intravenous drug users (IVDU) or injection drug use (IDU)

see also:

• drug dependency
• opiate and opioid dependence
• infective endocarditis (including SBE)

• intravenous drug users are a high risk patient group
• ED issues include:
  • drug seeking behaviour
  • overdose, particularly, opiates and opioids
  • drug toxicity reactions, particularly, Mx of psychostimulant toxicity from amphetamines and related substances
  • withdrawal reactions
  • transmissible infections such as hepatitis and HIV / AIDS
  • drug-induced or exacerbated psychiatric problems including psychoses
  • malnutrition
  • psychosocial issues
  • criminal issues
  • septicaemic complications including infective endocarditis (including SBE), and bacterial seeding elsewhere
  • foreign body complications such as pulmonary granulomatosis and its complications
  • road trauma and legal issues relating to driving whilst intoxicated
  • intravenous access issues

• IVDUs have a 10x risk of community acquired pneumonia
• tuberculosis (TB) is more prevalent due to poverty, homelessness, malnutrition, HIV / AIDS, and poor medical care
• septic emboli/infective endocarditis (including SBE) related complications include pulmonary infiltrates, cavities, abscesses, infarction and pulmonary gangrene.

• injection of pulverised tablets as well as filler agents such as talc may lodge in the pulmonary capillaries causing chronic inflammation, granulomata, interstitial fibrosis, emphysema and pulmonary hypertension.

• particularly an issue with HIV / AIDS patients but also with foreign body granulomatosis
• radiographic incidence of upper lobe bullous lung disease in ivdu's is said to be 2%
• habitual iv use of methyphenidate has been associated with panlobar emphysema (lower lobes) within 1 to 6 years

• may arise from attempts at iv access via subclavian and jugular veins
• may arise due to septic pulmonary emboli or bullous disease

• cocaine and opiate use substantially increases risk of critical attacks of asthma

• mainly in association with HIV / AIDS

• regardless of route, cocaine may cause:
  • pulmonary oedema
  • pulmonary haemorrhage
  • bronchiolitis obliterans with organizing pneumonia
  • acute bronchospasm
  • “crack lung” - presumably a hypersensitivity reaction with wheezing, fever, infiltrates, eosinophilia, raised IgE - Rx steroids