The physical health of people who inject drugs: complexities, challenges, and continuity

Patients using intravenous drugs have particular physical healthcare needs. 1 Drug-related death rates for patients using heroin and morphine have risen sharply recently.2 Nevertheless, drug overdoses are only one of many factors that contribute to the high mortality rate.Methadone or buprenorphine treatment reduces but does not eliminate the high mortality rate.Patients in this group also experience high morbidity rates.3 WHAT SPECIFIC PHYSICAL PROBLEMS DO GPS NEED TO BE AWARE OF? InfectionsO'Donnell and colleagues alert us to the high prevalence of skin and groin infections.Infections in this group are complex and wide ranging.Injecting manure and other materials used in heroin production produces predictable soft-tissue infections and abscesses, as well as the occasional exotic infection such as botulism, necrotising fasciitis, or tetanus.Other relatively more common but still serious infections include subacute bacterial endocarditis (SABE) and osteomyelitis, which may be difficult to diagnose, perhaps because it is not easy to think of the diagnoses in standard consultations.Infections not directly related to injecting, such as pneumonia, are also more common than the general population and likely to be caused by poor living conditions and poor nutrition.