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What is Skin Popping?

Drug users inject drugs in different ways. One of these ways is skin popping. Skin popping is a method used by some drug users to inject illicit drugs. 

Heroin is the most commonly injected drug. Drugs like cocaine, buprenorphine barbiturates, and other opiates are also injected into the skin.1

Skin popping can also be referred to as subcutaneous injection or intradermal injection

  • Intradermal injection involves delivering the illicit drug into the dermis. The dermis is the upper layer of the skin above the subcutaneous layer. 
  • Subcutaneous injection involves delivering the drug into the subcutaneous layer. This is the fat tissue layer below the skin but above the muscles.

By using intradermal or subcutaneous injection, drug users aim to reduce the risk of drug overdose and achieve slower absorption compared to intravenous drug administration. 

Drugs injected into or directly under the skin are absorbed at a slower rate and their effects last longer compared to intravenous injections.

Both subcutaneous injections and intradermal injections are dangerous. They can result in drug addiction and medical complications. These include botulism (an infection caused by the bacteria Clostridium botulinum) and other soft tissue infections.

Symptoms of Skin Popping

Skin popping scars give important clues when trying to identify a case of substance use.5 Usually, the frequently injected drugs cause lesions which can help health professionals detect subcutaneous drug use. 

Some common symptoms of skin popping include:

  • Scars, sores, or track marks on their arms, legs, or hands
  • Always wearing long sleeve clothes to conceal tissue scars
  • Skin infections and other skin manifestations such as irritation and formation of abscesses
  • Formation of lumps in the injection site, which occurs as a result of the accumulation of scar tissue
  • Discoloration of the site that has been frequently injected subcutaneously 
  • Always keeping around a small box or bag containing tools for injecting the substances (e.g., cotton wool and syringe)

Some behavioral signs are also typical of drug addicts who inject drugs subcutaneously, intradermally, or intravenously. 

These signs include:

  • Appetite changes
  • Weight loss
  • Changes in sleeping patterns or sleep problems
  • Mood swings 
  • Malnutrition
  • Mental health problems

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Why Do Some Drug Users Skin Pop? 

Drug users have different ways of injecting illicit drugs. Intravenous injection is one common method of injecting drugs. 

However, for several reasons, drug users now opt for skin popping which can be given either as an intradermal or subcutaneous injection. 

Some of the reasons injection drug users receive intradermal or subcutaneous injection are:

  • It eliminates the difficult task of finding a vein 
  • It makes self-administration easier as the syringe does not penetrate deep
  • It results in slower drug absorption
  • It may make the drug last longer compared to intravenous drug use
  • It reduces the risk of drug overdose4

Injection drug users tend to switch to skin popping if intravenous injections have caused severe tissue scarring at the injection site. This is because the veins can no longer be accessed easily. 

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What are the Most Commonly Injected Drugs?

Some of the most commonly injected drugs are:

  • Heroin, black tar heroin, and other opiates
  • Anabolic steroids
  • Cocaine
  • Central nervous system depressants such as barbiturates

Some of these substances are more addictive and dangerous than others. However, skin popping is not considered safe for any of them. 

These commonly used drugs can cause serious illness and life-threatening problems when injected into the body. 

Dangers & Complications of Skin Popping Drugs

Injecting illicit drugs is substance misuse. It is dangerous and can cause severe physical and psychological risks to health. 

Using drugs in this manner makes it easier for germs to penetrate the skin and stay underneath the skin or inside the subcutaneous fatty layer. This can, in turn, cause skin popping scars, abscesses, infections, and other life-threatening conditions.

Below are some common dangers and complications of skin popping.

Wound Botulism

Wound botulism is a severe infection that occurs when the bacteria Clostridium botulinum infiltrates a wound. 

This is one of the worst dangers that can develop among skin-popping drug users. 

The bacteria, which is usually found in contaminated drugs, can develop into a toxin that attacks the nerves.

Symptoms of wound botulism can appear within days of injecting a contaminated drug. These include: 

  • Muscle weakness
  • Double vision
  • Difficulty breathing 

Other infections

People who inject illicit drugs have serious risks of contracting certain skin and blood-borne infections (e.g., users who share syringes with others). 

A publication by Public Health England reported a shoot-up of infections among people who inject drugs in the UK as of 2018 and 2019.2

Infections that may develop as a result of skin popping include:

  • Hepatitis B and C
  • Tetanus
  • Endocarditis
  • Necrotizing fasciitis (flesh-eating disease)
  • Human immunodeficiency virus (HIV)
  • Other sexually transmitted diseases

Tissue scarring

Subcutaneous drug injection may cause long-term tissue scarring, cutaneous lesions, and cellulitis (hyperpigmentation). 

Scarring may be noticeable on the injection sites, such as the fingers, hands, forearms, wrists, and lower extremities.

A study showed that chronic complications of skin popping might include: 

  • Cutaneous granulomas (a group of diseases characterized by an inflammatory reaction of the skin)
  • Hyperpigmentation (skin patches that become darker than surrounding skin)
  • Necrosis of the fingers, particularly if a vasoconstrictive substance (like cocaine) is accidentally injected into the arterioles (small arteries)5

Drug overdose and addiction

Drugs like heroin kill many people every year. Injecting too much heroin at a time can lead to heroin overdose.

According to the Centers for Disease Control and Prevention (CDC), an estimated 841,000 people have died from a drug overdose since 1999.3 

Overdose symptoms include: 

  • Clammy skin
  • Seizures
  • Confusion
  • Loss of consciousness
  • Coma
  • Slow breathing

Over time, injecting drugs into the skin can lead to addiction. Drug addictions can be both physical and psychological. This is one of the reasons why drug users must speak to a psychologist immediately.

Treatment Options for Substance Use Disorder

Treatment for substance use disorder starts with seeking professional help. It is never too soon or too late to seek help, provided a life can still be saved. 

Substance use disorder is treatable. It typically requires multiple levels of care. 

Some people keep using drugs to avoid dealing with unpleasant withdrawal symptoms. However, it is best to deal with drug withdrawal and gain freedom from drug use. 

Drug withdrawals and cravings can be treated via medically supervised detoxification and healthy, natural processes. 

Some effective treatment options/programs for substance use disorder include:

  • Medical evaluation
  • Professional detoxification
  • Medication-assisted treatment (MAT)
  • Dialectical behavior therapy
  • Mindfulness and stress management
  • Cognitive-behavioral therapy (CBT)
  • Individual and group therapy
  • Peer support groups
  • Family therapy
  • Healthy living
  • Aftercare support

If you or your loved one is suffering from addiction or substance use disorder, talk to a professional.

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Resources

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Baciewicz Gloria. “Injection Drug Use.” Medscape. 19 August 2021 Czachorowski Maciej et al. “Shooting Up: Infections Among People Who Inject Drugs in the UK, 2018." Public Health England, December 2019.  Drug Overdose Deaths Remain High.” Centers for Disease Control and Prevention. 3 March 2021. Grunebaum, Amos and Skupski, Daniel. “Skin Popping Scars - A Telltale Sign of Past and Present Subcutaneous Drug Abuse.Case Reports in Perinatal Medicine, Vol. 1, no. 1-2, (2012): 37-39.  Saporito, Rachael et al. “Recognizing Skin Popping Scars: A Complication of Illicit Drug Use.Cureus, Vol. 10(6), e2726. 1 June 2018, doi: 10.7759/cureus.2726. Subcutaneous Route of Drug Administration: Advantages and Disadvantages.” Pharmapproach. 27 November 2020.

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