Intravenous drug use

Background

• Complications of intravenous drug use span all organ systems (in addition to the Toxidromes related to the specific chemical used).

Complications by System

Cardiovascular

• Endocarditis
• ACS
• Aortic Dissection
• Pseudo aneurysm

Soft Tissue Infections

• Necrotizing fasciitis
• Pyomyositis
• Subcutaneous abscess

Pulmonary

• PE
• Talcosis (trash lung)
• Pulmonary hypertension
• Pneumothorax (usually due to injecting in neck vessels)

Skeletal

• Osteomyelitis
• Diskitis
• Epidural Abscess (Spinal)
• Vertebral Osteomyelitis
• Sternal joint osteomyelitis
• DVT

Central Nervous System

• Endocarditis
• SAH - especially with sympathomimetics such as methamphetamine and cocaine
• Brain abscess
• Subdural empyema
• Botulism - especially with "skin popping" of black tar heroine
• CVA

Ocular

• Fungal endophthalmitis
• Amaurosis fugax

Hematogenous

• Sepsis
• Neutropenic Fever
• Neutropenia (esp. if using cocaine mixed with levimasole)

Infectious Disease

• Cotton fever
  • Occurs when cotton is used to filter drugs like heroin and due to the exotoxin from Pantoea agglomerans which colonizes cotton plants
• HIV related
  • Toxoplasmosis
  • Lymphoma
• TB