Medical Complications of

Drug Taking
Amjad Hussain
Lecturer (Pharmacy Practice)
University College of Pharmacy
University of the Punjab, Lahore.
Introduction
Illicit drug use is associated with a
multitude of serious adverse health,
social and economic consequences.
Can be categorized as
1. Health outcomes
2. Specific health outcomes
3. Social sequelae.

Health outcomes
Mortality rate; Studies revealed that MR among injecting
drug users is about 13 times greater than same age sex of non
users. Once HIV enters drug injecting population, HIV related
complication dominates & mortality rate increases.
Morbidity; injecting drug use is also associated with
considerable morbidity, most of which indirectly related to drug
injecting. This is because drug use
1. Is accompanied by hazardous consumption of legal & illegal
drugs (alcohol, BDZ, cocaine, cannabis, amphetamine etc)
2. Is associated with low socio-economic status, inadequate &
irregular diet, limited education, unemployment etc.
3. Poorer outcome bc of limited access to medical care.
Morbidity is more difficult to measure, hospital bed occupency is
main accepted marker for measuring morbidity.
Specific Health outcomes
(Medical Conditions Arising from Drug use)
Overdose; is the major cause of death
in injecting drug users, and second to AIDS
in HIV prevalent countries.
Types (intentional, as to no way out or
mainly unintentional due to low margin of
safety & poly pharmacy of CNS drugs)
Heroin + other depressants (alcohol, BDZ)
most common overdose.
Conti
Loss of tolerance to Opioid & relapse
to heroin injecting is very risky.
Typical symptoms of opiate overdose
include pinpoint pupil un reactive to
light, shallow respiration, low pulse
rate, hypotension, unconsciousness.
Naloxone, a parenteral short acting
Opioid antagonist is very effective for
overdose.

Causes of overdose
1. Drug interactions Psychoactive drugs, such as
opiates and stimulants, have a number of drug
interactions. These drugs may interact in a number of
ways, for example CNS depressants (e.g. alcohol,
benzodiazepines and TCAs) may increase sedation in
those on opiates and decrease respiration, increasing the
risk of overdose.
2. Poly-drug use Many injecting drug users
will be using more than one drug. There may be
additional complications associated with the
combined adverse effects of using the drugs.
Conti(Medical conditions)
Hepatitis & AIDS hepatitis B & C
due to stick injury, & AIDS, hepatitis B
also by sexual contact.
Drug user have 9 fold greater risk of
hepatitis A, it spread through faeco-
oral & common in drug users because
of poor standards of hygiene).

Conti
Sexually transmissible infections
and Gynae problems; AIDS, gonorrhea,
others, pelvic inflammatory disease, menstrual irregularities
are common among drug users. opioid users frequently
suffer from loss of libido,
Other infections; Tetanus, botulism is common
in drug user who inject SC with non sterile equipment, where
microbes find anaerobic environment.
Distal bacterial infection can result in septicemia,
endocarditis, lung, brain and joint abscesses.
Conti
Fungal infections; A.endophthalamitis is linked with
lemon juice containers used to acidify heroin.
Tuberculosis; common in HIV infected injecting drug
users.
Parasitic infections; malarial outbreaks are linked
with sharing of needles.
Cardiovascular complications; tachycardia,
vasoconstriction, rise in BP observed in users of CNS
stimulants & in CNS depressant withdrawal
Respiratory complications; all CNS drugs
cause respiratory depression which in overdoses life
threatening, cough suppressant
Conti
Dental Problems; Accelerated dental decay is
common among drug injectors. This is because of poor oral
hygiene, decreased salivary flow by Opioids.
Mental illness; Anti- social personality disorder
and affective disorder are extremely common among drug
users.
visual disturbances, impairment of cognition & psychomotor
function,
interference with short term memory that is necessary for
work performance
Amphetamine and cocaine used is linked with acute
paranoid psychosis.

Medical hazards of injecting
Abscess (sterile or cold abscess; when
vein is missed and infected or hot abscess
from using non sterile techniques)
Thrombophelibitis (bc of some irritant
excipient, veins of arms, legs are
commonly used; jugular vein & dorsal vein
of penis also used)
Gangrene (if barbiturates are injected into
femoral artery, amputation)
Septicemia (serious illness occur in drug
user who inject using non- sterile
techniques)
Conti
collapsed veins because of repeated use of same
vein, inappropriate injecting techniques.
Deep vein thrombosis by injecting in femoral vein.
Emboli because of unfiltered particles being injected.
Cellulitis bacterial infection of skin and soft tissue at
injecting site is very common which may develop to necrotic
ulcers.
Effect on immunity. (humoral immunity is
stimulated in heroin user)
Vitamin & other nutritional deficiencies
(most common among drug users)

Risks associated with non injecting
route of administration
Intranasal: Nose bleeds, ulceration, rhinitis, septal
perforation, risk of transmission of hepatitis C if equipment is
shared
Inhalation: Asphyxiation, aspiration, peri-oral
dermatitis
Smoking: Respiratory infection, cough, cancer,
accidental, burns, chronic lung disease
Oral. Gastric irritation
Health problems associated with
opiates

Respiratory: Opiates suppress the cough reflex,
leading to increased risk of aspiration and
bacterial infection. They also depress the
respiratory centre which is the main cause of
death.
Gastrointestinal: Nausea, vomiting and
constipation are all side effects of opiate use.
Cardiac: Right sided infectiontricuspid
endocarditishas been linked to injection of
opiate (and other) drugs.
Others Methadone suppresses saliva production. This
coupled with lifestyle factors such as poor diet can lead to
dental problems.

Health problems associated with
stimulants (cocaine and amphetamine)

Cardiac: Stimulants activate sympathetic
autonomic activity resulting in increased BP &
force of myocardial contraction (and
vasoconstriction with cocaine) so demand on the
heart is increased, These drugs may also cause
arrhythmias, and may precipitate tachycardia and
MI.

Neurological: Due to raised blood pressure, headaches, strokes
and cerebral bleeds may occur. Amphetamine can also induce a
psychotic state in some users.
Respiratory: Cough, airway burns, problems with nasal septum,
sinus infections, shortness of breath possible worsening of asthma.

Social sequelae
Including unemployment, accidents,
violence, crime, poor living conditions
are discussed under harms related to
drug use and dependence.
Other forms of drug misuse
No drug need
Wrong drug
ineffective drug
unsafe drug
Under use of available effective drugs
Under use of ORS in diarrhea of children
Incorrect use of drugs
Unlicensed drug prescribing
References
Pharmacy Practice by Kevin Taylor
Management of drug users in
community edited by Roy Robertson.
Drug Misuse, a Practical Handbook
for GPs, by Banks and T.A.N Waller