Intravenous Abuse Research Articles

US Cities Struggle to Implement Needle Exchanges Despite Apparent Success in European Cities

PHILOSOPHICAL arguments are seldom settled by numbers. In the case of drug abusers and acquired immunodeficiency syndrome (AIDS), many public health experts say the numbers support their view that, in the absence of effective means to eliminate intravenous (IV) substance abuse, the next best thing is to help addicts inject more safely. Opponents say that distributing free needles and syringes will encourage drug use and send the wrong message at a time when the nation appears increasingly concerned about the impact of illicit substance abuse. After numerous false starts, two cities in this country—New York and Portland, Ore—are poised to put the issue to the test. But given the politically charged environment, it is far from certain that the results of those tests will change minds. They may save lives, though. As many as 4.5 million men and women are "in the direct line of fire"—as IV drug users or

T lymphocyte subpopulations in anti-HIV-negative drug-dependent patients with intravenous abuse

In the group of patients studied by us, we found a slight disturbance of the balance between immunoregulatory T helper/inductor lymphocytes and cytotoxic T suppressor lymphocytes which is usually characterised by a 2 to 1 ratio. This disturbance was due to the presence of an absolutely and relatively enhanced quantity of T suppressor cells, by which the relation of these T-cell subsets to each other was slightly lower than in the normal controls. The average ratio was 1.37 and was pathologically reduced in 19% of the patients. Activation and increase in the number of T suppressor cells in conjunction with a relative lymphocytosis are probably less due to a directly drug-induced effect than to an adequate immunoreaction to increased antigen stimuli such as infections with hepatitis B virus, viruses of the herpes group and other viral pathogens.

Analysis of epidemiological data on agonist-antagonist analgesics

Epidemiological information on the abuse of opioid agonist-antagonists is scanty. Most of the available information relates to pentazocine, the ‘oldest’ of this class of drugs, and it appears that a sporadic episode of its intravenous abuse in several cities in the United States, is subsiding: reformulation of pentazocine tablets to contain naloxone may have contributed to the decline in this abuse. Apart from a few reports of buprenorphine abuse, there are only occasional accounts of abuse of other drugs in this class. However, the lack of data does not necessarily mean that abuse does not occur and it is essential that epidemiologically sound investigations should be made to explore the existence and extent of any such problem. The interpretation of epidemiological data relating to agonist-antagonist abuse is discussed.

Thrombocytopenia in a bisexual adolescent male with a history of intravenous drug use

Immunologically mediated thrombocytopenia has been repotted as a manifestation of human T-lymphotropic viras type III (HTLV-III) infection and intravenous (IV) drag abuse. The case report describes thrombocytopenia in a bisexual adolescent male with antibody to the HTLV-III virus and a history of infrequent IV drag abuse. The case underscores the need to consider HTLV-III infection and/or IV drug abuse in the differential diagnosis of thrombocytopenia in an adolescent.

Disseminated Candida infection syndrome in heroin addicts--dominance of a single Candida albicans biotype

Among 21 intravenous heroin abusers with cutaneous and ocular manifestations of disseminated Candida infection, a single C. albicans strain type (serotype A, biotype 153/7) was isolated from skin lesions in 14 cases. This suggests that central contamination of the heroin with C. albicans is less likely to be the source of infection than an endogenous source, and that one particular strain type is either better adapted than others to grow in the lemon juice used as a heroin solvent, or more likely than others to cause the specific pathology seen in these patients.

Intracranial Hemorrhage After Cocaine Abuse

To the Editor.— Cocaine abuse and its medical, psychiatric, and neurological complications have been well documented. 1 However, the incidence of intracranial hemorrhage in cocaine abuse must be exceedingly low, as only three cases have been reported in the American literature 2,3 despite a large and growing population of cocaine abusers. Use of a new and more potent form of cocaine, has recently reached epidemic proportions in many major cities, especially New York. 4 To our knowledge, no reports of intracranial hemorrhage associated with its abuse have been reported. In a two-week period, we evaluated five men aged 21 to 40 years with intracranial hemorrhage, one subsequent to confirmed abuse of crack, taken intravenously, one following intravenous cocaine abuse, and three with cocaine present in large amounts in their urine. Three of the patients had large intracerebral hematomas and two had subarachnoid hemorrhages. Two of the patients subsequently died,

Localized Gangrene of the Scrotum and Penis: A Complication of Heroin Injection into the Femoral Vessels

Long-term intravenous heroin abusers have problems of vascular access. After the accessible sites are sclerosed, the neck, axillae and groins are then used frequently. We report on 3 heroin abusers who presented with localized gangrene of the genitalia after injection into the femoral vessels. We postulate that the pathophysiology of this entity is related to arterial embolization of particulate matter into the microcirculation of the genitalia, which causes arterial thrombosis leading to localized gangrene. Of the 3 patients 2 were treated with local excision, debridement and primary closure. A fourth addict who injected heroin directly into the scrotum and perineum, presented with Fournier’s gangrene, a completely different, more lethal entity.

Brain stem mucormycosis in a narcotic addict with eventual recovery

In addition to the well-known infectious complications of intravenous narcotic abuse, a much rarer and more recently recognized association between intravenous narcotic addiction and mucormycotic abscesses of the central nervous system has been described. Only four cases have been cited in the literature, with a mortality rate of 100 percent in this group. This report describes a narcotic abuser who presented with obstructive hydrocephalus and a mucormycotic abscess of the brain stem, and recovered. Central nervous system mucormycosis should be included in the differential diagnosis of drug abusers who present with a rapid deterioration in neurologic status.

Multiple organ failure resulting from intravenous abuse of methylphenidate hydrochloride

A 32-year-old woman who abused methylphenidate hydrochloride developed complications including hepatic, renal, pancreatic, pulmonary, and CNS toxicities. These were manifested by abnormal liver function enzymes, poor urine output, hypotension, tachypnea, tachycardia, abnormal blood gases, rising serum BUN and creatinine, and hyperactive deep-tendon reflexes. All were reversible with medication withdrawal and supportive therapy. Toxicities of this medication and their implications are discussed.

Intravenous Amphetamine Abuse, Primary Cerebral Mucormycosis, and Acquired Immunodeficiency

Two intravenous amphetamine abusers had fatal, rapidly progressive cerebral mucormycosis with abscess formation in the presence of absolute lymphopenia. Postmortem examination confirmed the primary nature of the fungal cerebritis, documented by postmortem culture and histology. The clinical and pathologic features of these cases are compared to previously reported occurrences of primary fungal cerebritis (and abscess) among intravenous drug abusers, including cocaine users. Primary fungal cerebritis associated with intravenous abuse of stimulant drugs is discussed as a possible variant of the acquired immunodeficiency syndrome.

Isolation of lymphadenopathy-associated virus (LAV) and detection of LAV antibodies from US patients with AIDS.

A human retrovirus was isolated from the peripheral blood of three American patients newly diagnosed with the acquired immunodeficiency syndrome (AIDS). In each case the major core viral protein (p25) was shown to be antigenically identical to that of the prototype lymphadenopathy-associated virus (LAV). Two of the viral isolates were derived from intravenous narcotics abusers, the first demonstration of LAV isolation from this risk group. Antibody to LAV was detected by an IgG enzyme-linked immunosorbent assay in the serum samples of these and 14 additional American patients with AIDS and in none of 12 hospital worker controls. These findings provide support for the etiologic association of LAV and AIDS.

Longitudinal studies of drug abuse in a fifteen-year-old population. 3. Hidden drug abuse.

The hidden drug abuse in a stratified sample of a year cohort born in 1953 was studied by measuring the difference between drug abuse stated in interviews and registered in public health and social welfare files in 1968, 1973 and 1976. Among men who had stated high-frequency drug use in a school questionnaire in 1968 hidden drug abuse comprised two thirds of the total abuse, among women from the same group one half. In groups with lower degrees of abuse hidden drug abuse was 70-90% of the total abuse. Intravenous abuse was mostly known to public health and social welfare authorities. When trying to estimate the total number of drug abusers in an area there is reason to at least double the figures presented in case-finding studies.

Longitudinal studies of drug abuse in a fifteen-year-old population. 4. Chronic drug abusers.

In the Gothenburg year cohort of 1953 1% of the men and 0.2% of the women were registered for chronic drug abuse through 1979. An early début and a polydrug abuse with emphasis on intravenous abuse of central stimulants but not opiates were found. Compared with matched individuals who were unregistered for drug abuse, chronic drug abusers had a large over-consumption of psychiatric and social care. Their registered criminality was higher, they were more often sick-listed and had lower incomes than the controls. The prevalence and overall impairment of chronic abusers are similar to those of schizophrenics.

Longitudinal studies of drug abuse in a fifteen‐year‐old population

A representative, stratified sample from a year cohort of ninth-graders, mostly 15 years of age, examined in 1968 with a questionnaire, was followed over a decade in official registers. After 5 and 8 years, subsamples were also interviewed. During the period in question there was a polydrug abuse pattern in the area of Gothenburg, the second city in Sweden with approx. 450,000 inhabitants. The sample comprised 1,047 individuals and the whole year cohort 5,367. The estimated proportions of registered drug abusers in the cohort were 9% men and 8% women. 3% men and 5% women had drug careers for 2 years or less, 1% men and 0.2% women for 10 years or more. Those who became registered had with few exceptions stated drug use in the school questionnaire or had attended special classes or dropped out of school prematurely. After 5 years 60-80% of the registered abuse remained among the men in these groups and 30-40% among the women. According to interviews abuse remained in 70-90% of men who had admitted drug use in the school survey and in 50-60% of the women from the same groups. According to both registers and interviews intravenous abuse of central stimulants had increased among men but decreased among women. After 11 years, 20-60% of the registered abuse remained in men and 5-60% in the women.

Renal ultrasound in acquired immune deficiency syndrome.

Ten patients with clinical and laboratory features of acquired immune deficiency syndrome (AIDS) underwent renal ultrasonography prior to biopsy because of proteinuria, azotemia, or uremia. Four patients had a history of intravenous heroin abuse and were considered separately so as to exclude it as a cause of nephropathy. Histological examination revealed focal segmental glomerulosclerosis (FSGS), which in patients with AIDS is characterized by rapid progression to severe uremia (though FSGS can also occur in several other forms of renal disease). The authors recommend that AIDS-associated FSGS be considered as a cause of type I parenchymal disease and suggest that serial sonograms may be useful in monitoring progressive renal involvement.

Association of infection caused by Pseudomonas aeruginosa serotype O11 with intravenous abuse of pentazocine mixed with tripelennamine.

From July 1979 to June 1983, 25 of 40 intravenous drug addicts with systemic infections had Pseudomonas aeruginosa as the etiological agent; by 1982, P. aeruginosa had replaced Staphylococcus aureus as the most common pathogen. At least 21 of the 25 addicts with P. aeruginosa infection abused pentazocine mixed with tripelennamine (commonly known as T's and blues) compared with 6 of 15 addicts infected with other pathogens (P = 0.006). Of the 25 P. aeruginosa isolates, 23 were of serotype O11. Phenotypic patterns in isolates from addicts and in 22 serotype O11 control isolates from nonaddicts were determined by pyocin and electrophoretic enzyme typing, as well as by susceptibility to heavy metals and antibiotics. Of 25 isolates from addicts, 20 were identical or differed by only one marker, whereas the 22 nonaddict serotype O11 isolates were distributed among 17 distinct phenotypic patterns. We postulate that the emergence of P. aeruginosa as the major cause of deep infection in addicts is a consequence of contamination of their paraphernalia during preparation of pentazocine and tripelennamine for self-injection. The phenotypic similarity among isolates from addicts may reflect acquisition from related environmental sources and an unusual ability of certain serotype O11 strains to survive preparation of the drugs or to be invasive.

Candida albicans Meningitis in a Parenteral Drug Abuser

We have described a patient with meningitis due to Candida albicans, in whom the only identifiable risk factor was a history of intravenous amphetamine abuse. Despite intravenous therapy with 2 gm of amphotericin B and concurrent 5-fluorocytosine, symptoms, CSF pleocytosis, and hypoglycorrhachia persisted. After a brief course of intrathecal amphotericin B therapy, the patient improved clinically and the CSF returned to normal.

Disseminated candidiasis: evidence of a distinctive syndrome in heroin abusers.

Seven young men developed similar manifestations of disseminated candidiasis after a single episode of intravenous heroin abuse. Sequential development of lesions of the eye, skin, and bone or costal cartilage was noted within 10 days after injection. Skin lesions were confined to the scalp and other hair bearing areas. Candida albicans was cultured readily from affected skin and costal cartilage. Histological examination of scalp biopsy specimens showed infiltration of hair follicles with chronic inflammatory cells and C albicans. Pseudohyphas of C albicans were also identified in and around hair shafts. The skin, skeletal, and small eye lesions resolved on systemic treatment with 1 g amphotericin B plus flucytosine. Pars plana vitrectomy plus local instillation of amphotericin B cured progressive chorioretinitis. These features may represent a distinctive syndrome of disseminated candidiasis in heroin abusers. Systemic antifungal treatment is curative in most cases.

Acute Cardiomyopathy Secondary to Intravenous Amphetamine Abuse

Brief Reports1 October 1982Acute Cardiomyopathy Secondary to Intravenous Amphetamine AbuseTHOMAS D. CALL, M.D., JOSEPH HARTNECK, M.D., W. ANDREW DICKINSON, M.D., CLARK W. HARTMAN, M.D., ALAN G. BARTEL, M.D.THOMAS D. CALL, M.D.Search for more papers by this author, JOSEPH HARTNECK, M.D.Search for more papers by this author, W. ANDREW DICKINSON, M.D.Search for more papers by this author, CLARK W. HARTMAN, M.D.Search for more papers by this author, ALAN G. BARTEL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-97-4-559 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIntravenous drug abuse can cause serious medical problems. Endocarditis and noncardiac pulmonary edema are the main cardiopulmonary complications of use of intravenous street drugs (1, 2). Previous reports have not shown any consistent direct myocardial complications secondary to use of these drugs (3). We report a case of a woman who developed acute cardiomyopathy with myocardial dysfunction and pulmonary edema immediately after intravenous amphetamine abuse. Possible causes for this severe cardiac abnormality, as well as its clinical importance, are discussed.A 22-year-old white woman presented to the energency room 10 hours after intravenous amphetamine use with chest pain and shortness...

Central nervous system complications of addiction to "T's and Blues".

Thirteen patients displayed neurologic complications of intravenous abuse of "T's and Blues" (pentazocine and tripelennamine). In six, the major presentation was seizures. Three patients had strokes, and three had CNS infections, two fungal and one related to subacute bacterial endocarditis. One patient had hepatic failure and an unusual encephalopathy. Foreign body embolization is common; the materials enter the cerebral circulation because of pulmonary arteriovenous shunts. Emboli may cause seizures, which also occur as a toxic effect of the drugs. Infection is due to unsterile injections. Enzyme elevations and diffuse vasculopathy raise the possibility of immune mechanisms.