District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA.
Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Am Fam Physician. 2019 Jan 15;99(2):109-116.
More than 750,000 persons in the United States inject opioids, methamphetamine, cocaine, or ketamine, and that number is increasing because of the current opioid epidemic. Persons who inject drugs (PWID) are at higher risk of infectious and noninfectious skin, pulmonary, cardiac, neurologic, and other causes of morbidity and mortality. Nonjudgmental inquiries about current drug use can uncover information about readiness for addiction treatment and identify modifiable risk factors for complications of injection drug use. All PWID should be screened for human immunodeficiency virus infection, latent tuberculosis, and hepatitis B and C, and receive vaccinations for hepatitis A and B, tetanus, and pneumonia if indicated. Pre-exposure prophylaxis for human immunodeficiency virus infection should also be offered. Naloxone should be prescribed to those at risk of opioid overdose. Skin and soft tissue infections are the most common medical complication in PWID and the top reason for hospitalization in these patients. Signs of systemic infection require hospitalization, blood cultures, and a comprehensive history and physical examination to determine the source of infection. PWID have a higher incidence of community-acquired pneumonia and are at risk of other pulmonary complications, including opioid-associated pulmonary edema, asthma, and foreign body granulomatosis. Infectious endocarditis is the most common cardiac complication associated with injection drug use and more often involves the right-sided heart valves, which may not present with heart murmurs or peripheral signs and symptoms, in PWID. Injections increase the risk of osteomyelitis, as well as subdural and epidural abscesses.
超过 75 万名美国人注射阿片类药物、冰毒、可卡因或氯胺酮，由于目前的阿片类药物流行，这个数字还在增加。注射毒品者（PWID）感染性和非感染性皮肤、肺部、心脏、神经和其他疾病以及死亡的风险更高。对当前吸毒情况的非评判性询问可以发现有关成瘾治疗准备情况的信息，并确定可改变的注射毒品使用并发症的风险因素。所有 PWID 都应筛查人类免疫缺陷病毒感染、潜伏性结核以及乙型和丙型肝炎，并根据需要接种甲型和乙型肝炎、破伤风和肺炎疫苗。还应向人类免疫缺陷病毒感染高危人群提供暴露前预防。应向有阿片类药物过量风险的人开具纳洛酮。皮肤和软组织感染是 PWID 最常见的医疗并发症，也是这些患者住院的主要原因。全身感染的迹象需要住院、血培养以及全面的病史和体检，以确定感染源。PWID 社区获得性肺炎的发病率较高，并且存在其他肺部并发症的风险，包括阿片类药物相关肺水肿、哮喘和异物肉芽肿。感染性心内膜炎是与注射毒品使用相关的最常见心脏并发症，并且更常涉及右心瓣膜，PWID 可能没有心脏杂音或外周体征和症状。注射增加骨髓炎以及硬膜下和硬膜外脓肿的风险。
