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Abscesses From Intravenous (IV) Drug Use

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

January 17, 2019

Injecting a drug directly into the user’s vein, known as intravenous (IV) drug use, is very dangerous and exposes the user to disease-causing bacteria that could lead to an abscess. Abscesses are one of the most common skin and soft tissue infections plaguing injection drug users.

What Is An Abscess?

An abscess is a pocket of infected tissue which contains pus. This infection may occur within the skin (cutaneous) or below the surface (subcutaneous). An infection develops when your body attempts to fight a foreign germ such as bacteria. While some abscesses occur almost immediately, most take two to five days to emerge.

The United Nations Office on Drugs and Crime (UNODC) details how an abscess develops:

  • The infected tissue resembles a hard boil
  • White blood cells move into this area to fight the infection
  • As the infection grows, pus may develop within the infected tissues.
  • The pus and infection surround the source of the infection, such as the wound and/or bacteria
  • If the infection isn’t treated, it could erupt through the skin as an ulcer

Staphylococcus aureus bacteria is the leading cause of infections within both the skin and soft tissues, according to the Minnesota Department of Health. An infection caused by this bacteria is often referred to as a Staph infection.

Signs Of An Abscess

There are two types of abscesses: exploding and imploding. In an exploding abscess, the infection breaks through the skin and becomes visible as an open wound. With imploding, the infection and pus remain under the skin, spreading outwards from the infected site

Signs of an abscess may include:

  • Fever or chills
  • Swollen lymph nodes
  • Hardness beneath the skin
  • Pain
  • Redness and warmth
  • Swelling
  • Tenderness
  • A foul smell

If pressure is applied to the sore, or if it is bumped, fluid may leak out, clear in the early stages, and oozing pus as the infection grows.

If you do develop an abscess, don’t ignore it or try to treat it yourself. By doing so, you’re in jeopardy of developing numerous risks.

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How Does IV Drug Use Cause Abscesses?

Unsanitary and unsafe injection practices are the biggest reasons IV drug abuse transmits and causes so many diseases and medical complications.

Improper handling and cleaning of needles and syringes can lead to infection:

  • Shared needles: Sharing needles causes the risk of bloodborne illness to skyrocket. While the greatest risks are HIV/AIDS and Hepatitis B and C, this practice can result in abscesses.
  • Old needles: Using dull needles creates more damage to the injection site, making it more susceptible to infection.
  • Unclean needles: Dirty needles breed bacteria and other germs. Some people lick their needles prior to injection, introducing oral bacteria onto the needle.

Risk Factors

Some research asserts that the bacteria on your skin is linked more to infection than are shared needles. Our skin contains beneficial and harmful bacteria. When you inject, the needle pulls bad bacteria into the body and vein.

Many people also fail to clean the injection site properly (or lick it to do so). An unclean injection site increases the risk that abscess-forming bacteria will enter the injection site. Some people may also inject into an open sore. This makes an already damaged site even more prone to infection.

Nursing Times notes that when IV drug users’ veins become too damaged, “users may resort to injecting subcutaneously or intramuscularly (skin popping) which has been shown to have a direct link to the development of abscesses.”

The drug of choice is also a risk factor. Cocaine makes it harder for blood to flow to your tissues, allowing for an infection to easily take hold. Due to its many impurities, black tar heroin has been found to cause infections as well.

A compromised immune system makes any of these factors more troublesome. The purpose of our immune system is to fight infection. Chronic drug abuse drastically weakens a person’s immune system, making it much harder for the body to protect itself from this risk.

Complications From Abscesses

Abscess-forming bacteria can move throughout your body, causing other complications and infections, such as:

  • Amputation: if the infection becomes too severe and persists without treatment, maggots could begin to populate the wound. After, gangrene (a type of tissue death) could begin, resulting in amputation.
  • Chronic Abscesses: injection drug users of 10 years or more can develop recurrent abscesses.
  • Sepsis: Sepsis, or “blood poisoning,” occurs when the bacteria and infection move into the blood. Once in the blood, the infection can spread to other parts of the body. If ignored, the infection can move from a person’s skin to their blood (sepsis), and ultimately infect their heart (endocarditis).

More risks include:

  • Abscess of the brain or spine
  • Infection of the joints or bones
  • Necrotizing fasciitis (“flesh-eating bacteria”)
  • Pseudo-aneurysm
  • Toxins produced from certain bacteria
  • Wound botulism

If these conditions aren’t properly treated, a person could become fatally ill.

Treatment For Abscesses From Intravenous Drug Use

Should you develop an abscess, you need to seek medical treatment as soon as possible. As with other infections, antibiotics will be used to treat the offending bacteria. Pus can cause the infection to spread, so it needs to be removed. A needle or incision may be used to extract the pus from the wound.

In certain cases, a drain may be inserted to help discharge the fluid. The wound will also be cleaned, dressed, and monitored until it’s fully healed. Severe abscesses and certain complications may require surgery or other medical procedures.

Any adverse health effect, illness, or disease caused by drug abuse is preventable, abscesses included. Sobriety ensures your protection from these risks.

Nursing Times - What Are the Risk Factors for Soft Tissue Abscess Development among Injecting Drug Users?

United Nations Office on Drugs and Crime - Abscess Prevention and Management Among Injecting Drug Users

Minnesota Department of Health - Causes and Symptoms of Staphylococcus aureus

Scribd - The Care and Treatment of Skin and Soft Tissue Infections Among Injection Drug Users in the Community Setting

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