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PubMed1998

A sterile syringe for every drug user injection: how many injections take place annually, and how might pharmacists contribute to syringe distribution?

Our objectives were to estimate the annual number of injections by injection drug users (IDUs) in the United States of America, and to describe the potential role of pharmacists in providing IDUs with a sterile syringe for every injection. We estimated the number of annual injections by IDUs for the United States, selected U.S. states, and selected U.S. cities according to the following formula: number of injections per year = (number of IDUs) x (average number of injections per IDU per day) x 365. Data were obtained from published articles, personal communications with local experts, and selected national databases. We also reviewed published and unpublished studies of pharmacy kits, pharmacist attitudes, and pharmacist practices in the United States and abroad. Between 920 million and 1.7 billion injections by IDUs take place each year in the United States. We estimated 12 million injections per year in San Francisco and >80 million in New York City. A similar number of syringes would be needed to satisfy the goal of a sterile syringe for every injection. Pharmacy-based strategies, including the sale of kits for injection drug use, have provided sterile syringes to IDUs in Europe, Australia, and New Zealand. Modification of laws restricting syringe purchase and possession has led to marked increases in purchase of syringes from pharmacies and reductions in needle-sharing. In conclusion, large numbers of syringes would be required to provide a sterile syringe for every injection, but significant numbers of pharmacists seem to be willing to play a central role in syringe sale and distribution. Outreach programs should emphasize that using a sterile syringe for every injection is the optimal HIV prevention practice for IDUs who cannot or will not stop injecting. Pharmacy-based syringe sale or distribution has the potential to augment current efforts to prevent HIV infection in IDUs, their sex partners, and their children.

Australia↗
PubMed2004

Is a double-injection technique superior to a single injection in posterior subgluteal sciatic nerve block?

BACKGROUND AND OBJECTIVES: Currently, no information is available on the effects of a double-injection technique on onset time and efficacy following subgluteal sciatic nerve blockade. We hypothesized that the success rate and time to onset of subgluteal nerve block following a double-injection technique would be superior to that after a single injection. METHODS: Fifty ASA I or II patients undergoing foot or ankle surgery randomly received a single or double injection subgluteal sciatic nerve block. Group S (n=25) received a single injection of 30 ml of 0.75% ropivacaine to the sciatic nerve. In Group D (n = 25), 15 ml of the same solution was injected to each sciatic nerve component. Completion of sensory and motor blockade, and patient acceptance, was evaluated by a blinded anesthesiologist. RESULTS: Complete sensory and motor blockade of the foot was achieved faster with the double injection (7.4 [5.9-8.8] min and 12.3 [10.4-14.2] min, respectively) than with the single-injection technique (12.5 [10.7-14.3] min and 18.8 [16.7-21.0] min, respectively) (P<0.001 and P<0.001, respectively). Success rate and acceptance were similar in both groups. Severe or moderate discomfort during the procedure was less frequent after a single injection (P = 0.013). CONCLUSIONS: Both the single- and double-injection technique for subgluteal sciatic nerve blockade resulted in acceptable anesthesia in most patients. The double injection generated a faster onset of anesthesia than the single injection. However, the double-injection technique caused more patient discomfort during establishment of the nerve block.

Amides↗
PubMed2003

Intradermal radioisotope injection is superior to subdermal injection for the identification of the sentinel node in breast cancer patients.

BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate whether the intradermal injection of radiocolloids would improve the identification rate of sentinel nodes over the subdermal injection in breast cancer patients. METHODS: Sentinel node biopsy was performed in T2 breast cancer patients with clinically negative nodes, using subdermal or intradermal injection of radioisotopes with the peritumoral dye injection. We used Tc-99m tin colloid, with a larger particle size (0.4-5 microm), rather than sulfur colloid and colloidal albumin. RESULTS: The initial 55 patients underwent subdermal injection of radiocolloids; the next 61 patients underwent intradermal injection of radiocolloids for sentinel node biopsy. The detection rate of sentinel nodes was significantly (P = 0.048) higher in the intradermal injection group (61/61, 100%) than in the subdermal injection group (51/55, 92.7%). False-negative rates were comparable between the two groups. Lymphoscintigraphy visualized the sentinel nodes significantly (P < 0.0001) more often in the intradermal injection group (59/61, 96.7%) than in the subdermal injection group (20/54, 37.0%). CONCLUSIONS: A significantly higher identification rate of sentinel node biopsy and lymphoscintigraphy can be achieved by intradermal injection of Tc-99m tin colloid with a large particle size than by subdermal injection.

Axilla↗
PubMed1996

Subcutaneous or intramuscular injections of insulin in children. Are we injecting where we think we are?

OBJECTIVE: This study was designed to assess the insulin injection location in a group of children who had their injection according to their daily practice, thought to lead to subcutaneous injections. RESEARCH DESIGN AND METHODS: The location of the insulin deposit at the injection site was visualized using an ultrasound device. RESULTS: The exact insulin injection location could be localized, and 18 of 59 injections (30.5%) (one injection for each child) were in the intramuscular tissue. Of the children who had intramuscular injection, 15 of 18 were boys. The children who had an intramuscular injection had a significantly lower percentile of BMI (mean +/- SE: 47 +/- 8 vs. 72 +/- 4, P = 0.004), lower distance from skin surface to muscle fascia without a skinfold (5.6 +/- 0.6 vs. 11 +/- 0.7 mm, P < 0.0001), and a lower distance from skin surface to muscle fascia with a skinfold (8.1 +/- 0.9 vs. 15.9 +/- 0.8 mm, P < 0.0001) than children who had a subcutaneous insulin injection. CONCLUSIONS: We identified a group of children at risk for intramuscular insulin injections and that may deserve specific injection technique and advice.

Analysis of Variance↗
PubMed2000

Effects of 90Y-microspheres on liver tumors: comparison of intratumoral injection method and intra-arterial injection method.

UNLABELLED: Internal radiation therapy using intrahepatic arterial injection of 90Y-labeled glass microspheres (90Y-microspheres) has proven to be a promising therapeutic modality for inoperative liver tumor. Recently, direct intratumoral injection of 90Y-microspheres has been performed with even more encouraging results. The purpose of this study was to compare the treatment efficacy of these 2 methods using 90Y-microspheres. METHODS: Forty-eight male rats, each bearing a hepatic tumor, were divided into 4 groups (12 rats in each group) to evaluate the efficacy of treatment. Group 1 received an intratumoral injection of 37 MBq (1 mCi) 90Y-microspheres. Group 2 received an intratumoral injection of 0.1 mL normal saline as the control group. Group 3 received an intra-arterial injection of 37 MBq (1 mCi) 90Y-microspheres. Group 4 received an intra-arterial injection of 0.1 mL normal saline as the control group. Tumor size was measured by liver sonography before injection as well as at 2 and 4 wk after injection. Survival time was calculated from the day of treatment to 2 mo after treatment by Kaplan-Meier survival analysis. The response rate was evaluated by the change in tumor size and survival time. Fisher's exact, 2-tailed test was used to compare response rates. RESULTS: In the rats treated by intratumoral injection of 90-Y-microspheres, 83.3% (10/12) showed a good response. In contrast, all 12 rats in the control group showed a poor response. The difference was significant (P < 0.00001). Eighty-three percent (10/12) of the rats survived >60 d after intratumoral injection of 90Y-microspheres, whereas only 25% (3/12) of the control rats survived >60 d. The difference was significant (P = 0.0068). In the rats treated by intra-arterial injection of 90Y-microspheres, 58.3% (7/12) showed a good response to the treatment. All rats in the control group showed a poor response. The difference was significant (P = 0.0023). Sixty-six percent (8/12) of the rats survived >60 d after intra-arterial injection of 90Y-microspheres, whereas only 16.7% (2/12) of the control rats survived >60 d. The difference was significant (P = 0.0385). However, the response rate and survival time between the intratumoral treatment group and the intra-arterial treatment group showed no significant difference (P = 0.3707 and 0.3988, respectively). CONCLUSION: Both methods (intratumoral treatment and intraarterial treatment) showed a significantly good response rate and prolonged survival time compared with those of the control groups. However, no significant difference was found in the response rate or survival time between intratumoral treatment and intra-arterial treatment.

Animals↗
PubMedDate not supplied

Scintigraphic study on the distribution of radiolabeled cis-diamminedichloroplatinum (II) in the tumor-bearing rabbit: a comparison between intra-arterial injection with lipiodol and intravenous injection.

To compare the distribution of cis-diamminedichloroplatinum (II) (CDDP) on scintigraphic images between intra-arterial injection with lipiodol and intravenous injection, we obtained serial scintigraphic images using radiolabeled CDDP (Pt-195m CDDP), which had a high specific activity (7.4 x 10(6) Bq [200 microCi]/mg-CDDP), in the rabbit VX-2 tumor system. A dose of 9.25 x 10(6) Bq (250 microCi) of Pt-195m CDDP was injected at one shot via an ear vein, while 7.4 x 10(6) Bq (200 microCi of Pt-195m CDDP mixed with 1 ml of lipiodol was injected at one shot via a saphenous artery. Mean pixel count, which was corrected for the total dose injected, in the arterially injected tumor always exceeded than that in the intravenously injected tumor. Pt-195m CDDP uptake by the rabbit tumor at 2 hr was 7.8% of the total injected dose with intravenous injection and 16.0% with intra-arterial injection. These data suggest that intra-arterial injection with lipiodol is a more useful method to increase CDDP uptake by tumors than intra-venous injection.

Animals↗
PubMed1998

Prospective randomized controlled trial comparing percutaneous acetic acid injection and percutaneous ethanol injection for small hepatocellular carcinoma.

To assess whether ultrasound-guided percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small hepatocellular carcinoma (HCC), 60 patients with one to four HCCs smaller than 3 cm were entered onto a randomized controlled trial. Thirty-one and 29 patients, respectively, were treated by percutaneous acetic acid injection using 50% acetic acid or by percutaneous ethanol injection using absolute ethanol. There were no significant differences in age, sex ratio, Child-Pugh class, size of tumors, or number of tumors between the two groups. When there was no evidence of viable HCC from biopsy, plain and helical dynamic computed tomography, or angiography, the treatment was considered successful and was discontinued. All original tumors were treated successfully by either therapy. However, 8% of 38 tumors treated with percutaneous acetic acid injection and 37% of 35 tumors treated with percutaneous ethanol injection developed a local recurrence (P < .001) during the follow-up periods of 29 +/- 8 months and 23 +/- 10 months, respectively. The 1- and 2-year survival rates were 100% and 92% in percutaneous acetic acid injection and 83% and 63% in percutaneous ethanol injection (P = .0017). A multivariate analysis of prognostic factors revealed that treatment was an independent predictor of survival. The risk ratio of percutaneous acetic acid injection versus percutaneous ethanol injection was 0.120 (range, 0.027-0.528; P = .0050). In conclusion, percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small HCC.

Acetic Acid↗
PubMed2004

Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome.

BACKGROUND: Myofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. Several methods have been recommended for the inactivation of trigger points (TrP). OBJECTIVES: This prospective, single-blind study was proposed to compare TrP injection with botulinum toxin type A (BTX-A) to dry needling and lidocaine injection in MPS. METHODS: Eighty-seven trigger points (cervical and/or periscapular regions) in 23 female and six male patients with MPS were treated and randomly assigned to three groups: lidocaine injection (n=10, 32 TrP), dry needling (n=10, 33 TrP), and BTX-A injection (n=9, 22 TrP). OUTCOME MEASURES: Clinical assessment including cervical range of motion, TrP pain pressure threshold (PPT), pain scores (PS), and visual analog scales for pain, fatigue, and work disability were evaluated at entry and the end of the 4th week. Additionally, depression and anxiety were evaluated with the Hamilton depression and anxiety rating scales, and quality of life was assessed using the Nottingham health profile (NHP). The subjects were also asked to describe side effects. INJECTION PROCEDURE: One milliliter of 0.5% lidocaine was administered to each TrP in the lidocaine injection group, 10-20 IU of BTX-A to each TrP in the BTX-A group, and dry needling to each TrP in the last group, followed by stretching of the muscle groups involved. The patients were instructed to continue their home exercise programs. RESULTS: Pain pressure thresholds and PS significantly improved in all three groups. In the lidocaine group, PPT values were significantly higher than in the dry needle group, and PS were significantly lower than in both the BTX-A and dry needle groups. In all, visual analog scores significantly decreased in the lidocaine injection and BTX-A groups and did not significantly change in the dry needle group. Disturbance during the injection procedure was lowest in the lidocaine injection group. Quality of life scores assessed by NHP significantly improved in the lidocaine and BTX-A groups but not in the dry needle group. Depression and anxiety scores significantly improved only in the BTX-A-injected group. CONCLUSIONS: Injection is more practical and rapid, since it causes less disturbance than dry needling and is more cost effective than BTX-A injection, and seems the treatment of choice in MPS. On the other hand, BTX-A could be selectively used in MPS patients resistant to conventional treatments.

Adult↗
PubMed1995

A multicentred phase III comparative clinical trial of Mesigyna, Cyclofem and Injectable No. 1 given monthly by intramuscular injection to Chinese women. I. Contraceptive efficacy and sid effects.

A phase III clinical study was carried out among 5680 fertile Chinese women to evaluate efficacy and side effects of three monthly injectable contraceptives: Mesigyna, Cyclofem and Chinese Injectable No. 1. When used in a once-a-month treatment schedule (part 1 of study), the effectiveness of Chinese Injectable No. 1 was unacceptably low; 36 pregnancies occurred during the first 1743 women-months of use, 16 before the second injection. The study was restarted with a revised injection schedule for Injectable No. 1: two injections separated by 9 +/- 1 days during the first month and subsequent injections given 10-12 days after the onset of bleeding, or if no bleeding occurred, 28 days after previous injection. In part 2 of the study, 988, 990 and 992 subjects were provided Mesigyna, Cyclofem and Injectable No. 1, respectively. Life-table pregnancy rates at one year were 0.41%, 0% and 0.77% (p < 0.05), respectively; the overall discontinuation rates at one year were 13.9%, 19.1% and 20.4% (p < 0.001). Discontinuation rates for bleeding problems were significantly different between the groups: discontinuation rates for amenorrhea were 0.58%, 3.71% and 0.68% (p < 0.001) for Mesigyna, Cyclofem and Injectable No. 1; for other bleeding problems, the rates were 4.88%, 8.38% and 12.64% (p < 0.001). There were no significant differences between the groups regarding discontinuation for other medical or non-medical reasons. Mean weight changes after one year of use were small: 0.73, 0.86 and 0.17 kg for the three groups, respectively. Both Mesigyna and Cyclofem were very effective for contraception, but Mesigyna appeared to be tolerated slightly better with regard to cycle control; the modified dose regimen for Injectable No. 1 also gave a low pregnancy rate but was associated with higher rates of discontinuation.

Adolescent↗
PubMed2001

Physical injecting sites among injecting drug users in Sydney, Australia.

A sample of 200 injecting drug users were interviewed about their bodily injection sites. The mean number of injection sites ever used by subjects was 3.1, with a mean of 2.0 sites used in the previous 6 months. Sixteen percent of subjects had injected in five or more sites. Almost all (99%) had injected in the cubital fossa (crook of the arm). The next most popular site was the forearm (71%). Other sites included the hand (53%), foot (19%), leg (18%), neck (10%) and groin (6%). There was a clear progression in sites used, from the cubital fossa at initial injection to the use of sites such as the groin after 10 years of injecting. Females had used significantly more injection sites than males and reported more injection-related problems. The use of more injection sites was independently associated with a greater number of injection-related problems and a greater number of drug classes ever injected.

Adolescent↗
PubMed1996

Effect of injection speed on the spread of ethanol during experimental liver ethanol injections.

RATIONALE AND OBJECTIVES: Percutaneous ethanol injection therapy may cause serious complications, most likely due to the uncontrolled spread of ethanol. The authors changed the speed of the injection into postmortem pig livers and examined the adverse spread of ethanol from the injection site and the shape and size of the resulting lesion. METHODS: One milliliter of 96% ethanol was injected into pig livers under sonographic guidance at different speeds (0.075-0.91 mL/s). The spread (graded from I to III) and the volumes and shapes of the resulting lesions seen after dissection were recorded and correlated with the injection speed. RESULTS: When increasing the speed of the injections the large, grade III spread increased significantly (P < .01). The lesions created by more rapid injection were less spherical than were those created by slower injections (P = .08). The volumes of the lesions were not affected by the injection speed. CONCLUSION: This experimental model suggests that in percutaneous ethanol injection therapy, rapid injection (> 0.3-0.4 mL/s) should be avoided to reduce the uncontrolled spread of ethanol. Spherical spreading of ethanol around the needle tip is best achieved with slow injection.

Animals↗
PubMed2006

Variability of naked DNA expression after direct local injection: the influence of the injection speed.

The simple injection of DNA into muscles is known to result in the expression of the injected genes, even though at low and variable levels. We report that this variability in DNA expression is partly dependent on the injection speed. The acceleration of the injection speed from values around 2 mul/s up to ones around 25 mul/s (depending on the tissue) results in a significant increase in gene expression in skeletal muscle (280 times on an average) and in liver (50 times) and a nonsignificant sevenfold increase in tumors. Heparin, which inhibits the spontaneous uptake of the injected DNA, also inhibits the increases related to the injection speed. However, at the highest injection speed, this inhibition is not total because very fast injections provoke a direct permeabilization of the cells. This "hydroporation" could be similar to the permeabilization found in the hydrodynamics method based on the fast intravascular injection of a huge volume of DNA. Neither the "hydroporation" nor the heparin-inhibitable uptake mechanism induces histologically detectable lesions. There is a limited muscle cell stress independent of the injection speed. Heterogeneity in the injection speed might thus be an explanation for the variability in DNA expression after simple injection.

Animals↗
PubMed1993

Effects of postmortem injection time, injection level, and concentration of calcium chloride on beef quality traits.

Two experiments were conducted to determine the optimum protocol for maximizing meat quality with CaCl2 injection. Experiment 1 compared the effects of 30 min or 24 h postmortem injection of 175 mM CaCl2 or water at 10% (wt/wt) to controls on various measures of meat quality. An injection of CaCl2 reduced (P < .05) shear force values in all three beef muscles evaluated (longissimus, semimembranosus, and triceps brachii). Retail lean color was not affected (P > .05) by a CaCl2 injection at 24 h postmortem, but was slightly darker (P < .05) for an injection at 30 min postmortem. Psychrophilic and total aerobic microbial counts were higher (P < .05) in 30-min than in 24-h treatments and were higher (P < .05) in CaCl2- or water-injected semimembranosus muscle than in the control, but the treatment differences were minimal in 24-h injected meat. Experiment 2 compared the effects of 24-h postmortem injection of 200 mM or 250 mM CaCl2 at either 5 or 10% (wt/wt) to controls on meat quality traits. Both 200 and 250 mM CaCl2 reduced (P < .05) shear force values compared with the control. In addition, variation in shear force was decreased (P < .05) with CaCl2 injection. Beef flavor intensity was slightly lower (P < .05) and off-flavor ratings were slightly higher (P < .05) in CaCl2-injected meat, but the small differences were of no practical significance. Retail lean color was not affected (P > .05) by injection of the CaCl2 at 24 h. Injecting 200 mM CaCl2 at 5% (wt/wt) into 24 h postmortem meat can produce consistently tender meat without compromising other palatability or lean quality traits.

Animals↗
PubMed1998

Anesthetic efficacy of a repeated intraosseous injection given 30 min following an inferior alveolar nerve block/intraosseous injection.

To determine whether a repeated intraosseous (IO) injection would increase or prolong pulpal anesthesia, we measured the degree of anesthesia obtained by a repeated IO injection given 30 min following a combination inferior alveolar nerve block/intraosseous injection (IAN/IO) in mandibular second premolars and in first and second molars. Using a repeated-measures design, we randomly assigned 38 subjects to receive two combinations of injections at two separate appointments. The combinations were an IAN/IO injection followed approximately 30 min later by another IO injection of 0.9 ml of 2% lidocaine with 1:100,000 epinephrine and a combination IAN/IO injection followed approximately 30 min later by a mock IO injection. The second premolar, first molar, and second molar were blindly tested with an Analytic Technology pulp tester at 2-min cycles for 120 min postinjection. Anesthesia was considered successful when two consecutive readings of 80 were obtained. One hundred percent of the subjects had lip numbness with IAN/IO and with IAN/IO plus repeated IO techniques. Rates of anesthetic success for the IAN/IO and for the IAN/IO plus repeated IO injection, respectively, were 100% and 97% for the second premolar, 95% and 95% for the first molar, and 87% and 87% for the second molar. The repeated IO injection increased pulpal anesthesia for approximately 14 min in the second premolar and for 6 min in the first molar, but no statistically significant differences (P > 0.05) were shown. In conclusion, the repeated IO injection of 0.9 ml of 2% lidocaine with 1:100,000 epinephrine given 30 min following a combination IAN/IO injection did not significantly increase pulpal anesthesia in mandibular second premolars or in first and second molars.

Adolescent↗
PubMed1997

Pharmacokinetics and pharmacodynamics of nandrolone esters in oil vehicle: effects of ester, injection site and injection volume.

We studied healthy men who underwent blood sampling for plasma nandrolone, testosterone and inhibin measurements before and for 32 days after a single i.m. injection of 100 mg of nandrolone ester in arachis oil. Twenty-three men were randomized into groups receiving nandrolone phenylpropionate (group 1, n = 7) or nandrolone decanoate (group 2, n = 6) injected into the gluteal muscle in 4 ml of arachis oil vehicle or nandrolone decanoate in 1 ml of arachis oil vehicle injected into either the gluteal (group 3, n = 5) or deltoid (group 4, n = 5) muscles. Plasma nandrolone, testosterone and inhibin concentrations were analyzed by a mixed-effects indirect response model. Plasma nandrolone concentrations were influenced (P < .001) by different esters and injection sites, with higher and earlier peaks with the phenylpropionate ester, compared with the decanoate ester. After nandrolone decanoate injection, the highest bioavailability and peak nandrolone levels were observed with the 1-ml gluteal injection. Plasma testosterone concentrations were also influenced (P < .001) by the ester and injection site, with the most rapid, but briefest, suppression being due to the phenylpropionate ester, whereas the most sustained suppression was achieved with the 1-ml gluteal injection. Plasma inhibin concentrations were also significantly influenced by injection volume and site, with the lowest nadir occurring after the nandrolone decanoate 1-ml gluteal injection. Thus, the bioavailability and physiological effects of a nandrolone ester in an oil vehicle are greatest when the ester is injected in a small (1 ml vs. 4 ml) volume and into the gluteal vs. deltoid muscle. We conclude that the side-chain ester and the injection site and volume influence the pharmacokinetics and pharmacodynamics of nandrolone esters in an oil vehicle in men.

Adolescent↗
PubMed2006

First injection of ketamine among young injection drug users (IDUs) in three U.S. cities.

Ketamine, a dissociative anesthetic, has emerged as an increasingly common drug among subgroups of young injection drug users (IDUs) in cities across the United States. In-depth qualitative interviews were conducted with 213 young IDUs aged 16-28 years recruited in New York, New Orleans, and Los Angeles between 2004 and 2006. While some initiated injection drug use with ketamine, the drug was more frequently injected by IDUs with extensive polydrug using histories. IDUs initiating with ketamine commonly self-injected via an intramuscular mode of administration. The injection group provided crucial knowledge and material resources that enabled the injection event to occur, including ketamine, syringes, and injection skills. Injection paraphernalia was commonly shared during the first injection of ketamine, particularly vials of pharmaceutically-packaged liquid ketamine. Injection events infrequently occurred in a rave or club and more typically in a private home, which challenges ketamine's designation as a 'club' drug. The first injection of ketamine was a noteworthy event since it introduced a novel drug or new mode of administration to be further explored by some, or exposed others to a drug to be avoided in the future. Risk reduction messages directed towards young IDUs should be expanded to include ketamine.

Adolescent↗
PubMed2005

Prevalence and correlates of crack-cocaine injection among young injection drug users in the United States, 1997-1999.

OBJECTIVES: We estimated prevalence and identified correlates of crack-cocaine injection among young injection drug users in the United States. METHODS: We analyzed data from the second Collaborative Injection Drug Users Study (CIDUS II), a 1997-1999 cohort study of 18-30-year-old, street-recruited injection drug users from six US cities. RESULTS: Crack-cocaine injection was reported by 329 (15%) of 2198 participants. Prevalence varied considerably by site (range, 1.5-28.0%). No participants injected only crack-cocaine. At four sites where crack-cocaine injection prevalence was greater than 10%, recent (past 6 months) crack-cocaine injection was correlated with recent daily injection and sharing of syringes, equipment, and drug solution. Lifetime crack-cocaine injection was correlated with using shooting galleries, initiating others into drug injection, and having serologic evidence of hepatitis B virus and hepatitis C virus infection. CONCLUSIONS: Crack-cocaine injection may be a marker for high-risk behaviors that can be used to direct efforts to prevent HIV and other blood-borne viral infections.

Adolescent↗