed.

<span class="mw-page-title-main">Uniting Medically Supervised Injecting Centre</span> Hospital in New South Wales, Australia

The Uniting Medically Supervised Injecting Centre Kings Cross is a state government-supported facility in Kings Cross, New South Wales that provides safe injecting rooms, sterile equipment and medical supervision for individuals who wish to administer an illicit drug intravenously.

Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction.

References

  1. Academies, Committee on the Prevention of HIV Infection Among Injecting Drug Users in High-Risk Countries, Board on Global Health, Institute of Medicine of the National (2007). Preventing HIV infection among injecting drug users in high-risk countries an assessment of the evidence. Washington, D.C.: National Academies Press. ISBN   978-0-309-10280-3.{{cite book}}: CS1 maint: multiple names: authors list (link)
  2. Des Jarlais D. C., Arasteh K., Feelemyer J., McKnight C., Barnes D. M., Tross S., Hagan H. (2016). "From Long-Term Injecting to Long-Term Non-Injecting Heroin and Cocaine Use: The Persistence of Changed Drug Habits". Journal of Substance Abuse Treatment. 71: 48–53. doi:10.1016/j.jsat.2016.08.015. PMC   5117630 . PMID   27776677.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. COUGHLIN, P; MAVOR, A (1 October 2006). "Arterial Consequences of Recreational Drug Use". European Journal of Vascular and Endovascular Surgery. 32 (4): 389–396. doi: 10.1016/j.ejvs.2006.03.003 . PMID   16682239.
  4. Strang J, Keaney F, Butterworth G, Noble A, Best D (April 2001). "Different forms of heroin and their relationship to cook-up techniques: data on, and explanation of, use of lemon juice and other acids". Subst Use Misuse. 36 (5): 573–88. doi:10.1081/JA-100103561. PMID   11419488. S2CID   8516420.
  5. Helen Ogden-Grable; Gary W. Gill (2005-08-17). "Selecting The Venipuncture Site". American Society for Clinical Pathology. p. 4. Retrieved 2008-12-22.
  6. "Hydroxyzine - an overview | ScienceDirect Topics". www.sciencedirect.com.
  7. "Hydroxyzine".
  8. McNeil Jr., Donald G. (13 July 2010). "Desperate Heroin Addicts Inject Blood of Other Users". New York Times. Gale Health and Wellness. Retrieved 11 May 2022.
  9. 1 2 3 4 5 6 7 "Management of Common Health Problems of Drug Users" (PDF). World Health Organization. 2009.
  10. Davis, LL. (Dec 1983). "Pulmonary "mainline" granulomatosis: talcosis secondary to intravenous heroin abuse with characteristic x-ray findings of asbestosis". J Natl Med Assoc. 75 (12): 1225–8. PMC   2561715 . PMID   6655726.
  11. "HIV and Injection Drug Use: Syringe Services Programs for HIV Prevention | 2016 | Dear Colleague Letters | NCHHSTP | CDC". www.cdc.gov. Retrieved 2017-10-31.
  12. 1 2 3 "Syringe Services Programs | Injection Drug Use | HIV Risk and Prevention | HIV/AIDS | CDC". www.cdc.gov. 2017-09-28. Retrieved 2017-10-31.
  13. "Injection Drug Use | HIV Risk and Prevention | HIV/AIDS | CDC". www.cdc.gov. Retrieved 2017-10-31.
  14. Mackesy-Amiti, Mary E.; Boodram, Basmattee; Spiller, Michael W.; Paz-Bailey, Gabriela; Prachand, Nikhil; Broz, Dita; NHBS Study Group (2017-07-01). "Injection-Related Risk Behavior and Engagement in Outreach, Intervention and Prevention Services Across 20 US Cities". Journal of Acquired Immune Deficiency Syndromes. 75 Suppl 3 (3): S316–S324. doi:10.1097/QAI.0000000000001406. ISSN   1944-7884. PMID   28604433. S2CID   3505532.
  15. "Do Not Share Syringes: Department of Health". www.health.ri.gov. Retrieved 2017-10-30.
  16. "Health District, Trac-B Exchange, launch Southern Nevada's first needle exchange". southernnevadahealthdistrict.org. Archived from the original on 2018-07-09. Retrieved 2017-10-30.
  17. Obadia, Yolande (December 1999). "Syringe Vending Machines for Injection Drug Users: An Experiment in Marseille, France". American Journal of Public Health. 89 (12): 1852–1854. doi:10.2105/ajph.89.12.1852. PMC   1509009 . PMID   10589315.
  18. Helpern, Milton (1977). "An Epidemic of Sorts". Autopsy : the memoirs of Milton Helpern, the world's greatest medical detective. New York: St. Martin's Press. p. 73. ISBN   0-312-06211-7.
  19. Helpern, Milton (1977). "An Epidemic of Sorts". Autopsy : the memoirs of Milton Helpern, the world's greatest medical detective. New York: St. Martin's Press. p. 77. ISBN   0-312-06211-7.
  20. Halbsguth U, Rentsch KM, Eich-Höchli D, Diterich I, Fattinger K (2008). "Oral diacetylmorphine (heroin) yields greater morphine bioavailability than oral morphine: bioavailability related to dosage and prior opioid exposure". British Journal of Clinical Pharmacology. 66 (6): 781–791. doi:10.1111/j.1365-2125.2008.03286.x. PMC   2675771 . PMID   18945270.