Active Heroin Abuse

Abstract

A 21 year old heroin addict continues his habit by repeated injections of heroin into his arteriovenous access used for maintenance hemodialysis. Heroin addiction began during a three year prison term for armed robbery, his seventh felony arrest and fourth conviction. His dialysis course of two years has been complicated by bacterial endocarditis and multiple skin abscesses, the result of continue use of “dirty” needles and syringes. Neither his family — from which he is estranged — nor his parole officer have been able to “reason” with the patient. Over the preceding five months, the addiction has intensified and the patient has infected and destroyed three surgically created accesses in his arms. Dialysis is currently performed by repeated femoral vein cannulation. The responsible vascular surgeon refuses any further access surgery so long as the patient continues to inject heroin into any available vein.