Prevalence and correlates of neck injection among people who inject drugs in Tijuana, Mexico

Abstract

Introduction and Aims Injecting drugs in the neck has been related to adverse health conditions such as jugular vein thrombosis, deep neck infections, aneurysm, haematomas, airway obstruction, vocal cord paralysis and wound botulism, among others. We identified prevalence and correlates of neck injection among people who inject drugs (PWID) in Tijuana, Mexico. Design and Methods Beginning in 2011, PWID aged ≥18 years who injected drugs within the last month were recruited into a prospective cohort. At baseline and semi-annually, PWID completed interviewer-administered surveys soliciting data on drug-injecting practices. Logistic regression was used to identify predictors of injecting in the neck as the most frequent injection site at a single visit. Results Of 380 PWID, 35.3% injected in the neck at least once in the past 6 months, among whom 71.6% reported it as their most common injection site, the most common injecting site after the arms (47%). Controlling for age, years injecting and injecting frequency, injecting heroin and methamphetamine two or more times per day and having sought injection assistance were associated with injecting in the neck [adjusted odds ratios (AOR): 2.12; 95% confidence intervals (CI): 1.27–3.53 and AOR: 2.65; 95% CI: 1.52–4.53 respectively]. Discussion and Conclusions Injecting in the neck was very common among PWID in Tijuana and was associated with polydrug use and seeking injection assistance. Tailoring harm reduction education interventions for individuals who provide injection assistance (‘hit doctors’) may allow for the dissemination of safe injecting knowledge to reduce injection-related morbidity and mortality.

Injection into the jugular vein among people who inject drugs in the United Kingdom: Prevalence, associated factors and harms

“…In this Canadian study, injection into the jugular vein was associated with daily injection and the authors hypothesized that venous access difficulties were likely to occur among people engaging in high frequency injecting drug use (Hoda, et al, 2008). Frequent injection (that is injecting more than once daily) was also associated with jugular vein injection in Tijuana (Rafful, et al, 2015), and in both the Canadian and Mexican studies people who had injected into their jugular vein were more likely to require or seek assistance with injecting (Hoda, et al, 2008;Rafful, et al, 2015). In a national study undertaken in Iran in 2007, 12% of people who injected heroin daily or more frequently reported their neck as their usual injection site (Karimi, et al, 2014).…”

“…The few studies that have investigated injection into the jugular vein have reported substantial differences in the prevalence of this practice. In a recent study in Tijuana (Mexico) one third of PWID reported that the neck was the main site used for injection in 2011 (Rafful, et al, 2015).…”

“…The high prevalence of jugular vein injection in Tijuana may reflect the predominance of black tar heroin in this region, the use of this form of heroin has been associated with venous sclerosis that makes intravenous injection difficult (Ciccarone, 2009 ;Rafful, et al, 2015). In a cohort study in Vancouver (Canada), around one quarter of participants who were followed-up during 2004-2005 had used the jugular vein as an injection site during the preceding 6 months (Hoda, et al, 2008).…”

“…These studies support the notion that the practice of injection into the jugular vein may be relatively common. This is a concern as injection into the jugular vein has been associated with a number of significant, and potentially costly, health problems (Lewis, et al, 1980;Myers, et al, 1988;Hoda, et al, 2008;Rafful, et al, 2015), including jugular vein thrombosis, deep neck infections, pneumothorax, endocarditis and sepsis (Lewis, et al, 1980;Myers, et al, 1988).…”

Potential benefits of using ecological momentary assessment to study high-risk polydrug use

“…Participants in our study were engaging in high-risk polydrug use. Evidence suggests, even when compared to other types of illicit drug users, polydrug users are a very stigmatized and marginalized group who may engage in more frequent high-risk drug use (51,52).…”