Vol 15 Edition 3

Feeling hot, red and swollen?

Injecting-related injury and disease part 1

Injecting drug use is associated with a range of health problems. The ones we’re most familiar with are overdose and viral diseases like hepatitis C and HIV. However, there are other conditions affecting people who inject drugs that, despite being much more common, are somewhat neglected in discussions around the consequences of injecting.

Injecting-related injury and disease – often referred to by the acronym ‘IRID’ – is an umbrella term for a range of conditions associated with injecting drug use. In contrast to the big-ticket items like HIV or overdose, IRID is more likely refer to things like bacterial infections, vein damage and bruising.

Dr Phill Read, director of the Kirketon Road Centre in Kings Cross, Sydney, describes IRIDs as “complications from injecting” that are “not related to the specific pharmacological effects of the drug being injected”.

“IRIDs therefore don’t include drug overdose nor blood borne virus infections such as hepatitis C or HIV,” says Phill.

IRIDs are not caused by effects of the drugs. Instead, they’re caused by a multitude of other factors related to injecting such as injecting practices and equipment.

People who inject drugs experience a range of barriers to accessing health services such as stigma, low service engagement and low health literacy. So, while IRIDs are generally minor and highly treatable, people often do not seek treatment for their IRIDs.

Phill says that left untreated, IRIDs can lead to serious chronic health conditions and, in rare cases, can lead to the loss of fingers or limbs and even death.

Frontline workers are uniquely positioned to provide support and advice to clients about IRIDs but knowing how to bring up these minor conditions can be difficult.

Phill says the best thing frontline workers can do is to “be alert to IRIDs” and feel confident in asking clients about their veins or injecting technique. It’s also important to know where to refer clients if they present with an IRID.

What is an IRID and what causes them?

Many IRIDs are often found at the site of injection such as vein damage or an abscess but can also be further away on the body. Some IRIDs are whole-body conditions, such as an infection in the blood stream.

Phill splits up IRIDs into three broad categories:

  1. Cutaneous IRIDs are those which relate to the skin. These include abscesses (collections of pus at the injecting site), cellulitis (a bacterial infection characterised by hot, red or swollen skin), and skin ulceration (sores that don’t go away). These are easily treated if addressed early, though if left untreated they can cause significant health problems.
  2. Vascular conditions are those relating to blood vessels. These are mainly caused by poor injecting technique, reusing equipment or not using filters. The needle becomes damaged even after a single use, so reusing needles can cause considerable damage to veins and this gets worse the more a needle is reused.Filters are another important way to prevent vein damage. Not using filters allows small, non-soluble particles into the blood stream which damage and even block veins and arteries. At their most severe, a blockage (thrombosis) can result in the loss of an appendage like a finger or a limb. (You can read more about filters in Anex Bulletin’s previous edition. It’s important to note that a filter won’t protect against blood-borne viruses, no matter the type of filter.)
  3. The final category is made up of internal bacterial or fungal infections related to injecting such as infections of the blood (septicaemia), bone (osteomyelitis), joints (septic arthritis) and the heart (endocarditis). These conditions are quite serious and may be caused by minor infections that are left untreated, leading to more serious conditions.

How common are IRIDs?

Exact information about the number of people who have or have ever had an IRID are very difficult to estimate. This is for a range of reasons, including low health service engagement amongst people who inject drugs.

Phill advises that at the Kirketon Road Centre around one-in-four clients report having experienced an IRID at some point in their life, and around 10-12 per cent of consultations involved treatment of an IRID.

Risk factors

Sarah Larney

While there are a number of things people can do to minimise the risk of injecting-related injury, Dr Sarah Larney from the National Drug and Alcohol Research Centre says that injecting always carries some risk of injury. Phill agrees, noting that injecting-related infections and injuries occur even in hospital settings.

Sarah has identified a number of risk factors for IRIDs:

  • repeated use of the same injection site;
  • not cleaning the injection site;
  • use of non-sterile equipment; and
  • poor injecting technique.

Other risk factors include scratching or skin-picking, injecting in sites other than on the arms (e.g. feet, legs or groin) and injecting in prison (due to a lack of access to sterile equipment).

What can be done to prevent IRIDs?

Sarah says that both prevention and early intervention are key for addressing IRIDs. Washing hands thoroughly and swabbing sites prior to injecting reduce the risk of infection, and ensuring that new, unused needles are used for each injection minimises the risk of getting a vein injury.

Phill agrees, saying that IRIDs are most commonly caused by a breakdown of good injecting practice. This includes proper preparation before injecting, good injecting technique and then adequate post-injection care (applying pressure to an injection site afterwards, discarding used equipment etc.).

Both Phill and Sarah note that people who inject drugs who have an IRID often delay seeking care. By the time they present for treatment at a GP and hospital, the opportunity for early intervention has often passed and the IRID may have developed into a more significant problem

NSP staff are therefore ideally placed to provide early interventions to people with IRIDs such as advice and referrals.

Sarah says that the best way to do this is to check-in with NSP clients about minor things, like asking about veins and their general wellbeing.

What can NSP staff do?

Phill says that the best thing NSP staff can do is to touch base with their clients every time they see them.

“Ask them about their veins, ask about their injection technique and if they need a refresher. Those quick, casual interventions can be quite effective over time,” Phill says.

Sarah agrees, noting that “checking in with clients about their well-being can really show that you care and helps build rapport. Having a good relationship with a client means more opportunities to engage them about their health.”

– Dr James Petty

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