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Identifying A Heroin Needle: Dangers Of IM And IV Injections

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

Injecting heroin into a vein (intravenous injection), into a muscle (intramuscular injection), or under the skin (skin popping) can quickly lead to addiction and major medical problems, including severe infections.

Heroin Syringe (Needle) Dangers Of IM And IV Injections

Injecting heroin, which is also referred to as shooting up or slamming heroin, is a highly invasive way of using the drug. Heroin may be injected into a vein, into a muscle, or under the skin, all of which can cause addiction and dangerous complications such as illness, disease, or even death.

Unsafe and unsanitary injection practices are one of the biggest reasons why injection drug abuse transmits diseases and causes so many medical problems, such as major infection.

Heroin often contains additives that increase the risk of side effects and dangers of injection. This risk is especially high when a person shoots up or injects black tar heroin.

Black tar heroin frequently has impurities due to crude processing methods, including Clostridium bacteria spores from dirt that could lead to serious infections.

Many people who abuse heroin and develop an infection or medical problem will put off seeking help due to a sense of shame or for fear of going to jail. Doing so could result in long-term health problems and death, situations that may be avoided by seeking prompt medical help.

Heroin Abuse: How Heroin Is Injected

In order to understand the dangers of heroin injection, it’s important to be aware of the different ways that heroin can be injected, including:

  • intravenous injection (IV): An individual injects heroin into their vein. Frequent injection sites include the arm, groin, leg, and neck.
  • intramuscular injection (IM): A person injects heroin into their muscle, commonly into the buttocks. When abusing heroin this way a person may say they are going to muscle it or that they are muscling.
  • subcutaneous injection (SC): Heroin is injected directly beneath the skin. People who inject heroin commonly refers to this as skin popping.

Injecting heroin directly into the vein causes an intense and rapid high that can peak in seven to eight seconds. When heroin is injected into the muscle, the high is somewhat slower, taking five to eight minutes.

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Many people who inject heroin prefer IV heroin injection due to this faster and more immediate high. While any form of injection drug abuse is dangerous, IV heroin injection carries even greater risks, including a higher danger of overdose.

Heroin Injection And Infection

Heroin abuse of any form can weaken a person’s immune system and make it easier for an infection to take hold. It can also make it harder for the body to fight infection off.

When a person injects heroin in any way, they’re exposing their body to an even greater risk of infection. Bacteria, viruses, and even fungi can cause painful, severe, and/or life-threatening infections.

Dirty And Shared Heroin Needles And Infection

Improper cleaning and handling of needles and syringes can lead to infection. When a needle has bacteria or another pathogen on it, an injection can pass pathogens into a person’s body or bloodstream.

The following factors can increase the risk of infection from heroin injection:

  • dirty needles: Unclean or dirty needles can be bacteria breeding grounds. Failure to properly sanitize a heroin needle before injection can transmit infection. People who clean their needles with saliva can infect them with oral bacteria or pathogens that can also cause infection.
  • old needles: Needles dull over time and with repeated use. Dull needles can create more trauma and damage at the injection site, which can make it more vulnerable to infection. Using the same needle over and over again, as many people do, can increase the odds that harmful bacteria grow on the needle as well.
  • shared needles: Shared needles can transmit germs, such as bacteria, viruses, and transmissible diseases from one person to the next. Sharing cotton and water for injecting can also transmit blood-borne illnesses.

Heroin Injection: Risk Factors For Infection

In addition to risks carried by needles and other heroin injection equipment, the way a person injects heroin can make them more vulnerable to infection or disease.

Being aware of the risk factors can help a person to avoid them, so that they’re better protected against the dangers they cause.

The following circumstances can act as risk factors for infection:

  • skin bacteria: Harmful bacteria on the skin may enter a person’s body or bloodstream through the injection site, leading to infection.
  • an unclean injection site: Failing to clean the injection site properly or licking the skin to clean the site can increase the risk of infection-causing bacteria or other microorganisms entering the injection site. Cleaning the skin prior to injection, such as with alcohol wipes, can reduce the threat of infection.
  • injecting into a wound: When overcome by intense cravings, some people may inject into an open wound. This could carry bacteria into the body and cause further harm to a wound that is already battling an infection.
  • changing the route of injection due to damaged veins: People who are struggling to inject heroin into their veins due to scarring or collapsed veins may switch to intramuscular injection or skin popping.

Infections Caused By Injecting Heroin

From abscesses to HIV and infections of the heart, many infections caused by injection heroin abuse lead to hospitalizations and long-term health problems. A good number of them are medical emergencies that could cause death without prompt medical treatment.

While all ways of injecting heroin can lead to infection, certain routes may expose a person to certain types of infection more than others.

One scientific review found that people who skin-pop have a five times greater risk of developing an abscess or cellulitis, both painful and potentially dangerous infections. Intramuscular injections may also place a person at a greater risk of developing an abscess.

In addition to tetanus, ulcers, and methicillin-resistant Staphylococcus aureus (MRSA), the following infections can be caused by injecting heroin:

Injection Heroin Abuse And Abscesses

People who inject drugs intravenously, intramuscularly, or who skin pop may develop soft tissue abscesses. An abscess is when pus and infected material collects in a pocket around invading germs or another source of infection.

An abscess from heroin may be cutaneous and occur in the skin or subcutaneous and develop just beneath the skin. Abscesses are red, raised and painful.

When untreated, an abscess from skin-popping, IM, or IV heroin abuse can result in serious and even life-threatening complications, including amputations, sepsis, and death. Abscess scars may also lead to ulcers.

Injection Heroin Abuse And Cellulitis

Cellulitis is a skin and soft tissue infection that is caused by bacteria that enter the body when a person injects heroin or another drug. In addition to IM and IV drug use, skin popping can cause cellulitis.

Symptoms of cellulitis typically emerge in two to five days after the bacteria has been introduced to a person’s body. When a person has cellulitis their the skin will be red, swollen, and often warm. Cellulitis can be extremely painful.

Additional signs of cellulitis include:

  • blisters
  • dimpled skin
  • fever
  • red spots
  • tenderness

Without the proper treatments, an infection may spread into a person’s bloodstream and lymph nodes and become deadly.

Though rare, this infection may move deep into a person’s tissue and cause a deep-layer infection called necrotizing fasciitis. Often referred to as the flesh-eating disease, necrotizing fasciitis from injecting heroin is a serious medical emergency that can quickly cause death if not treated.

Intravenous (IV) Heroin Abuse And Endocarditis

Endocarditis is a potentially life-threatening infection of the heart that essentially devours the heart muscle. Endocarditis causes the endocardium or the heart’s inner lining and valves to become infected.

Endocarditis occurs when bacteria, including those commonly found in the body and mouth, make their way into the bloodstream. Injecting heroin into the vein can introduce these harmful bacteria into a person’s blood.

In the beginning, endocarditis may appear like the flu, however, symptoms can worsen and may result in death. Without treatment, endocarditis from heroin injection can damage or destroy the valves of a person’s heart.

Injection Heroin Abuse And HIV/AIDS, Hepatitis, And Other Blood Borne Illness

People who inject heroin have an increased risk of contracting HIV/AIDS, hepatitis B and C, and other blood-borne viruses. While unsafe sexual practices that often accompany heroin abuse could lead to these illnesses, shooting up heroin can make this risk much higher.

People who share needles, syringes, or other injection paraphernalia can be exposed to these bloodborne illnesses. HIV/AIDS and hepatitis B and C from dirty heroin needles can be life-threatening.

People who damage more minor veins due to frequent injecting may begin to inject in the larger jugular and femoral veins. It’s believed that this could increase the risk of HIV and hepatitis C.

Though somewhat rare, a person may also get human T-cell lymphotropic virus (HTLV). This bloodborne retrovirus could cause a fatal type of leukemia, neurologic disorders, or chronic pulmonary infections.

Injection Heroin Abuse And Organ Damage

Heroin is often cut or laced with additives. When heroin is injected into the vein, these additives can travel throughout the bloodstream and body and clog vital blood vessels leading to the brain, kidneys, liver, or lungs. If this happens, cell death or infection can happen in these vital organs.

Sepsis And Heroin Injection Drug Abuse

Sepsis from IV drug abuse is a medical emergency that could lead to dangerous blood clots, endocarditis, gangrene, septic shock, major organ damage and failure, and death. Sepsis, also referred to as septicemia, is blood poisoning from bacteria, however, fungi and viruses from dirty needles can also cause it.

Sepsis occurs when a major infection or an infection throughout the whole body has spread through a person’s blood. When a person’s body responds to this infection by releasing certain chemicals, this chemical change can cause great damage throughout the body.

The following infections caused by skin popping, IV injection, or IM injection may lead to sepsis:

  • abscesses
  • cellulitis
  • necrotizing fasciitis

Sharing needles can increase the danger of infection and sepsis, however, people who don’t share needles are also at risk.

Heroin Injection And Wound Botulism

Injecting heroin can cause wound botulism, a serious and life-threatening illness caused by Clostridium botulinum. People who skin pop or abuse heroin through an IM injection may have an increased risk of wound botulism. This risk can be even higher for people who inject black tar heroin.

Wound botulism releases a nerve-attacking toxin into the body that can cause muscle weakness, paralysis, and death. While wound botulism can be treated, recovery may involve a long-term hospital stay of several weeks to months.

Additional Health Risks And Dangers Of Injecting Heroin

In addition to infection, injecting heroin can also cause physical and mental health problems, illness, and disease, such as:

Heroin Needle Injection: Collapsed Veins, Scarring, And Track Marks From Heroin Abuse

Repeated intravenous heroin abuse can cause massive damage to the veins. Chronic heroin abuse can lead to collapsed veins, scarring (venous sclerosis), and heroin needle track marks. People who skin pop may have multiple, round, depressed scars on their arms, legs, and other areas of their body.

Further, if a person damages a vein below their waist they could have circulation problems.

Some of these conditions may be long-lasting and permanent. In the case of heroin needle marks like scarring and track marks, this damage could forever mark a person as someone who injected drugs in the past.

Intravenous (IV) Heroin Abuse, Blood Clots, And Deep Vein Thrombosis (DVT)

People who inject heroin into the femoral vein or other deep veins in the leg may develop blood clots, a condition called deep vein thrombosis (DVT). These blood clots could be carried to a person’s lungs if they’re too large and/or if they detach from the walls of the vein.

If this happens, a person could have a heart attack or pulmonary embolism. Complications from deep vein thrombosis from IV heroin injection can also be deadly. Signs of a DVT include pain, redness, swelling, and warmth in the leg.

Intravenous (IV) Heroin Abuse And Cotton Fever

Cotton fever can set in in a matter of minutes after a person injects heroin. Cotton fever is a flu-like illness that can cause abdominal pain, chills, fever, headache, muscle aches, nausea and vomiting, and shortness of breath.

Symptoms can begin in as little as 15 to 30 minutes and typically go away within six to 12 hours after they’ve begun, however, some people may feel sick for one to two days.
When preparing heroin for injection, cigarette filters or cotton balls are commonly used to filter or strain the drug before it’s placed in a syringe.

When overwhelmed by severe cravings, some people may attempt to extract heroin from used cotton balls, a practice called “shooting the cottons.” Using cotton balls in these ways is associated with cotton fever.

Other Heroin Abuse Risks And Dangers

Certain risks accompany heroin abuse no matter how the drug is abused.

In addition to causing great damage to a person’s job, family life, relationships, or schooling, injecting heroin could cause the following health and medical problems:

  • antisocial personality disorder
  • depression
  • irregular menstrual cycles in women
  • painful withdrawal
  • pneumonia
  • overdose
  • sexual dysfunction in men
  • structural changes in the brain
  • tuberculosis

Women who inject heroin while pregnant may expose their developing child to risks and dangers, including birth defects, premature birth, stillbirth, and neonatal abstinence syndrome (NAS), a condition where the newborn baby is also dependent on heroin.

Getting Help: Finding A Heroin Drug Rehab Program

By getting help and enrolling in a heroin drug rehab program, a person is better protected from these risks.

People with severe infections or medical problems may require intensive medical care at a hospital before they can progress to detox and rehab.

Heroin addiction is one of the most severe, and for this reason, an inpatient drug rehab program is often recommended. Inpatient, or residential treatment as it’s also called, often begins with a medical detox program.

A medically-supervised detox program for heroin addiction uses medications, such as Suboxone and other buprenorphine-based medications, to help wean a person off of heroin. These medications also reduce cravings and uncomfortable symptoms of withdrawal.

When a person enters an inpatient detox program, they should have 24-hour support and access to medical care. This treatment can be critical for people who have certain complications or health problems from injecting heroin.

For the highest chance of success, it’s typically recommended that a person moves to a rehab program for heroin once they’re stabilized.

An addiction treatment program for heroin teaches valuable coping and relapse prevention skills that could help a person stay healthy and maintain a drug-free life.

Contact Addiction Campuses today for more information on the dangers of injecting heroin and heroin treatment options.

Centers for Disease Control and Prevention - https://www.cdc.gov/botulism/wound-botulism.html

Center for Substance Abuse Research - http://www.cesar.umd.edu/cesar/drugs/heroin.asp

Cleveland Clinic - https://health.clevelandclinic.org/endocarditis-how-one-patient-beat-this-deadly-disease/

Johns Hopkins Medicine - https://www.hopkinsmedicine.org/health/conditions-and-diseases/septicemia

Journal of Clinical & Experimental Dermatology Research - https://www.longdom.org/open-access/dermatologic-signs-and-symptoms-of-substance-abuse-2155-9554-1000337.pdf

Journal of the American Board of Family Medicine - https://www.jabfm.org/content/29/2/276.full

Longdom Publishing - https://www.longdom.org/open-access/dermatologic-signs-and-symptoms-of-substance-abuse-2155-9554-1000337.pdf

Mayo Clinic - https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557

MedlinePlus - https://medlineplus.gov/ency/article/002861.htm

Medscape - https://emedicine.medscape.com/article/219285-overview

Merck Manual Consumer Version - https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/endocarditis/infective-endocarditis

National Institute of General Medical Sciences - https://www.nigms.nih.gov/education/Documents/Sepsis.pdf

National Institute on Drug Abuse - https://www.drugabuse.gov/publications/research-reports/heroin/overview

Nursing Times - https://www.nursingtimes.net/clinical-archive/substance-misuse/what-are-the-risk-factors-for-soft-tissue-abscess-development-among-injecting-drug-users/5015899.article

Springer Link - https://link.springer.com/article/10.1007/s11606-015-3424-1

United Nations Office on Drugs and Crime - http://www.unodc.org/documents/southasia/publications/sops/abcess-prevention-and-management-among-injecting-drug-users.pdf

US National Library of Medicine - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070054/

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC
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