High rates of midazolam injection among drug users in Bangkok, Thailand

Abstract

BackgroundReports from Thailand suggest that a growing number of people who inject drugs (IDU) are now injecting midazolam, a legal benzodiazepine with potent amnestic and ventilatory depressant effects. We therefore sought to examine midazolam injection among a community-recruited sample of Thai IDU.MethodsWe examined the prevalence and correlates of midazolam injection among 252 IDU participating in the Mitsampan Community Research Project, Bangkok, using multivariate logistic regression. We also examined the use of midazolam in combination with other drugs.Results252 IDU participated in this study, including 66 (26.2%) women. In total, 170 (67.5%) participants reported ever having injected midazolam, and 144 (57.1%) reported daily midazolam injection in the past six months. In multivariate analyses, a history of midazolam injection was independently associated with using drugs in combination (adjusted odds ratio [AOR] = 5.86; 95% confidence interval [CI]: 2.96-11.60), younger age (AOR = 0.43; 95%CI: 0.22-0.83), having a history of methadone treatment (AOR = 3.12, 95%CI: 1.55-6.90), and binge drug use (AOR = 2.25, 95%CI: 1.09-4.63). The drugs most commonly used in combination with midazolam were heroin (72.3%) and yaba (methamphetamine) (30.5%).ConclusionWe observed a high rate of midazolam injection among Thai IDU. Midazolam injection was strongly associated with polysubstance use and binge drug use, and was most commonly used in combination with both opiates and methamphetamines. Our findings suggest that midazolam injection has become increasingly common within Thailand. Evidence-based approaches for reducing harms associated with midazolam injection are needed.

Factors associated with methadone treatment among injection drug users in Bangkok, Thailand

“…The fast-acting benzodiazepine midazolam has become an increasingly common drug of abuse in Bangkok (Kerr et al, 2010;Kiatying-Angslee et al, 2004). It can be obtained through private clinics that sell or prescribe it as an alternative to methadone for the purposes of aiding opiate detoxification (National AIDS Prevention and Alleviation Committee, 2010).…”

“…Midazolam injection has been associated with health complications such as abscesses and vein collapse and other harms secondary to its amnesic effects (Kiatying-Angslee et al, 2004). Recently, reduced availability and increased cost of heroin in Thailand have led to decreased use of heroin by IDU and increased injection of midazolam (Kerr et al, 2010;Kiatying-Angslee et al, 2004). The positive association between accessing methadone treatment and frequent midazolam injection in our study indicates that methadone programs should assess for concomitant substance use and treat participants who are users of opioids and midazolam.…”

“…It can be obtained through private clinics that sell or prescribe it as an alternative to methadone for the purposes of aiding opiate detoxification (National AIDS Prevention and Alleviation Committee, 2010). It may be diverted and consumed by crushing and injecting the tablet form of the drug to potentiate the effects of heroin or as an alternative to opioids when they are not available (Kerr et al, 2010;Van Griensven et al, 2005). Midazolam injection has been associated with health complications such as abscesses and vein collapse and other harms secondary to its amnesic effects (Kiatying-Angslee et al, 2004).…”

“…IDU are referred to methadone treatment centers through self-referral, outreach, and compulsory drug treatment orders, and urine drug screening for eligibility is not routine (National AIDS Prevention and Alleviation Committee, 2010). Within the private sector, some clinics are licensed to provide narcotics as part of drug treatment, whereas others sell psychotropic drugs such as short-acting benzodiazepine midazolam to aid withdrawal, a practice that may do more harm than good given that midazolam is a common drug of abuse in Thailand (Tyndall, 2010;Kerr et al, 2010).…”

Diverse HIV epidemics among people who inject drugs in Thailand: Evidence from respondent-driven sampling surveys in Bangkok and Chiang Mai

“…Studies among PWID in Thailand have been conducted mainly in Bangkok and have typically recruited participants enrolled in clinical trials (Martin et al, 2010; Pitisuttithum et al, 2006; van Griensven et al, 2005; Vanichseni et al, 2001) or from studies that used convenience-based sampling methods (Fairbairn et al, 2009; Hayashi et al, 2011; Kerr et al, 2009, 2010; Werb et al, 2009). Few community-based epidemiological studies have used methods appropriate to obtain data on representative samples of PWID such as respondent-driven sampling (RDS; Heckathorn, 1997, 2002; Johnston et al, 2010, Magnani et al, 2005).…”