English summary: VASCULAR AND INFECTIOUS PROBLEMS FROM INTRAVENOUS AUTOINJECTION OFCRUSHED TABLETS IN THE HELSINKIREGION

Background

The International Narcotics Control Board (INCB) has predicted that prescription drugs will replace illicit drugs by 2010. If the estimated trend is maintained, both vascular and infectious problems due to intravenous use of crushed tablets will increase in the future. Administration of prescription drugs is usually oral, but when higher bioavailability is sought, abusers may crush or pulverize the tablets and dissolve them in water. Drug abuse may result in a wide spectrum of vascular complications, for example: cutaneous manifestations, pseudoaneurysms, infected deep vein thrombosis and tissue ischaemia.

Methods

Twenty-four patients were treated by vascular or plastic surgeons at Helsinki University Hospital during 2000-2005 following the injection of crushed tablets. Their medical records were collected and analyzed. The types of crushed drugs, the route and timing of administration were examined. Medical interventions, examinations and surgical procedures were recorded.

Results

The main types of manifestations were acute limb ischaemia (16) and infection (88 Jensenius M, Heger B, Dalgard O, Stiris M, Ringertz SH. Serious bacterial and fungal infections in intravenous drug addicts. Tidsskr Nor Laegeforen 1999;119:1759-62.), in some cases leading to distal and proximal amputations. All the patients had a previous history of intravenous drug abuse and lived in the Helsinki region. Males were affected more frequently with a ratio of 4:1. The ages ranged between 20 and 39 years (mean 26 years). The incidence of hepatitis B virus (HBV) infection was 88%. Buprenorphine was the most commonly used drug in 10 of the 25 patients and benzodiazepine derivatives were also used by 11 of the 25 patients.

Conclusions

The number of these patients has increased recently. When suspected, imaging may be helpful in diagnosis. Prompt drainage of any abscess is essential and fasciotomy is usually required. However, there is no consensus about the best medical therapy.