Health Risks and Dangers of IV Drug Use

What Is Injection Drug Use?

Injection drug use involves filling a syringe with a drug and injecting it into the body via needle. When injecting into a vein (i.e., intravenously. aka IV drug use), the drug goes directly into the bloodstream and reaches the brain almost immediately through the circulatory system. Thus, this method of use generates effects almost immediately, similar in speed to when a drug is smoked and much faster than snorting and oral ingestion.^1,2 The faster onset of IV injection and smoked drugs is associated with a more intense feeling of pleasure and greater addiction liability.¹

Intravenous, Intramuscular, and Subcutaneous Drug Use

While most injection drug use is intravenous (i.e., within a vein), some people inject drugs intramuscularly (i.e., into a muscle) or subcutaneously (i.e., under the skin), the latter of which is a method known as “skin popping.”³ Subcutaneous and intramuscular injection both have a slower absorption rate than IV injection, and these two alternative injection routes may be personal preference, the result of missing a vein, or done out of necessity when accessible veins are already damaged to the point that they no longer support IV injection.^3,4

Across this range of injection methods and substances, injection drug use has inherent risks, including blood-borne diseases and related conditions such as HIV/AIDS, hepatitis, infective endocarditis, etc.^2,5 Additionally, injection drug use is also associated with an increased risk of thrombosis, sexually transmitted diseases, overdose, and more.^7-9

Injection drug use—which is associated with severe forms of substance use disorders—seems to be on the rise.^2,10 According to data from the Centers from Disease Control and Prevention, an estimated 3.7 million people in the U.S. (i.e., 1.5% of the adult population) injected drugs in 2018, a figure that’s roughly 5 times higher than in 2011.¹⁰

Signs of IV Drug Use

Signs that someone is injecting drugs through IV use can include:⁵

• Bruising or scarring, aka track marks.
• Frequently wearing long sleeves to cover damaged skin.
• Patches of hyperpigmentation on the skin.
• Symptoms of intoxication or withdrawal.
• Presence of IV paraphernalia, such as needles, syringes, spoons used to dissolve the drug, and tourniquets.

Blood-Borne Infections from Injection Drug Use: Hepatitis, HIV, and More

Injection drug use can lead to a host of blood-borne diseases via needle sharing and syringe-related bacteria transmission, making it potentially the most harmful route of substance administration.⁹ Despite the risks, roughly 40% of those who inject drugs share injection supplies.¹¹

Blood-borne infections related to injection drug use include:^5,11-13

• Human immunodeficiency virus (HIV).
• Skin and soft tissue infections.
• Viral hepatitis A, B, and C.
• Pulmonary, bone, and skin infections.
• Tuberculosis.

Hepatitis C, HIV, and Injection Substance Use

Among the most worrisome infections related to injection drug use are HIV and hepatitis C. While controllable but not reversible, HIV attacks the body’s immune system, and if left untreated, it can lead to acquired immunodeficiency syndrome (AIDS), which can be fatal.¹⁴ Hepatitis C is a liver infection whose symptoms range from mild illness lasting a few weeks to a long-term, serious illness.¹⁵

Most people contract hepatitis C by sharing needles, syringes, and any related equipment.¹⁵ Aside from receptive anal sex, sharing needles carries the highest risk factor for contracting HIV.¹⁶ And according to the World Health Organization, HIV prevalence among IV drug users is relatively high. The WHO estimates that more than 13 million people worldwide inject drugs, and among this population, 1.7 million have HIV.¹¹

What are the Dangers of Injection Drug Use?

Along with an increased risk of the aforementioned infections, injections can damage the skin and veins, and nonsterile injections can introduce invasive bacteria and fungi into the bloodstream, which can ultimately lead to conditions such as:^{3,5,8,11,17-19}

• Infective endocarditis. Injection-related bacteria or fungi can travel to the heart and cause infective endocarditis, which is an infection of the heart’s inner lining and valves. In fact, almost 30% of hospitalizations for this condition are related to injection drug use.
• Epidural abscess. An epidural abscess is a type of infection in the epidural space in the brain or spinal column.
• Skin and soft tissue infections. Injecting a drug subcutaneously or intramuscularly makes it easier for bacteria to get into the skin, increasing the risk of skin infections such as cellulitis.
• Bone, joint, and skeletal infections. Thanks to the spread of bacteria from other sites (e.g., heart valves as well as skin and soft tissues), injection drug use can also lead to skeletal infections as well as a bone infection called osteomyelitis.
• Bacteremia and fungemia. These terms refer to bacteria and fungi in the blood, respectively.
• Wound botulism. Those who inject drugs are at risk for wound botulism, a potentially life-threatening illness that occurs when a germ called Clostridium botulinum enters and creates a toxin inside a wound. Those particularly at risk include people who inject black tar heroin and those who inject under the skin and/or into the muscle.
• Pulmonary infections. Lung infections, such as pneumonia and tuberculosis, are more prevalent among injection drug users.

Additional Dangers of Injection Drug Use

Along with blood-borne infections, injection drug use is associated with several additional dangers including:^{2,5,7,9,11,20}

• Vascular injuries. Repeated injection into a vein can destroy its function. dThus, vascular injuries such as collapsed veins are a common occurrence among injection drug users.
• Deep Vein Thrombosis (DVT). Injection drug use is a risk factor for deep vein thrombosis, a condition where a blood clot forms in a deep vein, usually in the leg. DVT can be serious as the clot may break loose and travel to the lungs, causing a pulmonary embolism. Thrombosis with injection drug use often goes undetected for years, making it a potentially silent killer.
• Noninfectious pulmonary complications. It’s common for injection drug use to deposit foreign bodies in the blood, which can lead to foreign body granulomatosis, a type of inflammatory reaction. Other associated pulmonary complications can include pulmonary edema, emphysema, pulmonary embolism, and fatal asthma exacerbations.
• Overdose – Given the fast-acting effects of injection drug use, it carries a disproportionate risk for overdose. Newer synthetic drug analogues, namely illicitly manufactured fentanyls, are usually more potent than other opioids, which can further increase the risk of overdose.

How to Reduce the Risk of Infections from Injection Drug Use

So how can someone decrease risks associated with injection drug use? Certainly, the best method is abstinence. However, for those unwilling or unable to maintain abstinence, risk reduction options include:^5,21-23

• Needle or syringe exchange programs. Offered by various private and public organizations, needle exchange programs are designed to reduce the transmission of blood-borne infections among those who inject drugs. These programs typically provide clean, sterile needles and syringes, safe disposal of used paraphernalia, education, counseling, and community outreach. One such program, the North American Syringe Exchange Network (NASEN), offers a map-based directory of some such programs operating in the U.S.
• Syringe prescriptions. Physicians in most states are also allowed to assist those who inject drugs by prescribing and dispensing syringes.
• Vaccinations. The risk of contracting some diseases can be reduced via vaccinations. For example, those who participate in IV drug use should be vaccinated against hepatitis A and B. Note, however, that there are no vaccines for Hepatitis C and HIV.
• Pre-exposure prophylaxis^, (PrEP). PrEP is a prescription medication used to prevent HIV. When taken as prescribed, it’s highly effective, as it reduces the risk of contracting HIV from sex by roughly 99% and from injection drug use by at least 74%. That said, it doesn’t protect against other STDs, so condom use during sex is still recommended.  
• Naloxone. While naloxone can’t prevent against infection, it can rapidly reverse an opioid overdose. The medication can be sprayed into the nose or injected into muscle, skin, or veins. However, its effects don’t last long, and it doesn’t reverse the effects of other substances that may be contributing to an overdose. So it’s important to seek medical help as soon as possible even after administering naloxone.

It’s important to note that using clean needles may not be enough to completely prevent blood-borne infections. That’s because when someone injects a substance, their blood may enter the needle, syringe, or other component of the injection equipment. So even if you disinfect the needle, the syringe or other components may have trace amounts of the previous user’s blood, which can then be transmitted—along with any bacteria and forms of infection—into the next user’s bloodstream. And unfortunately, those pathogens can stick around for a long time. According to the CDC, HIV can survive in a syringe for up to 42 days.¹⁶  

Treatment for Injection Drug Use

The aforementioned tactics can reduce the risks of injection drug use complications. However, the best way to ensure your physical and emotional health over the long term is abstinence from drug use altogether. Treatment can help you get there.

Since everyone is unique,  treatment plans are customized to the needs of each individual. That said, various  levels of care are available including:²⁴

• Medical detox.
• Inpatient rehab.
• Outpatient programs—including Intensive Outpatient Programs (IOPs), Partial Hospitalization Programs (PHPs), and telehealth care.

These treatment programs use a variety of types of therapies and interventions, and facilities offer a range of services and amenities to suit your needs and preferences. With facilities scattered across the country, American Addiction Centers (AAC) offers the full spectrum of care as well as a wide range of payment options. Plus, AAC treatment centers are in-network with a number of insurance providers, which typically cover part or all treatment costs.

To determine just how much you’d pay out of pocket for treatment, Reach out to connect with an AAC admissions navigator. Caring professionals are available 24/7 to confidentially explain your treatment options, answer your questions, and help you or a loved one take the first steps toward recovery today.