Identification, Treatment and Prevention
Abscesses are something most of us have encountered before and they can be excruciatingly painful. Sympathetic medical care can be hard to come by for many of us who use drugs and so some people resort to treating themselves. This can lead to some serious complications as the toxicity of an abscess can vary considerably. Here are a few things to remember when it comes to getting to grips with an abscess….
Abscesses present themselves as raised lumps on the skin and can either be sterile or infected.
Many drug injectors will have an abcess at some stage in their inecting careers but it is by no means a certainty – they can be prevented.
A sterile abscess is caused by injecting either an irritating or insoluble substance into a vein – particularly so if you miss the vein and your drugs leak into the muscle / skin area. It may develop slowly and not usually show signs of heat although there may be a touch of redness and it can feel like a solid nodule under the skin but generally will not be sore to the touch. Don’t try to squeeze or poke it as it will usually go away in its own time ( although this can take quite a while and it may look pretty ugly.) See ‘What’s in an Abscess’ for what happens if you decide to squeeze…
An infected abscess, on the other hand, is a different story. Caused by either using non-sterile injecting equipment or by bacteria from your skin entering under the skin via the injecting process, an infected abscess will soon come up as a swollen lump on or near the injection site. Appearing inflamed and red, it feels hot to the touch and soon becomes very painful. The abscess may come to a ‘head’ or ‘point’ and be filled with pus. It can be tempting to squeeze or burst it now – but DON’T! This will only spread the infection, driving it deeper and wider, and it could head for the bloodstream giving you blood poisoning.
If you want to know what inside your abscess – here’s a little insight.
What’s in an abscess?
The abscess is actually a cavity under the skin, filled with many little ‘walls’ that contain the pus. The pus itself contains blood, white blood cells (for fighting infection), damaged or dead tissue and bacteria. Some of this bacteria can still be ‘live’ which is why squeezing, poking about etc, can easily spread the infection. Your body has made this cavity in an attempt to localise the infection so it won’t spread. An infected abscess won’t go away on it’s own, you really need to seek medical treatment.
In the early stages you may be given antibiotics to clear it up. Or if necessary, if a head has developed on the abscess, a doctor will lance it and drain out the pus. The resulting hole should be thoroughly cleaned out, using prescription only agents and then packed. This is done so the wound will heal from the bottom up, otherwise the skin will just close over the top, leaving bacteria inside and the whole thing will start over again. Antibiotics would also be given.
Try and find a sympathetic doctor, go to A&E , or try a recommended needle exchange ( It will be kept confidential and some places can help with wound dressings, teaching you how to do them yourself at home.) The fear of going to your drug treatment clinic with an abscess, or to A&E, because of the effect it could have on your methadone script being changed, is unfortunately still a real one in some places/countries. But you must get advice and treatment – no matter what- because if left untreated, an abscess can lead to septicaemia (blood poisoning), which can be fatal, cellulitis ( a very painful infection of the surrounding tissue) and other complications. All this will put extra pressure on your immune system – not what you want if you are HIV or Hep C positive.
It is important to remember that you don’t have to end up with huge circular scars on your body.
As the ‘drugs war’ rages on, the ricocheting effects continue to reverberate around the drug using community. Abscesses have become our battle scars. If you are concerned about your scars there are camouflage creams available to conceal them – you can ask for a referral from a doctor to a clinic that will guide you in their use and help with the creams application.
Tips on preventing an abscess
Use new equipment – sterile water, works, swabs etc. Wash your hands before and after your fix- it is really essential you try and make this a habit – a part of your routine when injecting. Don’t use an old slimy (germy) bar soap, it is preferable to use antibacterial soap in a pump container.
Stapphococcus bacterium, the bacteria that is so often found in abscesses, actually lives on our skin, and thrives in hot sweaty areas that may not have seen a water for days. So it is really important to ensure you keep your injecting site clean, fresh and aired and you always wash your hands before handling injecting equipment, for you and any mates. And don’t let anyone hit you up without them washing their hands first as well! You wouldn’t let a nurse inject you without swabbing or putting gloves on would you?
Filters: It is also preferable to use surgical cotton wool because it is made up of fibres that won’t separate – unlike cotton wool, cigarette filters, tissue etc. Not only can loose fibres from these get trapped under the skin and cause an abscess , but they can also travel along your veins and cause blockages and infection in some seriously dangerous places – like your heart or get lodged somewhere along the way. This can be an extremely painful experience but fortunately, is not too common. However, if you ensure to wet your filter before you use it (and don’t tear it off with your teeth or dirty nails) you will be reducing your chances of fibres dislodging. Cut it longways, and always put the ‘shaggy’ side down in the spoon, so your syringe draws up on the smooth side. Don’t make it to small, if its wet you wont be trapping your drugs in it and you’ll have a better chance of it doing its job and ‘filtering’ your drugs of yukky bits.
There has been some very ‘dirty’ heroin going around lately, so be sure to use a good size filter and try not to miss the vein – another sure-fire way to cause an abscess.
Seconal (barbituates) are notorious for causing abscesses. Usually an abscess can be guaranteed if you miss a vein shooting this so BE CAREFUL.
If any gear looks suspect to you, consider other ways of taking it such as snorting, smoking or swallowing. Never skin pop with suss gear and it is not recommended to skin pop or inject in the muscle with brown heroin (another sure way to get an abscess).
Speed and coke are particularly irritant to your veins and tissues, so if you can bear it- try smoking or snorting it instead.
Cleaning your own syringes: If you must re-use a syringe that you have previously used, attempt to disinfect a rinsed syringe by;