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IV Drug Use: Signs, Dangers, and Treatment

Injection is a method used by individuals who misuse drugs to obtain a quick and powerful effect.1 Intravenous (IV) injection, or injection into a vein, is the practice referred to throughout this article as IV drug use. Injection into a vein or muscle carries certain risks.1 This article will focus on details, dangers, and how to decrease the harm associated with IV drug use.

What Is Intravenous Drug Use?

Intravenous drug use is a method whereby a person will self-inject a liquified form of a drug into their veins, and this is the most dangerous way to engage with drugs.2 The drug enters the blood directly and is not filtered by the lungs or liver as it is with smoking or oral ingestion.2 This form of drug misuse is strongly associated with an increased spread of HIV/AIDS, hepatitis, and other infections.1,3

An estimated 3.7 million people in the United States engaged in injection drug use in 2018, a significant increase over the previous 10 years.3 Injecting is not usually the first method tried, but as a person develops a need for more frequent or fast-acting results, they may try injection.1

Injecting drugs allows a person to feel the effects within seconds and causes stronger effects because the brain receives the full dose at once.1

The most common place that individuals may inject drugs is into the arms due to ease, accessibility, and relative safety.4 This is because there are often large, visible veins that are easily covered if injection results in bruises or scarring.4 However, if the veins in the arm are too damaged or are difficult to find, people may inject into any vein, including those in the hands, legs, feet, groin, or neck.4

Often used by people who commonly or compulsively misuse drugs, some IV drug use terminology may include:4

  • Shooting up or shooting drugs (drug use by injection).
  • Mainlining (injection into a major vein).
  • Getting off (injecting).
  • Booting (drawing blood back and re-injecting it).

Common Intravenous Drugs of Abuse

Intravenous drug abuse is largely limited to 3 main drug types: heroin, methamphetamine, and cocaine.2 However, nearly any type of drug—particularly those that come in tablet or pill form—can be dissolved into a liquid and injected if the person wants fast-acting effects.5

The 3 most common drugs are injected in the following ways:

  • Heroin is available in powdered forms or as black tar heroin. Both types can be dissolved and injected, though black tar heroin tends to clog injection needles more often.2
  • Methamphetamine comes in crystal or powdered form. People may inject meth after first dissolving the powder in water or alcohol.6
  • Cocaine is typically obtained as a white powder or crystal (crack cocaine). It may be injected after dissolving the powder in liquid or dissolving crack cocaine with an acidic solution.4,7

Signs Someone Is Shooting Up

When a person uses drugs that require needles, their habit may be more difficult to hide. If you are concerned that a loved one is shooting up drugs, you may notice:

  • Scarring or “track marks” on their arms or over other veins.8
  • Wearing long sleeves in warm weather, or using other methods to cover track marks.4
  • Needles, syringes, or other drug paraphernalia among their possessions.4
  • Symptoms of intoxication or withdrawal, depending on the time since their last use.6,7

If you think a loved one is engaging in IV drug use, it is important to get help as soon as possible. The risks of continued intravenous substance abuse are many and can affect a person long-term.1

IV Drug Use Complications and Dangers

Drug misuse of any kind is dangerous, but IV drug use carries an even higher risk of negative outcomes.2 Physical risks of IV drug use include:

  • Skin and soft tissue infections. Non-sterile needles and drugs, contaminants in substances obtained on the street, and injection into soft tissue instead of a vein can lead to abscesses, wound botulism, or necrotizing fasciitis.8,9
  • Scarring and track marks. Scarring occurs from repeated injections in the same sites, and track marks are the result of scars that appear in line with a vein on an arm. If a person injects in one place too often, the vein may collapse or completely scar over.4,8
  • Heart infection (endocarditis). Bacteria can be introduced to the blood, and then to the heart, from unsanitary needles or contaminated drug samples. The buildup of bacteria in the heart valves can lead to life-threatening problems with circulation and heart function.8
  • Blood-born infections. Conditions such as HIV, hepatitis, tetanus, and other blood-borne illnesses can be directly transmitted from person to person when sharing needles.8,9
  • Deep vein thrombosis. Injection into the legs (and sometimes the arms) can lead to blood clots that gather in the veins and block circulation. This may cause swelling and ulcers on the limbs (usually one leg) and become life-threatening if the clots dislodge and make their way to the heart or lungs.4,10
  • Overdose. Due to the quick-acting, intense effects of injected drugs, people who inject often cannot accurately gauge how much they have taken. Individuals who inject drugs are more likely to accidentally overdose, which can have life-threatening consequences, including death.2,8

In addition to the physical effects, people who use intravenous drugs are more likely to have problems with:2

Harm Reduction Methods for Intravenous Drug Use

Intravenous drug use is always dangerous, but there are ways to reduce the risks. Harm reduction is a set of practical strategies, education, and ideas put forth with the goal of reducing the negative consequences associated with drug use.11

These strategies aim to reduce stigma, reduce the transmission of blood-borne diseases, lower the number of deaths by overdose, and provide education that can help individuals avoid additional complications of IV drug use.11

Syringe services programs (SSPs) are present in many communities to provide access to and proper disposal of sterile syringes and injection materials for people who inject drugs.12 These programs usually also provide low-cost or free services for vaccination, disease testing, and connection to care for infectious diseases or mental health.12

Examples of harm reduction include:4,11

  • Provision of free syringe services programs.
  • Education on safer injection techniques.
  • Availability of naloxone kits and overdose prevention sites.
  • STI testing and treatment.
  • Information on wound care and injection site rotation.

Finding Treatment for IV Drug Abuse

IV drug use can cause many long-term complications alongside addiction, but help is available. Treatment for IV drug misuse may look different for each person, but it can occur in any of the following settings and with the following interventions:13

  • Detoxification is the process in which the body clears itself of a drug. This should be completed in a treatment center with medical assistance. Drug detoxification can be dangerous to undergo alone and/or at home.
  • Inpatient treatment consists of 24/7 care in a hospital or residential rehab. It provides a highly structured care environment that is beneficial for people with more severe substance use disorders.
  • Outpatient treatment takes place while the person lives at home, but it may vary widely in terms of time commitment and intensity depending on a person’s needs and the program type.
  • Aftercare or continued care is less structured and serves as continued support after the completion of a more formal treatment program. It can play a large role in reducing relapse and maintaining motivation for sobriety.
  • Medication may be used during detox or as ongoing treatment for stability. However, not every substance of misuse that creates dependency can be treated with medication.
  • Behavioral therapy is commonly used in all settings and at all stages of substance use disorder treatment. Some of its goals are building motivation to change, teaching coping skills to avoid relapse, and improving relationships.

Substance use disorder is a chronic condition that often involves relapse as a part of the healing process.13 It is important to be patient and encouraging with loved ones on their path to recovery, helping them adhere to treatment despite difficulties or setbacks.13

Only a professional can diagnose a substance use disorder and prescribe medication that may encourage long-term healing. Consulting with your primary care physician or a mental health professional is a good place to start when you decide to get help. Professional help can provide the structure and experienced guidance that can make a difference on the path to recovery.

If you or a loved one is looking for addiction help, American Addiction Centers (AAC) has nationwide treatment centers with a variety of specialties that may fit your treatment needs. Our admissions navigators can help you check your health insurance coverage and locate an AAC facility. Please contact us free at . Our hotline is available 24/7 and all calls are confidential.

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