Illicit drug use has an estimated prevalence of five per cent of the global population (200 million), states a recent issue of the New England Journal of Medicine. Approximately 13 million are injection-drug users, 78 per cent in developing nations. Infections are the most serious complications of drug use. These include transmission of human immunodeficiency virus (HIV), sexually transmitted diseases, viral hepatitis, and skin and soft-tissue infections as abscesses and cellulites.
Inexperience with injections predisposes to soft-tissue infection. Using dirty needles, failing to clean the skin before injection and “booting” (repeatedly flushing and pulling back during injection), crushing tablets and mixing in contaminated water and licking needles doubles the risk of cellulitis or abscess with oral streptococcal and anaerobic species.
Infections target the heart as infective endocarditis with an estimated incidence of 3.3 per 1000 injection-drug users annually. The risk is higher with cocaine, due to the vasoconstrictive effects and frequent injections.
Community-acquired pneumonia is 10 times more frequent, due to a compromised immune system secondary to malnutrition. Pulmonary tuberculosis is highly prevalent because of crowded living conditions as homeless shelters, “crack” cocaine houses and “shooting galleries”, delays in diagnosis, poor adherence to treatment, HIV infection and AIDS. Tuberculosis and other respiratory pathogens may also be transmitted through a practice known as “shotgunning” (smoking and inhaling a drug and then expelling the smoke into another person’s mouth), a common practice among smokers of crack cocaine.
Appropriate antibiotics are used for treatment. Prevention can be implied through education. — Dr Fatema Jawad
Iraqi marshlands saved
After a decade of decline in which the fabled marshlands of Mesopotemia all but vanished almost 40 per cent have now recovered to their former 1970s extent. This phenomenal rate of recovery of the marshlands in southern Iraq, considered by some as the original biblical “Garden of Eden” and a key natural habitat for people, wildlife and fisheries, is revealed in new satellite images and preliminary analysis from the United Nations Environment Programme (UNEP).
The new satellite imagery shows a rapid increase in water and vegetation cover over the last two years, and while more detailed field analysis of soil and water quality is needed to gauge the exact state of rehabilitation, UNEP scientists believe the findings are a positive signal that the Iraqi marshlands are well on the road to recovery. The new findings on the growing extent of the marshes come from the recently launched Iraqi Marshlands Observation System (IMOS).
The project, launched a year ago with funding from the Government of Japan, is helping Iraq restore the environment and provide clean drinking water for upto 100,000 people living in or near the marshlands. It is achieving this via a variety of activities, ranging from the dissemination of appropriate “environmentally sound technologies” (ESTs) to the establishment of an internet-based marshlands information network and technical training.
The IMOS monitors the extent and distribution of reflooding developments and the associated vegetation cover. The systematic monitoring and bi-weekly reports are building an important knowledge base for Iraq. Such information is essential for reliable decision-making in all aspects of marshlands management.
Totalling almost 9,000 square kilometres of permanent wetlands, the Iraqi marshlands dwindled to just 760 square kilometres in 2002. As of August 2005, IMOS shows them covering almost 3,500 square kilometres, approximately 37 per cent of the former 1970s extent. In spring 2005, the figure was nearer to 50 per cent, shrinking with the high summer evaporation rates.
Working in close collaboration with the Government of Iraq and local people, the UNEP marshlands project is carrying out a wide range of activities. The project is also helping to train the Iraqi authorities, both at national government and local levels. About 250 Iraqis have been trained in wetland management and restoration, remote sensing and community-based resource management.
The Iraqi marshlands are one of the world’s largest wetland ecosystems. By the time the former Iraqi regime collapsed in 2003, these marshlands — with their rich biodiversity and unique cultural heritage — had been almost completely destroyed. In 2001, UNEP alerted the world to their plight when it released satellite images showing that 90 per cent of these fabled wetlands, home to rare and unique species like the Sacred Ibis, and a spawning ground for Gulf fisheries, had been lost.
In early 2003, UNEP revealed that the situation was getting worse. Experts feared that the entire wetlands, home to a 5,000 year-old civilization who are the heirs of the Babylonians and Sumerians, would disappear entirely unless urgent action was taken. With the collapse of the former Iraqi regime in mid-2003, local residents began opening floodgates and breaching embankments in order to bring water back into the marshlands.
