This was a fascinating workshop. It was the first time I had seen a group of presentations focussing on injecting related infections - not because I'd not attended such a thing before - it is more like there has rarely been such a workshop before. Two issues in particular I wanted to flag up here for any injectors or health professionals reading:
Don't lick the fruit!
Risk factors of systemic candidosis among intravenous drug users.
One study was on systemic candida infections in IDU's. Candida is a fungal infection, often attacking when the immune system is low (such as with those with HIV), mostly treated with anti fungal drugs but has the ability to cause some really awful systemic problems. Infecting various areas in the body such as the oesophegeus (sic) heart, bladder, eyes and many other areas, candidosis is primarily preventable using some simple harm reduction tips. Firstly one needs to know that candidosis is a fungus that occurs in lemons - the lemons some of us need to use to mix up our heroin. However, although there are many HR messages that say don't use lemon juice when trying to dissolve gear, the problems seem to come more from people licking the lemon after squeezing it into their gear, then, going on to bite off a piece of filter with their teeth. The candidosis is transmitted more effectively this way - increasing your chance of picking up this infection by 3.8%. Dirty hits were also thought to be a predisposing factor to contracting candidosis, although there was no research into what a 'dirty hit' actually was. The other area that spread candidosis to IDU's was from - yep - licking your spike before a hit, a habit I hope is on the decrease as we have more germs in our mouths than our arse...Or so I read somewhere! Interesting stuff. Look on the IHRA website for the session as titled above (session was as titled above, on monday, 2-3.30). So if you must use lemon, and it isn't advisable at all if you can possibly help it, dont lick it after you cut it open to then squeeze it into you spoon/gear. Don't lick your spike or needle end before injecting, especially if lemons were involved, and - stay tuned to the BP site as we will put up some info on signs of candidosis and things to watch out for, ways its treated and HR methods to avoid it happening to you.
And How We Weep... Wound and leg ulcer management for injecting IDU's by Marie White from Rochdale CDT, UK.
This was an excellent presentation, and the whole room was deeply interested. No doubt because again there is very very rarely, if ever, any information on leg ulcers as they present in IV drug users. There was a lot in this presentation and something we at BP are determined to red flag upon our return to Britain. Ulcers, particularly leg ulcers affect IV users big time, especcially those who are a little older - saying that I have seen them in users in their 20's. Primarily they occur when damage to the backflow valves in the legs, prevent the blood flowing back up the body to the heart. Once damage to these valves is done, it is not repairable and a pooling of blood and waste products spread out along the leg. Often appearing as a discoloured area or sensitve, coloured patch, they can burst into a ulcer from either being used as an injection site, or appearing years later, after injecting has stopped. But what was abundantly clear was that needle exchanges must have nurses who can carry out wound management, offer compression stockings, and preferably do home visits to those unable to come in to the clinic. All to often injectors might not have access to the right health interventions ulcers need (lack of experience at A&E depts, unable to return for further investigations,) or wont go to their GP for fear of losing their injectable prescriptions, being discovered they are injecting when they are not 'supposed' to be, being embarrassed at the site their ulcers have become, parlyzed as to how to deal with it, or they may even continue on trying to treat it themselves. The financial implications were also very clear. The cost of sending someone to an A&E dept far outweighed the cost of treating them at an NEP. And to not treat a leg ulcer? Well, what are the financial, social and psycological costs of someone losing their leg? The fact is IF YOU ARE NOT TREATING THE UNDERLYING PHYSIOLOGY (the venous circulation) LEG ULCERS WILL NOT HEAL ON THEIR OWN. One case study showed a woman who had been self treating her ulcer for 10 years. Her ulcer has opened 10 years previously and had never healed properly and was now, when she presented at the NEP (Rochdale CDT) it was a very large, open, weeping and very painful wound. She was using more street heroin and other drugs in order to self medicate for pain (we know how hard legal pain relief is to get for IVDU's) and eventually stopped attending even the NEP because she couldn't walk up the hill. We can see here the knock on effects of not treating these wounds in an anonymous, confidential manner - people can even stop going out of their house and the next stop could be losing their leg altogether.) Soon though, the terrific Marie (who presented this excellent presentation) managed to get to see her for home visists and with 14 weeks the ulcer had decreased dramatically in size and was substatially improved. There were many issues and interesting HR factors that popped up here and I would really recommend anyone with a connection with healthcare for users - get in touch with marie for more information. The UK organisation Exchange Supplies (www.exchangesupplies.org.uk) will be holding training in wound management in Glasgow in Dec 2007. Mite be worth chatting to them too or certainly attending their training day - which is open to users as well as health professionals might I add.
And there was more - much more that went on today...However my eyelids are starting to shift to red horizontal and a cuppa tea calls me to relax before a deep, sound sleep. Maybe I mite check out a bit ofpolish telly - I caught some this morning as I was waking up and I just could NOT get over the amount of pharmaceutical drug adverts! Every second ad was for constipation, hayfever, Irritable bowel syndrome, etc etc etc! What's the stoy there I wonder? Adios, till tomoorw when I hope to bring you snippets from a truely fascinating interview with the executive director of LEAP - Law Enforcement Against Prohibition. Jack Cole is the most amazingly lovely and committed man who speaks the most sense you may ever hear all year... Stay tuned. G'nite from Warsaw.
