13. Heroin Heroin comes in a white to brown powder or a dark tar-like substance, and is sold in a variety of packaging The most popular form of heroin is a dark tar-like substance called black tar, which is sold in small foil or cellophane packets or in small toy balloons. The most common use of heroin is by injection (called "mainlining" or "shooting"), but in it's powder form it can be inhaled through the nose or smoked.
14. Black tar heroin and the paraphernalia for injecting and storing the drug Paraphernalia for injecting heroin include hypodermic needles, small cotton balls used to strain the drug, and water and spoons or bottle caps used for "cooking" or liquefying the heroin. Paraphernalia for inhaling or smoking heroin includes razor blades, straws, rolled dollar bills, and pipes. The high from the drug usually lasts from four to six hours.
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31. Gordon R and Lowy F. N Engl J Med 2005;353:1945-1954 Organisms Responsible for Bacterial Infections in Drug Users
37. Skin, Soft-Tissue & Musculoskeletal Infections Soft-Tissue Abscess on the Leg of an Injection-Drug User. "Track" marks from injections extend along the calf. Provided courtesy of Robert Gwizdala. CA-MRSA PDF MRI in an Injection-Drug User with Vertebral Osteomyelitis Involving T6–T7 (Arrow) with an Adjacent Epidural Abscess. Culture grew Enterobacter cloacae .
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39. Tricuspid Endocarditis & Septic Pulmonary Emboli Right-sided staphylococcal endocarditis and multiple embolic pyogenic abscesses Petechial rash due to right-sided staph endocarditis Tricuspid valve endocarditis with Staphylococcus aureus , and multiple septic pulmonary emboli, prominent in the right upper lobe with both solid and cavitary appearance. Parasternal long axis view from a transthoracic echocardiogram. There is a small curvilinear vegetation on the mitral valve as indicated