DRUG USE RELATED INFECTIONS PROJECT Compiled by the West Virginia Chapter of the Association for Practitioners in Infection Control INTRODUCTION: The adverse effects of illicit drug use are many, among them damage to the skin, internal organs, and the immune system leading to frequent secondary infections. APIC- WV hopes to help discourage use of these drugs through education of students regarding potential disfiguring and life-threatening infectious complications. 1

Introduction We humans have bacteria and other microbes on all our skin surfaces; these belong on the surface but if allowed inside can cause infections, which can become chronic or even kill. Any place on the body used for injecting drugs can become infected, including between the toes & fingers, in the groin, and under the tongue. What follows are examples of skin infections seen commonly with intravenous drug use. 2

Skin Damage Cellulitis, a painful infection under the skin Cellulitis, a painful infection under the skin Skin infection with tissue death 3

Skin & Flesh Damage Open sores from skin popping and non- sterile tattooing Gangrene, skin & tissue death leading to amputation CDC Photo 4

Liver Damage Germs introduced through the skin can travel through your body to other organs, like your liver. These pictures are a normal liver and what can happen because of drug use. Your liver serves as a body filter to protect you from harm. A sick liver means you stay sick and may lead to a need for a liver transplant. Normal healthy liver Alcohol & drug damaged liver 5

Hepatitis B and C In addition to the drugs themselves, viral infections transferred between users through needle sharing or items used to snort drugs can lead to liver damage or liver cancer many years after the virus has entered the body. There are parts of West Virginia with some of the highest rates of hepatitis C in the country. 6

Heart & Lung Damage Bacterial infection of the heart and lungs happens to intravenous drug users when the drugs or other substances used to cut or dissolve the drugs travels to these organs causing damage that keeps the heart and lungs from operating efficiently. It makes the person constantly weak and gasping for air. Normal heart valves Diseased heart valves 7

Brain Damage Drug use can change your brain. Your brain doesn’t fully mature until around age 24, and drug use during teen years will affect you for the rest of your life, particularly the parts controlling your emotions and ability to understand and use good judgment. Normal brain Cocaine brain (National Institutes of Health/ National Institute on Drug Abuse photo) 8

Senior Pictures Using methamphetamine and crack cocaine has very ugly results, like loss of hair and teeth. The acids released with crack cocaine break down the membranes of your lips and gums and make blisters in your mouth. As the blisters break down, harmful infections of your mouth and gums loosen teeth and damage gums. 9

More Mouth Damage Snorting cocaine damages the membranes of your nose and mouth and can burn a hole between your nose and the roof of your mouth. 10

Physical Health Effects of Methamphetamine Acne & open sores Tooth decay Hair loss Acne & open sores Severe weight loss Self-inflicted wounds from removing hallucinatory "crank bugs" Liver damage Kidney and lung disorders Putrid body odor Convulsions or seizures Heart attack or stroke Death 11

Behavioral & Mental Effects of Methamphetamine Hallucinations Hallucinations Aggression Aggression Paranoia Paranoia Anxiety Anxiety Confusion Confusion Mood swings Mood swings Depression Depression Insomnia Insomnia Psychotic behavior Psychotic behavior 12

Prescription Drugs Any drug will always change something in your body. Even those needed for medical reasons can have serious side effects that can make it easier for germs to cause an infection. 13

New Drugs New chemicals are being developed under a variety of names. The effects on mental and physical health are not yet known. One thing for sure, germs are always ready to take advantage of any opportunity. 14

We’re Number One! And you can die. In 2010, drug overdose & illicit drug poisoning death rates ranged from 3.4 to 28.9 per 100,000 population. The rate for the United States was The five states with the highest rates were Oklahoma (19.4), Nevada (20.7), Kentucky (23.6), New Mexico (23.8), and West Virginia (28.9), more than double the national rate. (CDC data, 2/12). 15

To find out more about the infections associated with drug use, go to one of the following references, or call an Infection Preventionist at your local hospital. We’re here to help. 16

References 17 Centers for Disease Control & Prevention: HIV-Infections HIV-Infections World Health Organization, se/en/ se/en/

References West Virginia Department of Health & Human Services: hep/resources/Pages/default.aspx hep/resources/Pages/default.aspx nts nts WGBH, May 17, 2011, “The Meth Epidemic” 18

References New England Journal of Medicine, “Bacterial Infections in Drug Users”, authors Rachel Gordon & Franklin Lowry, NEJM 335;18, Nov 3, 2005www.nejm.org Emedicine.medscape.com New Zealand Dermatological Society Inc, “Skin Infections in IV Drug Users”, author Amy Stanway, Oct