Section 2
Injuries and Illnesses
Injuries, illnesses, and general wound management are important topics because of how many risk factors exist for people using drugs and/or living in conditions which may affect their capacity to self-manage. There are many chronic and acute injuries that are recognized as harms associated with drug use; we can’t cover all the topics available, but can give an overview of examples, with tips on how our programs can support people through them.
Note that this is not a guide on how to diagnose illness or injury– however, this information can help inform the care and services we offer.
Injury and Illness Types
Acute Injury
A treatable condition such as an open sore, cut, scrape, bruise, or break. Acute injuries can be more likely when people have damaged skin due to sun or rain exposure, lowered immune systems, or previous injuries. Acute injuries are likely to lead to infection if hygiene supplies and regular cleaning aren’t accessible.
Chronic Condition
A bodily response to bacteria, fungus, or viruses where the body attempts to cleanse itself. Our bodies are able to clear some infections on their own (depending on the person’s health), while others require treatments such as antibiotics or other medications. Infections are most commonly either communicable diseases like the flu or common cold, or localized infections of a wound where bacteria enters open skin.
Infection
An ongoing, and sometimes lifelong, illness that affects a person. This includes conditions which are treatable such as Hepatitis C, or conditions which are lifelong such as HIV or diabetes. There are a wide variety of reasons people develop chronic conditions, but general environmental and lifestyle factors are some of the primary preventable factors for chronic conditions.
Considerations
Factors of Wound Management
The cleanliness of the environment, hands, and skin around the infection site keep infection from worsening. When people are sleeping outside without a place to wash, how can they keep their hands or wound clean?
Part of wound care is irrigating with clean drinking water at least once or twice daily, making sure any debris and pus is cleansed. How can people wash a wound if they can’t find clean drinking water?
Dressing for an infected wound needs to be removed and replaced with fresh gauze once or twice a day. How can people keep dressing fresh if they can’t afford or find fresh gauze?
How These factors Fit In
People’s daily living conditions greatly affect their body’s capacity to heal and prevent injury and illness
Street-based drugs, and re-using or sharing supplies, greatly increase the risk and potential for injury or infection
We want our community to live healthy, full lives; knowing the risks helps us develop programming options that can support our people more holistically. Someone who feels cared for is more likely to return, to access other services, to be involved in culture, and to find community!
Common Acute Injuries
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Exposure to any element for a prolonged time can lead to injury, and especially so when people are living outdoors or in an exposed environment without access to shelter. Common injuries include sunburn, hypothermia, heat exhaustion, heat stroke, frostbite, or nonfreezing cold injuries. All of these are preventable with access to either shade or warm environment, clean/dry clothes, and areas for rest. Any change to a person’s consciousness, any pain, strong dizziness or loss of coordination, and any major skin changes are potentially life-threatening injuries which need prompt treatment.
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Also common in underresourced, outdoor environments are burns, cuts, and scrapes. Because people’s immune systems and general health is undersupported, their skin can become more fragile or susceptible to injury. Additionally, if people are using torch lighters, or working with broken equipment such as pipes, there are risks of injury with using these items. Burns on lips for people who smoke through pipes, injuries related to impairment (ie. increased fall risk) Injection drug use is essentially opening many small injuries– each injection site is a small wound.
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Not getting enough water or electrolytes can severely deplete a person’s ability to function. Dehydration can become a serious or potentially fatal illness very quickly. When people aren’t able to get adequate food to replenish their electrolytes, when people are producing a lot of sweat either from heat or movement, and people not having access to drinking water are all factors that can lead to dehydration. Making sure people can get electrolyte packets and fresh water are excellent ways to prevent or reverse dehydration before it becomes a more severe situation.
Common Infections
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An abscess is essentially a localized pocket of pus. In this work, an abscess is likely to be related to an infection at an injection site, caused by either contaminated injection equipment or bacteria introduced during or after injection. Abscesses range widely in size. Any suspected abscess should be treated by a medical professional including antibiotics treatment. Supportive care for abscess recovery may include a warm compress, such as a well-insulated heating pad, and regularly-changed wound dressing.
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Cellulitis is a bacterial infection that usually affects the lower legs. Cellulitis can be caused by staph, strep, or other bacteria entering a wound. Cellulitis causes swelling that may look similar to edema, but is usually also red, tender, and hot. Suspected cellulitis should be treated by a medical professional including antibiotics treatment. Support during cellulitis recovery may include elevation of the legs, warm or cool compresses, regular cleaning of the infection area, and pain management.
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A “missed shot” is when someone unintentionally injects drugs into the wrong tissue layer. For example, if someone is attempting to inject intravenously and accidentally injects into their muscle or subcutaneous tissue, it can cause a lump at the area, pain, and soreness. While technically not an infection, missed shots are at high risk of developing into an infection.
Chronic Conditions
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Hepatitis C virus, or HCV, is a viral infection which affects the liver and causes organ inflammation. Hepatitis C is spread through blood-to-blood contact with someone who carries the virus. HCV is treatable, and early treatment prevents some of the more severe harms of long-term liver inflammation. There are a lot of ways HCV is contracted, but sharing injection equipment is a major risk factor for community members who inject drugs. Any suspected case of HCV should be treated by a medical professional. Care for people undergoing HCV treatment can include lots of fluids, rest, liver-friendly foods, and emotional support during the process.
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Chronic Venous Insufficiency (CVI) happens when the veins of the leg can’t return blood to the heart, or can’t properly circulate blood to the area. There are many reasons why CVI might develop, but collapsed veins from frequent injection is one cause affecting our relatives who use drugs. Symptoms of CVI include varicose veins, swelling, heaviness, changes to skin color or texture, and non-healing sores. CVI should be treated by a medical professional to prevent advanced injury or related infection. Care for people navigating CVI includes elevation and compression socks under professional guidance.
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Chronic Kidney Disease (CKD) is a condition of chronically damaged kidneys. This is commonly associated with diabetes and hypertension, though drug and alcohol use can contribute to development of CKD. As with HCV, conditions affecting an organ can cause serious and quickly life-threatening damage to the body’s functions. CKD has a wide range of symptoms, but any suspected CKD or those who may be at risk with co-morbid conditions (diabetes or hypertension) should be seen by a medical professional. Comfort for people navigating CKD include emotional care, support with a kidney-friendly diet, and rest.
Wound Care Concepts
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The general principles of wound care include keeping up with fresh dressing that is appropriate for how wet or dry the wound is, protecting the wound from additional damage, and frequent cleaning. For dressing, some wounds like small burns can get very dry and need moist dressing, while other wounds that ooze or have a lot of pus can become too wet for healing and need to be dressed with heavily-absorbent materials. Medical providers will be able to review wounds and see what kind of materials are most appropriate, but for people to self-manage it would be helpful to have access to dressing.
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Infection management looks similar to general wound care, but includes tracking changes to the wounds, care for people or may include medications and regular appointments. Infection management means observing the local wound site for any changes, and observing the person’s general physical health. Medical providers will explain what symptoms or signs to look for which could signal an emergency, which may include fever, worsening pain, spreading inflammation, and red/dark streaks on the skin. Having a medical professional available to support with infection management can be a life-saving resource for people dealing with infection risk.
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Belongings are often stolen or lost to the elements and can’t be refilled early, while appointments can mean either having to leave pets or items behind, or having to carry all of their belongings on the bus or foot. On-site safekeeping for medications such as medication lockers, bringing medication on a regular basis to encampments, and transportation support or bringing providers to an encampment can support people in these processes.