heroin and Abscess

Street-based heroin injectors represent an especially vulnerable population group subject to negative health outcomes and social stigma. Effective clinical treatment and public health intervention for this population requires an understanding of their cultural environment and experiences. Social science theory and methods offer tools to understand the reasons for economic and ethnic disparities that cause individual suffering and stress at the institutional level.. We used a cross-methodological approach that incorporated quantitative, clinical, and ethnographic data collected by two contemporaneous long-term San Francisco studies, one epidemiological and one ethnographic, to explore the impact of ethnicity on street-based heroin-injecting men 45 years of age or older who were self-identified as either African American or white. We triangulated our ethnographic findings by statistically examining 14 relevant epidemiological variables stratified by median age and ethnicity. We observed significant differences in social practices between self-identified African Americans and whites in our ethnographic social network sample with respect to patterns of (1) drug consumption; (2) income generation; (3) social and institutional relationships; and (4) personal health and hygiene. African Americans and whites tended to experience different structural relationships to their shared condition of addiction and poverty. Specifically, this generation of San Francisco injectors grew up as the children of poor rural to urban immigrants in an era (the late 1960s through 1970s) when industrial jobs disappeared and heroin became fashionable. This was also when violent segregated inner city youth gangs proliferated and the federal government initiated its "War on Drugs." African Americans had earlier and more negative contact with law enforcement but maintained long-term ties with their extended families. Most of the whites were expelled from their families when they began engaging in drug-related crime. These historical-structural conditions generated distinct presentations of self. Whites styled themselves as outcasts, defeated by addiction. They professed to be injecting heroin to stave off "dopesickness" rather than to seek pleasure. African Americans, in contrast, cast their physical addiction as an oppositional pursuit of autonomy and pleasure. They considered themselves to be professional outlaws and rejected any appearance of abjection. Many, but not all, of these ethnographic findings were corroborated by our epidemiological data, highlighting the variability of behaviors within ethnic categories.. Bringing quantitative and qualitative methodologies and perspectives into a collaborative dialog among cross-disciplinary researchers highlights the fact that clinical practice must go beyond simple racial or cultural categories. A clinical social science approach provides insights into how sociocultural processes are mediated by historically rooted and institutionally enforced power relations. Recognizing the logical underpinnings of ethnically specific behavioral patterns of street-based injectors is the foundation for cultural competence and for successful clinical relationships. It reduces the risk of suboptimal medical care for an exceptionally vulnerable and challenging patient population. Social science approaches can also help explain larger-scale patterns of health disparities; inform new approaches to structural and institutional-level public health initiatives; and enable clinicians to take more leadership in changing public policies that have negative health consequences.

Topics: Abscess; Anthropology, Cultural; Black or African American; Crime; Heroin; Heroin Dependence; Humans; Income; Injections, Intramuscular; Injections, Subcutaneous; Interpersonal Relations; Law Enforcement; Male; Middle Aged; Narcotics; Prevalence; Prisons; Social Medicine; Social Support; Socialization; Substance Abuse, Intravenous; White People

Topics: Abscess; Adult; Animals; Autopsy; Blindness; Brain Diseases; Cerebrovascular Disorders; Endocarditis; Haplorhini; Hepatitis A; Heroin; Heroin Dependence; Humans; Male; Muscular Diseases; Myelitis, Transverse; Nervous System Diseases; New York City; Peripheral Nervous System Diseases; Quinine; Substance-Related Disorders; Tetanus

We present fatal extensive soft tissue infections, a consequence of groin heroin injection, in three subjects, who were 27, 34, and 39 years old and had a history of over 10-, 15-, and 5-years of heroin injection (cases 1, 2, and 3, respectively). In all cases, the first symptoms of the infection appeared at least a week prior, with rapid deterioration on the last day. The hallmark was a disproportion between external and internal findings in the affected thighs. The latter presented as extensively spread suppurative inflammation with soft tissue necrosis. In case 1, subtle skin erythema was present in the left groin, with a wound suggestive of a recent abscess incision and injection-related scarring. However, dissection revealed that inguinal regions and deep soft tissue (including the muscle sheets) of the left thigh, gluteal region, and lower third of the anterior abdominal wall were inflamed with pus, alongside fibrinopurulent peritonitis. Case 2 had pronounced erythema and swelling of the thigh and knee. Diffuse suppuration was observed upon dissection in the inguinal regions, which extended into the iliopsoas muscles, with soft tissue and muscle necrosis. In the abdominal cavity, we detected 150 mL of serofibrinous exudate. Only case 3 had a prominent, 4 × 3.5-cm necrotic skin defect through which pus spontaneously drained. In contrast to the other two, although extensive pus collection within predominantly necrotic thigh's soft tissue was present, the inflammation did not expand above the inguinal ligament, and peritonitis was not observed. Toxicology analysis excluded acute heroin intoxications.

Topics: Abscess; Groin; Heroin; Humans; Necrosis; Soft Tissue Infections

Skin and soft tissue infections (SSTIs) are prevalent among people who inject heroin (PWIH). Delays in seeking health care lead to increased costs and potential mortality, yet the barriers to accessing care among PWIHs are poorly understood.. We administered a quantitative survey (N = 145) and conducted qualitative interviews (N = 12) with PWIH seeking syringe exchange services in two U.S. cities.. 66% of participants had experienced at least one SSTI. 38% reported waiting two weeks or more to seek care, and 57% reported leaving the hospital against medical advice. 54% reported undergoing a drainage procedure performed by a non-medical professional, and 32% reported taking antibiotics that were not prescribed to them. Two of the most common reasons for these behaviors were fear of withdrawal symptoms and inadequate pain control, and these reasons emerged as prominent themes in the qualitative findings. These issues are often predicated on previous negative experiences and exacerbated by stigma and an asymmetrical power dynamic with providers, resulting in perceived barriers to seeking and completing care for SSTIs.. For PWIH, unaddressed pain and withdrawal symptoms contribute to profoundly negative health care experiences, which then generate motivation for delaying care SSTI seeking and for discharge against medical advice. Health care providers and hospitals should develop policies to improve pain control, manage opioid withdrawal, minimize prejudice and stigma, and optimize communication with PWIH. These barriers should also be addressed by providing medical care in accessible and acceptable venues, such as safe injection facilities, street outreach, and other harm reduction venues.

Topics: Abscess; Adult; Cross-Sectional Studies; Female; Heroin; Humans; Male; Middle Aged; Pain; Pain Management; Patient Acceptance of Health Care; Prejudice; Retrospective Studies; Social Stigma; Soft Tissue Infections; Substance Abuse, Intravenous; Substance Withdrawal Syndrome

Injection-site vein loss and skin abscesses impose significant morbidity on people who inject drugs (PWID). The two common forms of street heroin available in the USA include black tar and powder heroin. Little research has investigated these different forms of heroin and their potential implications for health outcomes.. A multiple-choice survey was administered to a sample of 145 participants seeking services at reduction facilities in both Sacramento, CA and greater Boston, MA, USA. Multivariate regression models for reporting one or more abscesses in one year, injection-site veins lost in six months, and soft tissue injection.. Participants in Sacramento exclusively used black tar (99%), while those in Boston used powder heroin (96%). Those who used black tar heroin lost more injection-site veins (β=2.34, 95% CI: 0.66-4.03) and were more likely to report abscesses (AOR=7.68, 95% CI: 3.01-19.60). Soft tissue injection was also associated with abscesses (AOR=4.68, 95% CI: 1.84-11.93). Consistent venous access (AOR: 0.088, 95% CI: 0.011-0.74) and losing more injection sites (AOR: 1.22, 95% CI: 1.03-1.45) were associated with soft tissue injection.. Use of black tar heroin is associated with more frequent abscesses and more extensive vein loss. Poor venous access predisposes people who inject drugs to soft tissue injection, which may constitute a causal pathway between black tar heroin injection and abscess formation. The mechanisms by which black tar heroin contributes to vein loss and abscess formation must be further elucidated in order to develop actionable interventions for maintaining vein health and decreasing the abscess burden. Potential interventions include increased access to clean injection equipment and education, supervised injection facilities, opioid substitution therapy, and supply chain interventions targeting cutting agents.

Topics: Abscess; Adult; Boston; California; Cross-Sectional Studies; Female; Heroin; Humans; Injection Site Reaction; Male; Middle Aged; Substance Abuse, Intravenous

A 49-year-old man presented to the emergency department (ED) with shoulder pain after intramuscular injection of heroin into his right deltoid muscle. Point-of-care (POC) ultrasound identified a subdeltoid abscess, and ultrasound-guided aspiration of the fluid collection was performed. The patient was admitted and improved on antibiotics and made a complete recovery. POC ultrasound and ultrasound-guided aspiration can assist in the diagnosis and treatment of deep musculoskeletal abscesses.

Topics: Abscess; Biopsy, Fine-Needle; Deltoid Muscle; Drainage; Heroin; Heroin Dependence; Humans; Injections, Intramuscular; Male; Middle Aged; Point-of-Care Systems; Shoulder Pain; Substance Abuse, Intravenous; Ultrasonography, Interventional

Wound botulism in 7 heroin 'skin poppers' produced ophthalmoplegia and descending paralysis. Rapid recovery occurred in 2 who received the antitoxin within the fourth day of symptom onset. A poor outcome was seen in 4 who received the antitoxin after the eighth day of symptoms and 1 who did not receive the antitoxin. Early antitoxin administration is important in achieving a favorable outcome.

Topics: Abscess; Adult; Botulinum Antitoxin; Botulism; Female; Heroin; Humans; Injections, Subcutaneous; Male; Middle Aged; Skin Diseases; Treatment Outcome

Drug addiction is linked with increased prevalence of various illnesses. Of major importance are skin diseases which often have a powerful influence on the health. Analysis of the situation in Switzerland at the outset of the 1990s showed that not all drug addicts could be reached with the existing range of treatments. For this reason, heroin-supported treatment was examined as a new therapy option from 1994 on. The influence on the skin's health are examined in this study. The minimum age of those admitted was set at age 20. Heroin addiction had to date back at least two years, and several treatment efforts had to have failed. Data of 1,035 patients was based on tests at admission and after six, 12, and 18 months of treatment. Some 18% of drug consumers indicated abcesses at admission, and almost 30% showed phlegmones. The prevalence of all skin diseases examined show significant declines over the 18 months of treatment. The relative risk resulting from puncture points fell to 0.35 (SD: 0.26-0.47), from phlegmones to 0.24 (SD: 0.14-0.41), from absesses to 0.31 (SD: 0.15-0.60). This study shows that skin diseases are a frequent and important complication among intravenous drug addicts. Heroin-supported treatment led to favourable progress of the dermatological situation among patients.

Topics: Abscess; Adult; Cellulitis; Comorbidity; Cross-Sectional Studies; Female; Heroin; Heroin Dependence; Humans; Incidence; Male; Skin Diseases, Infectious; Substance Abuse, Intravenous; Switzerland

We present a retrospective analysis of 32 patients admitted over a 5-year period to a metropolitan regional trauma center with recently induced subcutaneous ("skin pop") illicit drug injectional injuries involving the hand. Cocaine derivatives were the most frequently reported illicit drug used (75%). All patients had local disease manifested by subcutaneous abscess formation, and several had regional disease (cellulitis, lymphangitis, or lymphadenopathy), but only one patient had systemic illness. Microbiological analysis revealed endogenous integumentary and oral flora sensitive to oral preparations of several antibiotic medications including cephalosporins. Primary therapy included intravenous administration of antibiotic medications in all instances and simple incision and drainage under local anesthesia in 26 patients (81%). Six patients (19%) required more radical operative therapy. All patients were hospitalized and recovered without sequelae, with preservation of hand function after follow-up evaluation, which ranged from weeks to months, except for 1 patient who required digital amputation because of necrosis. Although the issue of compliance in terms of wound and general medical care for this patient population is problematic, analysis of the data suggested that patients with illicit drug injectional injuries of the hand confined to subcutaneous regions could be effectively and safely managed in outpatient settings by simple wound care and orally administered cephalosporin medications.

Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Cocaine; Female; Hand; Heroin; Humans; Injections; Male; Middle Aged

Wound botulism is a rare infectious and toxicologic complication of trauma and i.v. drug abuse. Only 39 cases have been reported in detail in the English literature. This case report describes a patient with wound botulism who presented to four medical facilities before receiving definitive diagnosis and treatment. Although his history and physical examination were consistent with wound botulism, diagnosis and therapy were delayed because this rare disease was not considered initially in the differential diagnosis. Wound botulism should be considered in trauma patients and i.v. drug abusers who present with cranial nerve palsies and descending paresis.

Topics: Abscess; Adult; Botulism; Clostridium botulinum; Diagnostic Errors; Heroin; Humans; Male; Skin Diseases, Bacterial; Substance-Related Disorders; Wound Infection

Topics: Abscess; Epidural Space; Heroin; Humans; Male; Middle Aged; Nocardia Infections; Spinal Diseases; Substance-Related Disorders

Topics: Abscess; Aged; Female; Heroin; Humans; Infusions, Parenteral

A 25 year old woman who had received intravenous heroin over one year previously developed an intervertebral abscess due to infection with Candida albicans. Immunological investigation of this patient showed no evidence of a specific defect in the host response to candida.

Topics: Abscess; Adult; Candidiasis; Female; Heroin; Humans; Spinal Diseases; Substance-Related Disorders

Topics: Abscess; Adult; Cerebellar Diseases; Female; Heroin; Humans; Nocardia Infections; Substance-Related Disorders

Topics: Abscess; Adult; Candidiasis; Combined Modality Therapy; Endophthalmitis; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Streptococcal Infections

Topics: Abscess; Adolescent; Adult; Female; Heroin; Heroin Dependence; Humans; Injections, Subcutaneous; Ireland; Male; Skin Diseases, Infectious

The purpose of this paper is to emphasize the importance of heroin injections in the neck as an etiology of superficial and deep neck infections and to familiarize the otolaryngologist with the problems in the diagnosis and management of such infections. This study represents the first series to be reported in the world literature of patients with neck infections secondary to heroin injections. Fifty-seven patients with neck infections related to injection of heroin in the neck (main-lining) were studied. These patients were admitted to Detroit General Hospital during the three-year period between January 1974 and December 1976. The clinical signs and symptoms, location of the abscesses, soft tissue radiographs of the neck, arteriograms and ultrasound examinations of the neck are discussed. The diagnostic evaluation and the treatment of the heroin addict who presents with an inflammatory neck mass are outlined, emphasizing the difficulty and the importance of differentiating between cellulitis, abscess, and pseudoaneurysms of the carotid and subclavian arteries.

Topics: Abscess; Adult; Aneurysm; Carotid Artery Diseases; Cellulitis; Diagnosis, Differential; Edema; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Neck; Subclavian Artery

The authors report the case of a patient with spinal abscess in whom operation was withheld because of severe concomitant medical problems. Conservative management resulted in apparent cure.

Topics: Abscess; Anti-Bacterial Agents; Cefazolin; Cocaine; Duodenal Ulcer; Heroin; Humans; Kidney Failure, Chronic; Male; Meninges; Methicillin; Middle Aged; Myelography; Oxacillin; Renal Dialysis; Spinal Cord Diseases; Staphylococcal Infections; Staphylococcus aureus; Subdural Space; Substance-Related Disorders

Topics: Abscess; Aneurysm, Infected; Arteritis; Arthritis; Chemical and Drug Induced Liver Injury; Drainage; Endocarditis; Gastrointestinal Diseases; Hand; Heart Valve Prosthesis; Heroin; Heroin Dependence; Humans; Injections, Intra-Arterial; Injections, Intravenous; Injections, Subcutaneous; Lung Diseases; Myositis; Narcotics; Pancreatitis; Phlebitis; Substance-Related Disorders; Surgical Procedures, Operative

Topics: Abscess; Adolescent; Adult; Chemical and Drug Induced Liver Injury; Chromosomes; Endocarditis; Female; Heroin; Heroin Dependence; Humans; Liver; Lung Diseases; Male; Methadone; Nephrotic Syndrome; Nervous System Diseases; Osteomyelitis

Topics: Abscess; Adult; Arthritis, Infectious; Blood; Cartilage; Female; Heroin; Heroin Dependence; Humans; Knee Joint; Male; Osteomyelitis; Pseudomonas aeruginosa; Radiography; Ribs; Staphylococcus; Sternoclavicular Joint; Sternum; Substance-Related Disorders; Suppuration

Topics: Abscess; Chronic Disease; Criminal Psychology; Drug and Narcotic Control; Drug Contamination; Ethics, Medical; Heroin; Heroin Dependence; Humans; Methadone; Quinine; Skin Diseases; Terminology as Topic; United States

Topics: Abscess; Adult; Autopsy; Diagnosis, Differential; Disseminated Intravascular Coagulation; Endocarditis, Bacterial; Heroin; Humans; Infarction; Kidney Diseases; Lung Abscess; Male; Myocardium; Pleural Effusion; Pulmonary Embolism; Splenic Diseases; Splenic Infarction; Staphylococcal Infections; Staphylococcus; Substance-Related Disorders; Tricuspid Valve

Topics: Abscess; Acanthosis Nigricans; Adult; Burns; Edema; Heroin; Humans; Jaundice; Male; Melanosis; Pigmentation; Pruritus; Skin Manifestations; Skin Ulcer; Substance-Related Disorders

Topics: Abscess; Barbiturates; Emergency Service, Hospital; Heroin; Humans; Injections; London; Poisoning; Skin Ulcer; Substance-Related Disorders

Topics: Abscess; Adult; Chicago; Female; Filariasis; Heroin; Humans; Male; Myositis; Nigeria; Substance-Related Disorders; Suppuration; Tropical Medicine

Topics: Abscess; Hepatitis A; Heroin; Humans; Injections; New York City; Sepsis; Substance-Related Disorders

Topics: Abscess; Arthritis; Arthritis, Infectious; Bacteroides; Benzoates; Brain Abscess; Camphor; Cellulitis; Endocarditis; Endocarditis, Bacterial; Endocarditis, Subacute Bacterial; Hepatitis; Hepatitis B virus; Heroin; Humans; Infections; Meningitis; Methicillin; Opium; Penicillin G; Pneumothorax; Sepsis; Staphylococcal Infections; Substance-Related Disorders; Toxicology