When people think of the many healthcare providers addressing the opioid crisis, a hand and upper extremity therapist might not be the first person that comes to mind. However, many therapists and surgeons will tell you that they see people who come into the clinic with hand and upper extremity injuries related to a drug injection. These injuries can be challenging to treat not only because they are complex and can be very serious, but also because of the psychological and social aspects related to drug use.
People who inject drugs, as well as those around them - family, friends, counselors, healthcare workers, and others - need to know that infections may occur at injection sites. Research shows that infections from drug injection are a common reason for people affected by drug use to visit the hospital. People inject drugs into many areas of the body, but hand and upper extremity therapists generally see injuries in the shoulder, elbow, forearm, wrist, and hand. These injuries typically occur when an infection is left untreated too long and causes compromise to tendons, nerves, muscles, arteries and/or veins. Typically more than one of these types of tissues is affected.
While infections are often the root of the injury, they can lead to other problems and symptoms, both during and after the infection. These can include pain, swelling, stiffness, weakness, deformity, scarring, and even amputation. In addition, these infections may start to affect other areas of the body and cause complications such as osteomyelitis (an infection in the bone) or sepsis, when bacteria start to infect the bloodstream which can lead to organ damage.
While the health impacts of these injuries in themselves are difficult enough, stigma can also make treatment difficult. Stigma can be thought of as a mark of shame that people who use drugs experience on a regular basis. Drug-related stigma from others may lead the person to feel fear and isolation, like they are being blamed or judged, that they are a failure, or that they will get treated differently by healthcare workers. When people who inject drugs have experienced this stigma, it can cause them to avoid seeking treatment, often until the injury is advanced. It may also cause them to stop treatment earlier than they should. Addressing stigma in 2017, the Office of National Drug Control Policy sent out an executive memo asking healthcare providers to change the ways they speak to and about persons with a substance use disorder.
A hand and upper extremity therapist might see a patient with this type of injury at a walk-in clinic, while they are still in the hospital, or in an outpatient facility. They may receive a variety of treatments:
Hand and upper extremity therapists know that injuries related to drug injection may require special considerations including the susceptibility to infectious diseases such as HIV, Hepatitis C, and MRSA. Another important role for the therapist is patient education for things like caring for their wound at home, precautions, and how to avoid the risks that might contribute to future infections.
While these are physical injuries, there are psychological and social aspects that are important to consider. The individual may spend a significant amount of time with the hand therapist during their treatment. During this time they may express physical or emotional needs with which the hand therapist can assist by referring to other specialists. These may include pain management specialists, support groups, social workers, peer support specialists, addiction specialists, and harm reduction resources.
For more information about Certified Hand Therapists and how they can help you with these and other types of conditions, please visit: https://www.asht.org/patients.
If you would like to find a Certified Hand Therapist in your area, please visit: https://www.asht.org/find-a-therapist.
Tauni Malmgren, OTD, OTR/L is an occupational therapist and is a member of the American Society of Hand Therapists. She is experienced in harm reduction and promoting health equity for people affected by drug use.
Kimberly Masker, OTD, OTR/L, CHT, is a Certified Hand Therapist and is a member of the American Society of Hand Therapists and an affiliate member of the American Society for Surgery of the Hand. She has experience with harm reduction and the treatment of hand and upper extremity wounds related to injection of drugs.