Prevalence and Characteristics of Femoral Injection among Seattle-Area Injection Drug Users

Abstract

Injection drug use (IDU) into central veins, most common among long-term IDUs with no other options, can lead to severe infectious, vascular, and traumatic medical consequences. To follow-up on anecdotal reports of femoral vein injection and related medical problems in Seattle, we analyzed data from the annual survey of a community-based syringe exchange program. A total of 276 (81%) of 343 program attendees completed the survey in August 2010. Among 248 IDUs, 66% were male, 78% white, and 86% primarily injected opiates. One hundred respondents (40%) had injected into the femoral vein, 55% of whom were actively doing so, and 58% of whom reported medical complications that they attributed to the practice. Most (66%) used the femoral vein due to difficulty accessing other veins, although 61% reported other veins they could access and 67% reporting using other sites since initiating femoral injection. While injecting into muscle was more frequent among older IDUs with longer injection careers, the prevalence of femoral injection was highest among respondents in their late twenties with 2.5-6 years of injecting drugs. Multivariate analysis demonstrated an increased risk of initiating femoral injection each calendar year after 2007. Injecting into the femoral vein was also associated with white versus other race (odds ratio [OR] 2.7, 95% CI 1.3-5.4) and injection of primarily opiates versus other drugs (OR 6.3, 95% CI 1.2-32.9) and not associated with age, length of IDU career, or a history of injecting into muscle. These findings suggest a secular trend of increasing femoral injection among Seattle-area IDUs with a high rate of related medical problems. Interventions, such as education regarding the hazards of central venous injection and guidance on safe injection into peripheral veins, are needed to minimize the health consequences of femoral injection.

Not in the vein: ‘missed hits’, subcutaneous and intramuscular injections and associated harms among people who inject psychoactive drugs in Bristol, United Kingdom

“…The extent of having ever injected subcutaneously or intramuscularly, either by intent or by accident, in our study was similar to the extent of ever injecting into the muscle found in Seattle, USA (Coffin, et al, 2012), but higher than that reported in an study in San Francisco, California (Binswanger, Kral, Bluthenthal, & Rybold, 2000). Subcutaneous and intramuscular injecting are likely to occur in other populations of people who inject drugs, particular among those populations were people have been injecting for long periods (Coffin, et al, 2012).…”

“…Subcutaneous and intramuscular injecting are likely to occur in other populations of people who inject drugs, particular among those populations were people have been injecting for long periods (Coffin, et al, 2012). Over time these practices, and their associated harms, may become an issue among the ageing cohorts of people who inject drugs that are found in many high income countries (European Monitoring Centre for Drugs and Drug Addiction, 2010), where people who have been injecting for long periods will be come more common.…”

“…In a study from 1997 conducted in San Francisco, California, 22% reported subcutaneous or intramuscular injections in the previous 30 days (Binswanger, Kral, Bluthenthal, & Rybold, 2000), and a more recent study from 2003-2005 indicated these practices were also common in Los Angeles, Oakland, and Berkeley, California, but didn't report on their extent (Fink, Lindsay, Slymen, Kral, & Bluthenth, 2013). In a third study undertaken during 2010 in Seattle, Washington, 56% had ever injected intramuscularly (Coffin, Coffin, Murphy, Jenkins, & Golden, 2012). However, the extent of these practices in the western USA may, in part at least, be related to the injection of 'black tar' heroin and the particular problems associated the use of this drug (Coffin, Coffin, Murphy, Jenkins, & Golden, 2012), thus limiting the generalisability of these findings other areas with different patterns of drug use.…”

“…In a third study undertaken during 2010 in Seattle, Washington, 56% had ever injected intramuscularly (Coffin, Coffin, Murphy, Jenkins, & Golden, 2012). However, the extent of these practices in the western USA may, in part at least, be related to the injection of 'black tar' heroin and the particular problems associated the use of this drug (Coffin, Coffin, Murphy, Jenkins, & Golden, 2012), thus limiting the generalisability of these findings other areas with different patterns of drug use.…”

Accessi venosi difficili e consumatori di sostanze: indagine sulle sedi di prelievo e sulle difficoltà grave; di esecuzione

“…Oltre alla compromissione del patrimonio venoso, sono note altre complicanze legate all'uso endovenoso di sostanze: ascessi, celluliti, trombosi, tromboflebite settica, fistole artero-venose e pseudo aneurismi. Mission 46............................................................................................................................................................................................................59 L'iniezione può inoltre esporre a infezioni locali o sistemiche (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Non è solo la pratica iniettiva a presentare dei rischi per la salute, ma anche altre tipologie di consumo che, accompagnandosi a comportamenti a rischio, possono ad esempio incrementare il rischio di contrarre infezioni sessualmente trasmesse, pertanto la valutazione clinica dovrebbe includere domande relative agli attuali modelli di uso di sostanze e comportamenti a rischio, al fine di mettere in atto interventi di educazione sanitaria per entrambe le tipologie di pazienti.…”