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Substance Abuse and Wound Care: Implications for Wound and Skin Management

By Cheryl Carver, LPN, WCC, CWCA, CWCP, DAPWCA, FACCWS, CLTC – Wound Educator

The challenges for all clinicians associated with substance abuse and addiction are at an all-time high. We are seeing more and more overdoses and skin and wound issues. There needs to be less judgment and more education. Not every person with substance abuse issues is addicted due to a poor choice. Reasons for abuse can be related to unmanaged mental illness, self-medication and family genetics, to name a few. Compassion is lacking for this group of folks. I have seen it firsthand. This topic hits close to home as I have a son in recovery. This problem is an epidemic and needs to be talked about more. I live in Ohio, and we are one of the top five states for heroin and methamphetamine (meth) abuse.

Controlled Substances and Related Wounds

Heroin – Intravenous Drug Complications

Abscesses are common in those who use heroin because the substance is not sterile and is often mixed with citric acid. Citric acid can also cause acid burns in the vessels or subcutaneous tissues, leading to necrosis. Heroin can be smoked, snorted, or injected. The stronger the addiction, the more apt the user is to inject the drug. Skin infections and injection site-type wounds are becoming more of the "norm." Skin breakdown, abscess, infection, sepsis, deep vein thrombosis, and amputation are common. Substance abusers inject in their arms, legs, and even genitalia to hide the site. When a user cannot find a good site (skin popping), the drug can build up under the skin and be absorbed into subcutaneous tissues.

Methamphetamine – Meth Mites and Crank Bites

People who use meth are known for having open sores on their bodies. This can happen if the user is smoking, snorting, or injecting the drug. Open wounds or "pocks" are mostly caused by the hallucinations of what are referred to as "meth mites" or "crank bites" that meth users think are under their skin. It is common for meth users to feel anxious or like they are being eaten alive by insects. These open areas of the skin can lead to infection.

Krokodil – Skin-Induced Necrosis

Krokodil is the street name for desomorphine. This drug is injected and leads to skin necrosis. Russian doctors first noticed wounds with a crocodile hide appearance in the early 2000s. The drug was being made in the homes of Russians and Siberians. Krokodil causes skin necrosis and damages internal organs. It has also been referred to as a "flesh-eating drug." Bone infections and amputations are common. Krokodil has since spread to Europe and the United States (Utah, Illinois, Arizona, and Ohio).1


It has been reported that one third of substance abusers will develop an injection-related abscess, sore, or open wound within a one-year period.2 Education about substance abuse, skin issues, and wound care is an important part of helping not only the user, but also the health care staff encountering this epidemic more and more often.


1. Ocean Hills Recovery. What is Krokodil?

2. Finnie A, Nicolson P. Homeless people and injection drug users: implication for wound care. Leg Ulcer Forum J. 2003;17:17–20.

About the Author

Cheryl Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. She currently works as a Clinical Specialist for a leading independent provider of wound care solutions for long term care facilities in the United States, American Medical Technologies a d/b/a of Gordian Medical, Inc. Carver is not only known for her knowledge and expertise, but for enjoying her vocation as much as anyone possibly could. Her strong passion is driven from a life long list of personal experiences as a caregiver. Her mother passed away in in her arms at the young age of 47, due to complications from diabetes, amputation, and pressure ulcers. She now has dedicated her professional career to wound care education in hopes to bolster quality of care and strengthen pressure ulcer prevention. She has received many high reviews from her fellow physician and nurse students from across the country, including but not limited to: plastic surgeons, cardio-thoracic surgeons, general surgeons with wound care experience. Ms. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease specific educational video sessions accessible to employee providers and colleagues. 

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.