ABSCESSES -

Identification, Treatment and Prevention

Abscesses are something most of us have encountered before and they can be excruciatingly painful. Sympathetic medical care can be hard to come by for many of us and so some people resort to treating themselves. This can lead to some serious complications as the toxicity of an abscess can vary considerably. Here are a few things to remember when it comes to getting to grips with an abscess....

Abscesses present themselves as raised lumps on the skin and can either be sterile or infected.

A sterile abscess is caused by injecting either an irritating or insoluble substance into a vein - particularly so if you miss it. They may develop slowly and not usually show signs of heat although there may be a touch of redness. They feel like solid nodules under the skin and are not sore to the touch. Don't try to squeeze it as it will usually go away in its own time ( although this can take quite a while.)

An infected abscess, on the other hand, is a different story. Caused by either using non-sterile injecting equipment or by bacteria entering through your hit that the body cannot fight, an infected abscess will soon come up as a swollen lump on or near the injection site. Appearing inflamed and red, they feel hot to the touch and soon become very painful. The abscess may come to a 'head' or 'point' and be filled with pus. It can be tempting to squeeze or burst it now - but DON'T! This will only spread the infection..

If you want to know what inside your abscess - here's a little insight. The abscess is actually a cavity under the skin, filled with many little 'walls' that contain the pus. The pus itself contains blood, white blood cells (for fighting infection), damaged or dead tissue and bacteria. Some of this bacteria can still be 'live' which is why squeezing, poking about etc, can easily spread the infection. Your body has made this cavity in an attempt to localise the infection so it won't spread. An infected abscess won't go away on it's own, you really need to seek medical treatment
 

TREATMENT

In the early stages you may be given antibiotics to clear it up. Or if necessary, if a head has developed on the abscess, a doctor will lance it and drain out the pus. The resulting hole should be thoroughly cleaned out, using prescription only agents and then packed. This is done so the wound will heal from the bottom up, otherwise the skin will just close over the top, leaving bacteria inside and the whole thing will start over again. Antibiotics would also be given.

Try and find a sympathetic doctor, go to A&E , or try a recommended needle exchange ( It will be kept confidential and some places can help with wound dressings, teaching you how to do them yourself at home.) The fear of going to your drug treatment clinic with an abscess, or to A&E, because of the effect it could have on your methadone script being changed, is unfortunately a real one. But you must get advice and treatment - no matter what- because if left untreated, an abscess can lead to septicaemia (blood poisoning), which can be fatal, cellulitis ( a very painful infection of the surrounding tissue) and other complications. All this will put extra pressure on your immune system - not what you want if you are HIV or Hep C positive. Really, you don't have to end up with huge circular scars on your body.

As the 'drugs war' rages on, the ricocheting effects continue to reverberate around the drug using community. Abscesses have become our battle scars. If you are concerned about your scars there are camouflage creams available to conceal them - you can ask for a referral from a doctor to a clinic that will guide you in their use or come into The Caravan, where you can also receive a referral - and help with the creams application.

Tips on preventing an abscess

• Use new equipment - sterile water, works, swabs etc. Wash your hands before and after your fix- try and make this a habit. ( Actually, there is some debate about using swabs- check out the pull out guide ).
• Try and use only surgical cotton wool because it is made up of fibres that won't separate - unlike cotton wool, cigarette filters, tissue etc. Not only can loose fibres from these get trapped under the skin and cause an abscess , but they can also travel along your veins and cause blockages and infection in some seriously dangerous places - like your heart. This can be an extremely painful experience but fortunately, is not too common.
  There has been some very 'dirty' heroin going around lately, so be sure to use a good size filter and try not to miss the vein.
• Seconal are notorious for causing abscesses. Usually an abscess can be guaranteed if you miss a vein shooting this so BE CAREFUL.
• If any gear looks suspect to you, consider other ways of taking it such as snorting, smoking or swallowing. Don't skin pop with suss gear.
• Speed and coke are particularly irritant to your veins and tissues, so if you can bear it- try smoking or snorting it instead.
• You know, you don't have to be left with big circular scars from an abscess anymore as long as you get treatment in time. However, there are ways to disguise them and there are special concealer creams available. Some are specialist creams available through hospitals, clinics and GP surgeries. Others, such as Prescriptives Phase Two Concealer creams are available over the counter.
  Make sure you check out the pull -out guide on tips for better /safer injecting techniques.
  If you must use a syringe that someone else has used (this includes your partners and friends), attempt to disinfect a rinsed syringe by;

Take the rinsed syringe apart
Soak it in bleach for at 2 minutes
Make sure the whole syringe is covered in bleach
Rinse thoroughly by flushing with fresh cold water, at
Least twice.

Make sure that the bleach you have is full strength (5.25%
hydrochloride), and that it has not passed its used by date. Some of the cheaper brands aren't strong enough and sometimes bottles can be left to sit on the supermarket shelf or in your cupboard until after the used by date, making them less effective. While it is good to rinse your works in full strength bleach, it is far more effective to soak them. The more time the bleach stays in contact with blood the more likely it is that viruses will be destroyed.

 

HOW TO BLEACH YOUR WORKS

The original 2x2x2 (rinse, bleach, rinse) message was developed in response to HIV. It was originally thought to be effective for disinfecting hepatitis C from works as well. Several years on however, it has been discovered that the effectiveness of bleach against hepatitis C was, and is, still unknown.

It is difficult to test this because Hepatitis C cannot yet be grown in a laboratory and researched properly. It should be pointed out here though that cleaning with bleach as described in the processes below does prevent the spread of HIV and Hep B and is very likely to significantly reduce the risk of Hepatitis C transmission. To prevent the spread of Hepatitis C, nothing is guaranteed except using new equipment for every hit, and avoiding the transference of blood from one person to another through swabs, water, filters, spoons, cups, tourniquets, hands, surfaces and other equipment used for injecting. Remember, it's blood that transmits viruses, not just equipment on it's own. That's why it's so important to concentrate on what is happening with any blood during the preparation and injection of your drugs and the disposal of equipment. Think about where the blood is going- your blood and that of your using partners. Remember though, if you already have Hep C or HIV, you can still become re-infected with a different strain from someone else. This could mean a more virulent, or drug resistant strain which could put even more pressure on your immune system.

If your not in a position to soak your works, then flush like this;

Flush the syringe out at least twice (the more the better)
in clean, cold water. Make sure you get rid of any visible blood before bleaching.
Fill the syringe with full strength bleach and shake it for at least 30 seconds (again, the longer you leave it
the better). Do this at least twice, remembering to shake your works for at least 30 seconds each time.
Use a watch, or count seconds with 'one thousand, two thousand,' etc.
Flush the syringe out at least twice with a separate cup of cold water (not the same one you used to flush the syringe the first time as this will already be contaminated).
(Taken in part from 'Disaffected or Disinfected,' a report on bleach as a Hepatitis C disinfectant, McFarlane Burnett Centre for Medical Research, 1996 and NUAA News 1998)