Heroin–gel capsule cocktails and groin injecting practices among ethnic Vietnamese in Melbourne, Australia

Higgs, Peter; Dwyer, Robyn; Duong, Duyen; Thach, My Li; Hellard, Margaret; Power, Robert; Maher, Lisa

doi:10.1016/j.drugpo.2008.05.001

Cited by 10 publications

(10 citation statements)

References 30 publications

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“…Our findings differ from older data in which long-term IDUs access central veins as a last resort 16 and are consistent with recent trends toward normalization of femoral injection seen in Australia and the United Kingdom. 9,17,18 Although many femoral injectors in our study had trouble finding veins, most still had peripheral venous options and there was no association with muscling, a common practice for IDUs that have lost venous access. Most of our respondents who reported femoral injection learned the practice from friends, family, or acquaintances, consistent with a report from South East England which found that current femoral injectors train others.…”

Section: Discussionmentioning

confidence: 77%

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

Coffin

Murphy

et al. 2012

J Urban Health

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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.

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Section: Discussionmentioning

confidence: 77%

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

Coffin

Murphy

et al. 2012

J Urban Health

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“…Zopiclone is from the same family of drugs as Lunesta (eszopiclone) and Ambien (zolpidem). Diphenhydramine is an antihistamine, which reports indicate has been mixed with heroin and injected in other settings [ 24 ]. Participants in Kulob reported that some PWID add diphenhydramine to heroin after they purchase it to potentiate the effects of the heroin when there is a shortage.…”

Section: Resultsmentioning

confidence: 99%

Factors that influence the characteristics of needles and syringes used by people who inject drugs in Tajikistan

Zule

Latypov²,

Otiashvili³

et al. 2015

Harm Reduct J

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Background“Low dead space” syringes with permanently attached needles retain less fluid, blood, and HIV after use than standard “high dead space” syringes. This reduces the probability of HIV transmission if they are shared by people who inject drugs (PWID). The World Health Organization recently recommended that needle and syringe programs (NSP) offer clients low dead space syringes. The success of this recommendation will depend on PWID switching to low dead space needles and syringes. This paper examines the needles and syringes that PWID in Tajikistan use and factors that influence their choices.MethodsIn May 2014, we conducted six focus groups in Kulob and six in Khorog, Tajikistan, with a total of 100 participants. NSP staff members recruited participants. Focus group topics included the needles and syringes used and factors that influence choice of needles and syringes. Focus groups were conducted in Russian and Tajik, audio recorded, transcribed, and translated into English. The translated files were imported into NVivo 10 for coding and analysis.ResultsAll participants in both cities were male and reported injecting heroin. Everyone also reported using syringes with detachable needles almost exclusively. The most popular syringe sizes were 2 and 5 ml. Needles ranged in gauge from 25 to 21 g. Needle gauge was influenced by the size of the vein, the viscosity of drug solution to be injected, and problems with blood clotting. Needles ranged in length from 12 to 38 mm, with 25 and 32 mm being the most popular. Needle length was influenced by the depth of the vein being used. Many PWID inject volumes of fluid greater than 1 ml into deep veins that require needles at least 25 mm long and 25 g in diameter.ConclusionMost low dead space syringes are 1-ml insulin syringes with 12 mm 28 g permanently attached needles. Findings from this project suggest that these will not be acceptable to PWID who need larger syringes and longer and thicker needles that are detachable. Low dead space detachable needles appear to be an acceptable option that could overcome barriers to the widespread use of low dead space equipment for reducing HIV and HCV transmission.

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“…The effects of removing temazepam gelcaps from the publicly subsidised medication list in Australia were modest but positive, but the very substantial decrease in prescribing that resulted led to the notable success achieved when they were removed from the market in 2002 [80]. However, their removal was associated with a subsequent rise in injection of diphenhydramine gel capsules, which has met with no regulatory response to date [81]. While the effect of moving flunitrazepam to a more restrictive schedule has not yet been evaluated, alprazolam has become the preferred benzodiazepine for injection by injection drug users in Australia [15].…”

Section: A Brief Note On Benzodiazepinesmentioning

confidence: 99%

Increasing the benefits and reducing the harms of prescription opioid analgesics

Hallinan

Osborn

Cohen

et al. 2011

Drug and Alcohol Review

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Heroin–gel capsule cocktails and groin injecting practices among ethnic Vietnamese in Melbourne, Australia

Cited by 10 publications

References 30 publications

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

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

Factors that influence the characteristics of needles and syringes used by people who inject drugs in Tajikistan

Increasing the benefits and reducing the harms of prescription opioid analgesics

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