Anthrax Warning for European Heroin Users -especially Brits

ANTHRAX WARNING -including the most up-to-date and well researched guide on the subject of ANTHRAX and the contamination of street heroin -and ARE WE AT RISK? Thanks to INPUD for the information below and their new guide.

OK, so the picture is pretty horrid but it is nothing to how bad an anthrax infection can get -along with it being FATAL for some of our heroin using peers. This is an extremely serious (sometimes fatal) infection that, although still uncommon, it continues to rear its deadly head since it first popped up on the scene a few years back. Now this affects:

INJECTORS of ALL MODES -intravenous AND intramuscular AND subcutaneous (or in street speak, mainlining, and IM (in the muscle like top of arm, front of thigh, or muscle area of bum cheek), or skin popping – right into the fat/skin (not deeper, like into the muscle).

SMOKERS – Yes, you heard right. This also affects heroin smokers.

SWALLOWING – Yep, you read it right. Read the guide for more info on gastrointestinal infection from swallowing or inserting street (anthrax spore infected) heroin (smuggling, hiding internally etc -this concerns you too!)

INPUD’s INPUT

INPUD (International Network of People who Use Drugs) have thoroughly researched the available information on anthrax spores in our street heroin and how it has been affecting users AND popping up in places across Europe, mainly Britain and have produced a brief (but thorough) guide (PDF) for print out, sharing and dissemination amongst your peers and user groups. See also INPUD’s main website and blog. (copy freely but credit INPUD!)

Just to pull out a few interesting bits, INPUD’s up to date and well researched guide for heroin users and health workers on anthrax can be found here; INPUDanthrax …

Black Poppy lifted some text from INPUD’s excellent guide in order to flesh out the background a bit -and why it should concern us, especially in the UK. INPUD’s Guide states;

“…Subsequent to the crisis in Scotland during 2009/10, where an outbreak of anthrax infected 47 people, causing 14 fatalities; further cases and deaths have been reported this year in Germany, Denmark, and France. Scotland has again been affected, with a confirmed case in Lanarkshire on 24th July this year….

……Although at the time of this publication, no further cases have been reported on the European mainland, anthrax infection continues to infect, hospitalise, and kill heroin users throughout the UK.”

It goes on to say;

“…..The spores found in the heroin responsible for the recent cases in Germany were shown to be indistinguishable from those found in the 2009/10 cases in Scotland. This suggests that the same batch of heroin could be responsible….

INPUD’s guide goes on to state clearly….

“…Research published subsequent to the 2009/10 outbreak has produced no evidence of nefarious intent, with the heroin likely being contaminated by the use of bone-meal based cutting agents, or contact with animal hides whilst in Turkey, during transit from the Afghan source…”

The guide shares a bit of background as well, which i have again copied for you here…
On the 17th June 2012, a heroin injector presented to a Berlin Hospital with symptoms of cutaneous anthrax i.e. infection at the injection site. Symptoms were black eschar (black dry scab), massive swelling, erythema (redness) and thrombosis.
Diagnosis was confirmed at the Robert Koch Institute by PCR, and serology showed that this was an anthrax infection due to the injection of an anthrax-contaminated batch of heroin.
Subsequent to the crisis in Scotland during 2009/10, where an outbreak of anthrax infected 47 people, causing 14 fatalities; further cases and deaths have been reported this year in
Germany, Denmark, and France. Scotland has again been affected, with a confirmed case in Lanarkshire on 24th July this year.

This is the best guide we have seen on this subject –

For the INPUD ANTHRAX Guide:  INPUDs Guide on ANTHRAX for heroin users
Just about everything you need to know right now about anthrax is in this guide.
Topics include;
What is anthrax?
Routes of Infection
Smuggling heroin
Can you identify it?
Can you filter out the anthrax spores?
White Vs Brown (heroin)
Signs and Symptoms
What to look out for.
Advanced Infections
Treatment
Risks to Family and Friends?
Useful links – and more. Including some very unpleasant (though real) pictures.
After thought...; Anyone who has a proven case of anthrax in any country, please dont forget (if you or a friend is able) to let your local large drug service or drug user group know about it (so we can share information, anonymous is fine of course) -or even tell us – at BP or INPUD.
It is essential these episodes are recorded -and sometimes, as we well know, we may need to do it ourselves to make sure its done and disseminated.  It wouldn’t be impossible for some medics around the entire globe to attempt to treat what might be a milder anthrax case and then not identify it or record it properly etc etc. Is it possible there could be more cases globally?? There may have been deaths not recorded accurately, (now that feels like a pretty common scenario for ‘junkies’ who die – (I’m going to be really rocking the boat here but…) 30 years experience tells me that health issues (like ulcers, COPD, necrotic skin around abscesses not treated, kept or healing  properly etc (esp if one’s homeless etc) can be overlooked because, for example, as one coroner said on camera “We leave the junkies til last because we already know they’re OD’s so it don’t take us long at the end of the day”…..I swear to God I heard a coroner say that. What if the drug user also has HIV or HCV, then they have to be kept quarantined. Hassle, hassle, hassle! Especially if they have no loved ones…What happens then if that person is covered in weeping sores and the coroner is overworked, underpaid AND a bigot -all at the same time!
No, (we need a little quiet investigation one of these days soon regarding the attitudes towards ‘junkies’ at coroners and funeral places my friends…) OK so it is rocking the boat but how many more of us to just get stamped ‘OVERDOSE’ on the death certificate when there could have been a myriad of things that precipitated that.
I know its complex, and people are busy and services short of money, but sometimes its worth remembering the very very painful reality that junkies are loathed mostly, or at least misunderstood, or for medics confronting a dead ‘opiate addict’ for example on a busy workday- suddenly shoot straight to the top (or bottom) of the pile -as a very straightforward case of an opiate overdose….How many times has that answer not provided family and friends with a believable occurrence  How many times are there no police reports clearly written out, or evidence gathered, or questions asked or investigated, friends questioned, or the personal doctors getting involved…? Let alone proper toxicology reports…
In fact – I was involved in research in Britain about 8 or 10 years back amongst coroners within the UK (or maybe it was across the 33 boroughs in London…). In any case it was voluntary for them to take part, and only a small percentage did, but what that told us was worrying. Ill dig some material out – but check out your country, ask your academic mates and allies to help; just how DO they record the number of drug related deaths in your country – and where are those results fed into?
Have an off the record chat with your local coroner, or funeral dude/dudette, morgue technician etc. Write an article about it.
Dont forget to check out http://inpud.net and http://inpud.wordpress.com

Krokodil- Home made heroin of the very worst kind

Viktor Ivanov, the head of Russia's Drug Contr...

Viktor Ivanov, the head of Russia’s Drug Control Agency

 

 

I am reprinting here an Independent article from June on what is perhaps one of the most disturbing issues to confront the drug using community in years. Home made heroin – desomorphine (also called Krokodil because of what it does to the skin) is becoming more and more common in Russia, affecting the poorest heroin users and having the most horrendous effects on the body. The Russian government continues to look the other way, refusing to provide methadone or subutex or humane and evidenced based treatments. Their lame attempt at banning one of the ingredients (over the counter sales of codeine)will do little to circumvent what is fast becoming an epidemic of home made drugs of dire quality. Please read this article and check out our videos down the right hand side of the page on the effects of desomorphine.Note: desomorphine was apparently invented in the USA in 1923 as a pharmaceutical preparation and was used in Switzerland under the trade name Permonid (strong opiate, fast onset, short duration). Krokodil and desomorphine as home made in Russia, seems more to pertain to the extremely hazardous way it is made, using ingrdients as mentioned below – and not in the sterile pharmy environment that desomorphine could in fact be made, without all the added human health problems associated with it. Worrying, Krokodil, the ‘home made’ desomorphine, has recently spread to Germany. Unless someone makes Russia listen soon and implement harm reduction such as OST, Needle exchange, etc -we are going to see this death and destruction of lives continue to spread further than Russia.

Krokodil: The drug that eats junkies  (Click link for the original Independant article June 22nd 2011)

A home-made heroin substitute is having a horrific effect on thousands of Russia’s drug addicts

By Shaun Walker

Oleg glances furtively around him and, confident that nobody is watching, slips inside the entrance to a decaying Soviet-era block of flats, where Sasha is waiting for him. Ensconced in the dingy kitchen of one of the apartments, they empty the contents of a blue carrier bag that Oleg has brought with him – painkillers, iodine, lighter fluid, industrial cleaning oil, and an array of vials, syringes, and cooking implements.

Half an hour later, after much boiling, distilling, mixing and shaking, what remains is a caramel-coloured gunge held in the end of a syringe, and the acrid smell of burnt iodine in the air. Sasha fixes a dirty needle to the syringe and looks for a vein in his bruised forearm. After some time, he finds a suitable place, and hands the syringe to Oleg, telling him to inject the fluid. He closes his eyes, and takes the hit.

Russia has more heroin users than any other country in the world – up to two million, according to unofficial estimates. For most, their lot is a life of crime, stints in prison, probable contraction of HIV and hepatitis C, and an early death. As efforts to stem the flow of Afghan heroin into Russia bring some limited success, and the street price of the drug goes up, for those addicts who can’t afford their next hit, an even more terrifying spectre has raised its head.

(See video on vod pod – bottom right column)

The home-made drug that Oleg and Sasha inject is known as krokodil, or “crocodile”. It is desomorphine, a synthetic opiate many times more powerful than heroin that is created from a complex chain of mixing and chemical reactions, which the addicts perform from memory several times a day. While heroin costs from £20 to £60 per dose, desomorphine can be “cooked” from codeine-based headache pills that cost £2 per pack, and other household ingredients available cheaply from the markets.

It is a drug for the poor, and its effects are horrific. It was given its reptilian name because its poisonous ingredients quickly turn the skin scaly. Worse follows. Oleg and Sasha have not been using for long, but Oleg has rotting sores on the back of his neck.

“If you miss the vein, that’s an abscess straight away,” says Sasha. Essentially, they are injecting poison directly into their flesh. One of their friends, in a neighbouring apartment block, is further down the line.

“She won’t go to hospital, she just keeps injecting. Her flesh is falling off and she can hardly move anymore,” says Sasha. Photographs of late-stage krokodil addicts are disturbing in the extreme. Flesh goes grey and peels away to leave bones exposed. People literally rot to death.

Russian heroin addicts first discovered how to make krokodil around four years ago, and there has been a steady rise in consumption, with a sudden peak in recent months. “Over the past five years, sales of codeine-based tablets have grown by dozens of times,” says Viktor Ivanov, the head of Russia’s Drug Control Agency. “It’s pretty obvious that it’s not because everyone has suddenly developed headaches.”

Heroin addiction kills 30,000 people per year in Russia – a third of global deaths from the drug – but now there is the added problem of krokodil. Mr Ivanov recalled a recent visit to a drug-treatment centre in Western Siberia. “They told me that two years ago almost all their drug users used heroin,” said the drugs tsar. “Now, more than half of them are on desomorphine.”

He estimates that overall, around 5 per cent of Russian drug users are on krokodil and other home-made drugs, which works out at about 100,000 people. It’s a huge, hidden epidemic – worse in the really isolated parts of Russia where supplies of heroin are patchy – but palpable even in cities such as Tver.

It has a population of half a million, and is a couple of hours by train from Moscow, en route to St Petersburg. Its city centre, sat on the River Volga, is lined with pretty, Tsarist-era buildings, but the suburbs are miserable. People sit on cracked wooden benches in a weed-infested “park”, gulping cans of Jaguar, an alcoholic energy drink. In the background, there are rows of crumbling apartment blocks. The shops and restaurants of Moscow are a world away; for a treat, people take the bus to the McDonald’s by the train station.

 

In the city’s main drug treatment centre, Artyom Yegorov talks of the devastation that krokodil is causing. “Desomorphine causes the strongest levels of addiction, and is the hardest to cure,” says the young doctor, sitting in a treatment room in the scruffy clinic, below a picture of Hugh Laurie as Dr House.

“With heroin withdrawal, the main symptoms last for five to 10 days. After that there is still a big danger of relapse but the physical pain will be gone. With krokodil, the pain can last up to a month, and it’s unbearable. They have to be injected with extremely strong tranquilisers just to keep them from passing out from the pain.”

Dr Yegorov says krokodil users are instantly identifiable because of their smell. “It’s that smell of iodine that infuses all their clothes,” he says. “There’s no way to wash it out, all you can do is burn the clothes. Any flat that has been used as a krokodil cooking house is best forgotten about as a place to live. You’ll never get that smell out of the flat.”

Addicts in Tver say they never have any problems buying the key ingredient for krokodil – codeine pills, which are sold without prescription. “Once I was trying to buy four packs, and the woman told me they could only sell two to any one person,” recalls one, with a laugh. “So I bought two packs, then came back five minutes later and bought another two. Other than that, they never refuse to sell it to us, even though they know what we’re going to do with it.” The solution, to many, is obvious: ban the sale of codeine tablets, or at least make them prescription-only. But despite the authorities being aware of the problem for well over a year, nothing has been done.

President Dmitry Medvedev has called for websites which explain how to make krokodil to be closed down, but he has not ordered the banning of the pills. Last month, a spokesman for the ministry of health said that there were plans to make codeine-based tablets available only on prescription, but that it was impossible to introduce the measure quickly. Opponents claim lobbying by pharmaceutical companies has caused the inaction.

“A year ago we said that we need to introduce prescriptions,” says Mr Ivanov. “These tablets don’t cost much but the profit margins are high. Some pharmacies make up to 25 per cent of their profits from the sale of these tablets. It’s not in the interests of pharmaceutical companies or pharmacies themselves to stop this, so the government needs to use its power to regulate their sale.”

In addition to krokodil, there are reports of drug users injecting other artificial mixes, and the latest street drug is tropicamide. Used as eye drops by ophthalmologists to dilate the pupils during eye examinations, Dr Yegorov says patients have no trouble getting hold of capsules of it for about £2 per vial. Injected, the drug has severe psychiatric effects and brings on suicidal feelings.

“Addicts are being sold drugs by normal Russian women working in pharmacies, who know exactly what they’ll be used for,” said Yevgeny Roizman, an anti-drugs activist who was one of the first to talk publicly about the krokodil issue earlier this year. “Selling them to boys the same age as their own sons. Russians are killing Russians.”

Zhenya, quietly spoken and wearing dark glasses, agrees to tell his story while I sit in the back of his car in a lay-by on the outskirts of Tver. He managed to kick the habit, after spending weeks at a detox clinic ,experiencing horrendous withdrawal symptoms that included seizures, a 40-degree temperature and vomiting. He lost 14 teeth after his gums rotted away, and contracted hepatitis C.

But his fate is essentially a miraculous escape – after all, he’s still alive. Zhenya is from a small town outside Tver, and was a heroin addict for a decade before he moved onto krokodil a year ago. Of the ten friends he started injecting heroin with a decade ago, seven are dead.

Unlike heroin, where the hit can last for several hours, a krokodil high only lasts between 90 minutes and two hours, says Zhenya. Given that the “cooking” process takes at least half an hour, being a krokodil addict is basically a full-time job.

“I remember one day, we cooked for three days straight,” says one of Zhenya’s friends. “You don’t sleep much when you’re on krokodil, as you need to wake up every couple of hours for another hit. At the time we were cooking it at our place, and loads of people came round and pitched in. For three days we just kept on making it. By the end, we all staggered out yellow, exhausted and stinking of iodine.”

In Tver, most krokodil users inject the drug only when they run out of money for heroin. As soon as they earn or steal enough, they go back to heroin. In other more isolated regions of Russia, where heroin is more expensive and people are poorer, the problem is worse. People become full-time krokodil addicts, giving them a life expectancy of less than a year.

Zhenya says every single addict he knows in his town has moved from heroin to krokodil, because it’s cheaper and easier to get hold of. “You can feel how disgusting it is when you’re doing it,” he recalls. “You’re dreaming of heroin, of something that feels clean and not like poison. But you can’t afford it, so you keep doing the krokodil. Until you die.”

Some of the names in this story have been changed

Osteomyelitis

Note: To read the complete article and not this abstract, please click here

Big Name, Big Infection

After noticing an increase in the numbers of IV drug users who have been diagnosed with osteomyelitis, BP thought some investigation was needed as it appears to be an infection most of us know very little about, but which can have some extremely serious consequences if left untreated. Osteomyelitis is a serious bone infection which can occur in virtually any bone in the body although it usually crops up in the spine, foot or in long tubular bones such as those in the arm or leg, even fingers.

osteomyelitis – an extremely painful infection inside the bone, and one that can affect injectors.

While quite rare in many countries, there has recently been a rise in the numbers of intravenous drug users (IVDUs) becoming infected and this is particularly disturbing considering its often vague initial signs and symptoms which can mean diagnosis is often delayed. This, coupled with the problems IVDUs often encounter when accessing health care can mean that many users are suffering unnecessarily through late diagnosis.

This is a particular concern as some forms of the disease, such as vertebral (spinal) osteomyelitis can, if left untreated, lead to permanent paralysis, significant spinal deformity or even death. It can be an extremely painful infection of the bone and can take some time to heal so it is important for all of us to be aware of osteomyelitis and its symptoms so we know what to look out for. People with compromised immune systems such as cancer or HIV/AIDS, need also be very aware of this debilitating condition as it is often more likely to appear in people whose immune systems are not functioning well.

What is it?

Osteomyelitis is usually a secondary infection that follows an infection borne elsewhere in the body – perhaps caused by a wound, (such as an infected abscess), surgery, bone fracture, or a foreign body such as a surgical plate. IV line, urinary catheter or bullet. Once started, the infection can then spread to the bone via the blood and when the bone is infected, pus is produced within the bone. This can result in an abscess, depriving the bone of its blood supply. Early treatment can save the bone from destruction but as bone is hard tissue it is often resistant to antibodies and this can be difficult to treat.

Similar to infective endocarditis (BP issue 7 and BP’s A-Z of Health), osteomyelitis is usually caused by the same bacteria: Staphylococcus aureus (Staph. a). This bacterium can be introduced into the body in a variety of ways. Staph a. live intermittently on the skin in more than 70% of the population at any one time and the other 14 are colonized persistently. Those who use injecting equipment on a regular basis and inject in sites that are potentially Staph A colonized such as the feet, hands, groin etc can be at greater risk of attracting infection (see prevention). Again, this is why a hygienic injecting regime is essential for all IV users to help reduce as many factors as possible that could encourage an infection, (see overleaf & BP no. 7).

To read the rest of this important article on osteomyelitis and catch up on the symptoms, treatment, its relation to intravenous drug use and more, click here (from BP issue 8)

Staph Infection – a very interesting run down on an injectors worst enemy

bug for today: staphylococcus aureus

Staphylococcus aureus (Image by estherase via Flickr)

I found a very interesting article on Staphylococcus infection. There is floating bits of discussion about it in the harm reduction scene and many people (especially injectors) have heard of it. It is interesting for drug injectors as its an infection that turns up when we get abscesses, or endocarditis (infection in heart valve), or osteomyelitis (infection in bone) cellulitis (in skin) and blood poisoning. Here is an article that, in layman’s language, talks about staph, its life on the body and how it gets to play a role in so many infections. Definitely useful information to have if you either inject drugs or you work with injectors and/or harm reduction. Here’s an excerpt of the article and a link to the page…

“….Anyone can develop a Staph infection, although certain groups of people are at greater risk, including newborn infants, breast feeding women, and people with chronic conditions such as diabetes, cancer, vascular disease, and lung disease. Injecting drug users, those with skin injuries or disorders, intravenous catheters, surgical incisions, and those with a weakened immune system all have an increased risk of developing Staph infections.

Symptoms and Signs

Staphylococcal disease of the skin usually results in a localized collection of pus, known as an abscess, boil, or furuncle. The affected area may be red, swollen, and painful. Drainage or pus is common.

Skin infections are the most common type of disease produced by Staphylococcus. Staph infections of the skin can progress to impetigo (a crusting of the skin) or cellulitis (inflammation of the connective tissue under the skin, leading to swelling and redness of the area). In rare cases, a serious complication known as scalded skin syndrome can develop. In breastfeeding women, Staph can result in mastitis (inflammation of the breast) or in abscess of the breast.

Staphylococcal pneumonia predominantly affects people with underlying lung disease and can lead to abscess formation within the lungs.

Infection of the heart valves (endocarditis) can lead to heart failure. Spread of Staphylococci to the bones can result in severe inflammation of the bones known as osteomyelitis.

When Staph bacteria are present in the blood, a condition known as Staphylococcal sepsis (widespread infection of the bloodstream) or Staphylococcal bacteremia exists. Spread of the organisms to the bloodstream is known as bacteremia or sepsis. When Staph is in the blood (bacteremia or sepsis) it can cause high fevers, chills, and low blood pressure.Staphylococcal sepsis is a leading cause of shock and circulatory collapse, leading to death, in people with severe burns over large areas of the body. When untreated, Staph aureus sepsis carries a mortality (death) rate of over 80 percent.

Toxic shock syndrome is an illness caused by toxins secreted by Staph aureus bacteria growing under conditions in which there is little or no oxygen.

Staphylococcal infections should be contagious and can be transmitted from person to person. Pus from infected wounds may contain the bacteria, proper hygiene and handwashing is required when caring for Staph-infected wounds.

Are Staph infections contagious?

Staph skin infections are contagious. They can spread by:

* Skin to skin contact with infected person

* Sharing razors, towels, clothes, bed linens, sport equipment (athletes!), toys

* Walking barefoot or sitting around swimming pools

* Contact with infected pets

* Auto-infection by nose picking and skin scratching

* Sneezing – when droplets from the nose of infected person (or staph carrier) fall on an injured skin of another person

To read the rest of what is a useful article – and of which an excerpt, click here.

Endocarditis

Heart diagram with labels in English. Blue com...

Image via Wikipedia

BP takes a long hard look at INFECTIVE ENDOCARDITIS, a potentially life-threatening infection of the heart valve. Mainly caused by bacteria entering the skin through injecting, IE can be extremely unpleasant and has a nasty habit of ironing you out completely if left untreated. Know the signs & symptoms.

Although relatively uncommon in comparison to most health problems intravenous drug users encounter, it is extremely important for us to be aware of infective endocarditis (IE) for several reasons:

First of all, Infective Endocarditis has a high mortality rate, and almost always kills the patient if left untreated;

Secondly, it is often preventable. Knowledge of the symptoms of IE, early diagnosis and correct manage­ment are what makes all the difference to your recovery.

And thirdly, a hygienic injecting regime is crucial when avoiding the types of bacteria that cause endocarditis.

In most cases, these organisms are streptococci (“strep”), staphylococci (“staph”) or members of other species of bacteria that normally live on body surfaces, entering the bloodstream through a break in the skin, as happens through injecting,

What is it?

Explaining what endocarditis is requires a little translation of the name; endo- means inside, -card- refers to the heart (like ‘cardiac’) and the -itis bit signifies a process of inflammation. Combining all three gives you an inflammation of the inside of the heart, usually caused by an infection, but occasionally by a fungus.

To read the rest of the article (which appeared in Black Poppy Issue 8) click here

Clostridium

Remember the news that seems to pop up each year concerning contaminated heroin? Dozens of injecting drug users have died over the years from contaminated heroin containing the bactrium Clostridium. And while it is still reasonably rare – it DOES HAPPEN with reasonable regularity and we see no reason why such a bacteria would stop any time soon. There are things you can do to keep aware of it though. Be sure to check out info on Anthrax as well (being another emerging poison affecting injecting drug users – and it seems heroin smokers as well.)

If you are an intravenous or intramuscular injector – this concerns you.

The bacteria (Clostridium) has been present in a few batches of contaminated heroin over the last few years, which appeared to particularly affect people who either injected into the muscle, skin-popped, or who missed a vein when injecting. Tragically, around 35 drug users have died as a result so far.

Over the last 10 years, various outbreaks have occurred affecting drug users in Dublin, Glasgow and London as they began turning up in surgeries and hospitals, exhibiting very similar symptoms to each other. It was initially thought that the same batch of heroin had been ‘retrieved’, mixed with different gear to disguise the ‘look’ and put back out on the street for re-sale.

This was a Black Poppy leaflet, to read the rest, click here.

Abscesses; Sterile or Infected?

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

An abscess on the skin, showing the redness, swelling & characteristic blackish ring surrounding the head.

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 – For the remaining article, which appeared in Black Poppy issue 2, click here.

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