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An Introductory Guide for Assessing and Understanding Common Wounds with People who Inject Drugs

Posted 8/18/2020 (updated 9/2/2021)

This guide was created for harm reduction medical staff and volunteers as a resource about the types of wounds common with injection drug use and also to increase knowledge about treatment modalities for this population. Skin and soft-tissue infections are the most common cause of hospitalization among people who inject drugs. One study reported that 32% of active injection drug users had a current soft-tissue infection, and this number is most likely higher in areas where tar heroin is prevalent. Effectively treating skin and soft-tissue infections is an imperative component of harm reduction, as these infections can lead to catastrophic conditions such as sepsis and endocarditis and can also negatively impact injection drug users’ social and employment status.

Due to concerns about finances, lack of health insurance, and stigmatization by health care providers, people who inject drugs typically seek professional medical care as a last resort. A study done in Washington DC in 2009 noted that 81% of those who inject drugs have reported having had an injection-related wound, and that 93.9% of them reported self-management of wounds, including such potentially dangerous practices as self-incision and drainage and the use of non-prescribed antibiotics. Though self-management of wounds among injection drug users presents dangers, it is also potentially an advantage, as this community shows a strong history of resilience and self-care. With this background of self reliance, given the right tools and information, people who inject drugs may be able to safely and effectively prevent minor infections from becoming catastrophic. This guide was created as a starting point for assessing, educating, triaging, and providing care in harm reduction settings.