An abscess on the skin, showing the redness an...

An Infected Abscess

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.

Battle Scars

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;

Leave a comment


  1. lori

     /  February 21, 2015

    Hi im 26 and i shot up meth and missed at the.end it blew my skin and i started bleeding it stoped so u thought oh ill be fine then now 3 days later i have black hole in the middle of a red hot swollen the middle is black and feels like a scab but wont come off idk what i should do or even what it is

  2. So I’m 25, turning 26 in September. I have insurance through my parent’s but it will run out soon. I just quit shooting heroin (11 days now!) But before quitting I was injecting into my butt muscle pretty much 3 times a day. I have multiple abscesses, some healed but left my skin concave. I still have about 4 areas on the side of my butt that drain if I press on them. Even just sitting in a chair, it’s like I’ll come home at the end of the day and my underwear will have dried leakage from the abscesses on both sides of my boxers. I think the obvious thing is to see a doctor-which I can do- but anything I can do about the healed concave brown skin on the sides of my butt from healed abscesses? WHAT SHOULD I DO IN GENERAL? I’m clean but can my body heal? I used to have a great butt (lol) but now it’s got open sores and concave Brown areas all over. Any help much appreciated!

  3. URGENT :: Shot up in the veins on my bisepts and missed or had the cord to tight and it blew up my vein and missed it all in one. Feels like half a golf ball in my arm. Not to painful but I don’t know if these ones will go away like others I have had. Any help Thanks. Doctor is last resort. Family will disown me.

    • Hi Michael,

      The question you raise is a serious one. While I can respect that you have very legitimate concerns about being disowned by your family, you need to place your personal health and safety above these concerns. It sounds like you’re going to be ok anyhow, but here are some basic things to watch out for:

      1) increased swelling at the injection site, or around it
      2) heat coming off of the wound
      3) breaking open of the wound and the release of infected discharge
      4) increase in general symptoms related to skin and blood infections (explained below)

      Many injection failures, like the one you’ve suffered, result in some kind of damage to the skin and surrounding tissues. You are best advised to keep the wound clean; to apply ice to reduce swelling; to watch out for an increase in the heat being given off by the wound (ie: if it’s getting hotter to the touch, chances are good that infection is increasing); watch out for a rise in your general temperature as well as feelings of nausea and other physical indicators of a general infection.

      If the wound does not start to go down in swelling, or if you should start to experience any of the additional symptoms described above, you need to seek medical attention as soon as possible. Failure to do so could result in additional damage being caused to the injection site and, in the worst case scenarios, could even lead to loss of the arm or death from blood infections. It may be possible for you to access help anonymously through a specialized drug service/agency (such as a needle exchange or other specialist Harm Reduction program). Failing this, you should remember that you CAN access casualty (A and E) hospital services without being identified – that is, you may be asked for your name (and address), but not for evidence of your identity (eg. drivers license). If, however, they decide to admit you for treatment, they will require proper details of your ID – for instance, to communicate with your GP – so be prepared for that eventuality. In short: they will ask for name and address to start with, but they won’t check them or use them to contact your GP unless you’re being admitted to a ward for treatment. If you have any serious concerns about this injury, I suggest that you get it checked out as soon as possible. And, if you are currently making use of NEP services right now, particularly through pharmacies, your should use the Terumo needles provided in the WHITE kit, and then use the rest of the cooking equipment provided with the (terrible) “Filter Syringe” kits (this is how injection kits are made up in Liverpool – they may differ across the rest of the UK). Good luck mate; sincerely hope you start to feel better.
      Answered by: Dr. Nuke

  1. Abscesses; Sterile or Infected? | Black Poppy's Junk Mail

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