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PubMed2003

Prior opiate injection and incarceration history predict injection drug use among inmates.

AIMS: To describe injection drug use among inmates, and to identify correlates of drug injection while incarcerated. DESIGN: Cross-sectional survey. SETTING: Six provincial correctional centres in Ontario, Canada. PARTICIPANTS: Face-to-face interviews were conducted with a random sample of 439 adult males and 158 females. MEASUREMENTS: Inmates were asked about drug use in their lifetime, outside the year prior to their current incarceration, and while incarcerated in the past year. Among the 32% (189 / 597) with a prior history of drug injection, independent correlates of injection while incarcerated in the past year were identified using multiple logistic regression. FINDINGS: Among all inmates while incarcerated in the past year, 45% (269 /597) used drugs and 19% (113 / 596) used non-cannabis drugs. Among those with a prior history of injecting, 11% (20 / 189) injected while incarcerated in the past year. Rates of injection with used needles were the same pre-incarceration as they were while incarcerated (32%). Independent correlates of drug injection while incarcerated were injection of heroin (OR = 6.4) or other opiates (OR = 7.9) and not injected with used needles (OR = 0.20) outside in the year prior to incarceration, and ever being incarcerated in a federal prison (OR = 5.3). CONCLUSIONS: The possibility of transmission of human immunodeficiency virus (HIV), hepatitis C (HCV) or other blood-borne diseases exists in Ontario correctional centres. In this setting, drug injection while incarcerated is primarily related to opiate use prior to incarceration. The correlation between injecting and extensive incarceration history suggests missed opportunities to improve inmates' health.

Adolescent↗

PubMed2004

Irish injecting drug users and hepatitis C: the importance of the social context of injecting.

BACKGROUND: The incidence of hepatitis C (HCV) infection among injecting drug users (IDUs) in Dublin is particularly high by international standards. The most robust predictor of an IDU's HCV status is his or her total number of lifetime injecting episodes. It has been proposed that participation in specific unsafe injecting practices is the principal contributor to this accumulated risk. We sought to test this hypothesis. The relationship between social context of injecting and HCV status was also examined. METHODS: We conducted a cross-sectional survey of IDUs recruited from treatment settings in Dublin. Participants had injected in the preceding six months and had not previously been tested for HCV. A structured interview was conducted. RESULTS: HCV testing was performed on 159 IDUs, and 61% were antibody positive. The three characteristics that were significant independent predictors of a positive test result were increased total number of lifetime injecting episodes, closer social relationships with other IDUs, and injecting in the home of other IDUs. Frequency of recipient syringe sharing (i.e. borrowing used syringes from other IDUs), backloading, and sharing of injecting paraphernalia were not independently associated with infection. CONCLUSIONS: We found that the robust association between HCV infection and number of lifetime injecting episodes was not explained by increased unsafe injecting practices. The socialized nature of heroin injecting in Dublin is contributing to the HCV epidemic in this population. Our findings suggest that accidental and unnoticed sharing of injecting equipment may be an important contributor to an IDU's increasing risk of infection over time.

Adult↗

PubMed2005

Requiring help injecting independently predicts incident HIV infection among injection drug users.

BACKGROUND: Requiring help injecting has been associated with syringe sharing among injection drug users (IDUs). No prospective study has fully examined this risk factor and its relation to rates of HIV infection. We investigated whether requiring help injecting illicit drugs was a predictor of HIV infection among a prospective cohort of IDUs. METHODS: The Vancouver Injection Drug User Study is a prospective study of more than 1500 IDUs who have been recruited from the Downtown Eastside of Vancouver since May 1996. At baseline and semiannually, subjects provided blood samples and completed an interviewer-administered questionnaire. The questionnaire elicits demographic data as well as information about drug use, HIV risk behavior, and drug treatment. HIV incidence rates were calculated using Kaplan-Meier methods, and Cox regression determined independent predictors of seroconversion. RESULTS: A total of 1013 baseline HIV-negative participants were eligible for this study. Within this population, 418 (41.3%) participants had required help injecting during the last 6 months at baseline. Participants requiring help injecting were more likely to be female (odds ratio = 2.3, 95% confidence interval [CI]: 1.8-3.0; P < 0.001), were slightly younger (33.5 vs. 34.9 years of age; P = 0.014), and had fewer years of experience injecting drugs (7 vs. 11 years; P < or = 0.001). Among participants who required help injecting at baseline, cumulative HIV incidence at 36 months was 16.1% compared with 8.8% among participants who did not require help injecting (log-rank, P < 0.001). In an adjusted model controlling for potential confounding variables, being aboriginal (relative hazard [RH] = 1.68, 95% CI: 1.15-2.48), injecting cocaine daily (RH = 2.71, 95% CI: 1.87-3.95), and requiring help injecting (RH = 1.79, 95% CI: 1.23-2.62) remained independent predictors of HIV seroconversion. CONCLUSIONS: These data demonstrate the need for interventions to reduce the risk of HIV infection among IDUs who require help injecting.

Adult↗

PubMed2000

Preference to have used a medically supervised injecting centre among injecting drug users in Kings Cross, Sydney.

OBJECTIVE: To assess factors affecting preference to have last injected in a medically supervised injecting centre (MSIC) among injecting drug users (IDUs) attending a needle syringe program (NSP) in Kings Cross, Sydney. METHODS: All NSP attenders over a two-day period in August 1999 were asked where they last injected, whether they injected alone and if they would have preferred to use an MSIC. This was in addition to the routine data collected, which included age, gender and last drug injected. RESULTS: Among the 178 respondents, 52 (29%) last injected in a public place and 77 (44%) last injected alone. Seventy-one per cent of all respondents would have preferred to use an MSIC. Of those who injected in public, 83% would have preferred to use an MSIC compared to 66% of those who injected in private, which was significant (p = 0.03). Age, gender, last drug injected and having injected alone did not affect preference to use an MSIC. CONCLUSIONS: Respondents' high preference to use an MSIC suggests that it may well achieve its public order and public health objectives. IMPLICATIONS: An MSIC may significantly shift current patterns of illicit drug use in Kings Cross, the community impact of which should be monitored and managed.

Adolescent↗

PubMed1992

Stability and sorption of FK 506 in 5% dextrose injection and 0.9% sodium chloride injection in glass, polyvinyl chloride, and polyolefin containers.

The effects of the diluent, the storage container, light, and infusion through various types of tubing on the stability and sorption of FK 506 were studied. Solutions of FK 506 in 0.9% sodium chloride injection or 5% dextrose injection were stored at room temperature (24 +/- 2 degrees C) in glass i.v. bottles, polyvinyl chloride (PVC) minibags, and polyolefin containers. FK 506 solution in 0.9% sodium chloride injection was stored in plastic syringes at room temperature and either exposed to normal room light or stored in the dark. FK 506 solution in 5% dextrose injection was placed in plastic syringes and infused through PVC anesthesia extension tubing, PVC i.v. administration set tubing, and fat emulsion tubing over a two-hour period. The infused samples and samples collected from the containers and syringes at intervals up to 48 hours were analyzed for FK 506 concentration by high-performance liquid chromatography. FK 506 concentrations remained greater than 90% of initial concentration for admixtures in 5% dextrose injection stored in glass bottles for 48 hours and for admixtures in 5% dextrose injection or 0.9% sodium chloride injection stored in polyolefin containers for 48 hours. No change in concentration was measured for admixtures in 0.9% sodium chloride injection stored in plastic syringes, and exposure to light did not affect the stability of FK 506 solution. No substantial change in concentration occurred in FK 506 solution in 5% dextrose injection infused through PVC anesthesia extension tubing, PVC i.v. administration set tubing, or fat emulsion tubing. FK 506 admixtures prepared with 5% dextrose injection or 0.9% sodium chloride injection should be stored in polyolefin containers. If polyolefin containers are not available, solutions should be prepared with 5% dextrose injection and stored in glass bottles.

Adsorption↗

PubMed2003

Comparison between the effects of intraperitoneal injection of LDL and intravenous injection of LDL on arterial endothelial cells apoptosis.

To observe the effect of oxidized low density lipoprotein (OxLDL) on arterial endothelial cells apoptosis in vivo, we established a model in which Sprague-Dawley rats were given intraperitoneal and intravenous injection of unmodified LDL (8 mg/kg every day) via the tail vein. Seven days after the injection, the aortic endothelial cells specimens were prepared by an en face preparation of rat aorta. The apoptotic cells were identified and counted by in situ nick and labelling (TUNEL) method and light microscopy. The numbers of the apoptotic cells were 12.52 +/- 4.71/field in the intraperitoneal injection control group, 11.41 +/- 2.94/field in the intravenous injection control group, 22.98 +/- 8.01/field in the intraperitoneal injection LDL group and 103.8 +/- 11.5/field in the intravenous injection LDL group, respectively. The difference was significant between injection LDL group and control (P < 0.01), and the difference was also significant between two LDL injection groups (P < 0.01). These findings suggest that injection of LDL can induce apoptosis in arterial endothelial cells and the effect is especially significant with intravenous injection LDL. After injection, oxidative modification of LDL may occur in local arteries and causes injury to the endothelial cells.

Adult↗

PubMed2003

Septic arthritis following intra-articular steroid injection of the knee--a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee.

Septic arthritis is a potential catastrophic complication of intra-articular steroid injection. There is lack of evidence regarding the precautions that should be taken to avoid such a complication, as well as how often it is encountered. The aim of this study was to evaluate the antiseptic precautions taken during intra-articular steroid injection of the knee in the United Kingdom (UK), and estimate how often septic arthritis is encountered by health professionals in the UK following steroid injection of the knee. A questionnaire was posted to 100 orthopaedic surgeons, 100 rheumatologists and 50 general practitioners (GPs), asking them about the cases of septic arthritis following intra-articular steroid injection of the knee that they encountered during their practice and the precautions they take when injecting knees. The response rate was 76.4%; 57.6% of the respondents used alcohol swabs to clean the skin, and the remaining 42.4% used chlorhexidine or Betadine. Only 16.3% used sterile towels to isolate the injection site. There were 32.5% of respondents who routinely used sterile gloves when injecting, and a total of 46.6% used either sterile or non-sterile gloves. Also, 91.1% changed needles between drawing the steroid and injecting it into the joint. Only 24 respondents (12.6%) had encountered septic arthritis after steroid injection of the knee (18 once, 3 twice, 2 three times, 1 several times). We concluded that septic arthritis post intra-articular steroid injection of the knee is probably rare. There is a wide variation in the precautions taken to avoid such a complication. However, the trend seems to be towards minimal use of antiseptic techniques. Further large prospective studies are needed to determine how frequently septic arthritis of the knee is encountered post steroid injection, and the exact precautions that should be taken to avoid it.

Adult↗

PubMed2006

Experience with intradermal injection and intradermal-plus-deep injection in the radioguided sentinel node biopsy of early breast cancer patients.

AIMS: Methods of administering (99m)Tc-phytate during sentinel node biopsy of early breast cancer patients were compared to improve the sensitivity of the technique. METHODS: Two injection methods, intradermal vs. intradermal-plus-deep injection, were compared in 648 early breast cancer patients. Intradermal injection was done in 323 consecutive patients (325 breasts), and intradermal-plus-deep injection was done in 325 consecutive patients (329 breasts). The following items were compared: (1) The number of axillary nodes detected scintigraphically and removed surgically, and the breast number of micrometastasis to axillary nodes; (2) The number of internal mammary nodes detected scintigraphically and removed surgically; and (3) The sensitivity of axillary SNB. RESULTS: The number of axillary nodes scintigraphically detected was 1.63+/-0.80 (mean+/-SD) in patients given intradermal injection, and was 1.82+/-0.94 in patients given intradermal-plus-deep injection. The number of axillary nodes surgically removed was 1.78+/-0.93 in patients given intradermal injection, and was 1.95+/-0.99 in patients given intradermal-plus-deep injection. The visualization of internal mammary nodes was superior with intradermal-plus-deep injection (5/325 for intradermal, and 51/329 for intradermal-plus-deep). The putative sensitivity was 71/72 (98.6%) for the intradermal-plus-deep method and 56/62 (90.3%) for the intradermal method. The frequency of detection of micrometastasis was 24 in 71 true positive (38.8%) for the intradermal-plus-deep method and 13 in 56 true positive (23.2%) for the intradermal method. CONCLUSIONS: The SNB procedure with the intradermal-plus-deep injection method detected more axillary and internal mammary nodes, more (not statistically significant) micrometastasis and improved the putative sensitivity more than the SNB procedure with the intradermal injection method.

Axilla↗

PubMed2006

Injections for health-related reasons amongst injecting drug users in New Delhi and Imphal, India.

OBJECTIVES: In many parts of the world where unsafe injection practices in health settings are common, the prevalence of blood-borne viruses (BBVs) is high amongst injecting drug users (IDUs). If IDUs in these settings are receiving injections for health-related reasons, the possibility of amplification of BBV transmission via medical injections exists. The aim of this study is to describe the nature and extent of injections received for health-related reasons amongst IDUs in two Indian cities, New Delhi and Imphal. METHODS: A cross-sectional survey of 200 IDUs was conducted in late 2004. Trained peer outreach workers asked participants about health problems experienced, consultations with healthcare providers and health-related injections received in the preceding 4 weeks. RESULTS: Most participants (99.5%) were male, the average age was 29 years, and the average time since first injection of illicit drugs was 6 years. A total of 133 injections were received for health-related reasons during the preceding 4 weeks by 15% of the participants. The average number of injections was 8.6/participant/year. CONCLUSION: Injections for health-related reasons were commonplace amongst these IDUs. Therefore, amplification of BBV transmission within communities due to unsafe injections is possible and warrants further investigation.

Adolescent↗

PubMed2004

Injection pain and postinjection pain of the palatal-anterior superior alveolar injection, administered with the Wand Plus system, comparing 2% lidocaine with 1:100,000 epinephrine to 3% mepivacaine.

PURPOSE: The purpose of this prospective, randomized, double-blind study was to compare injection pain and postinjection pain of 2% lidocaine with 1:100,000 epinephrine and 3% mepivacaine using the computer-assisted Wand Plus injection system to administer the palatal-anterior superior alveolar (P-ASA) injection. Additionally study was done to determine if the use of topical anesthetic decreased the pain of needle insertion with the P-ASA injection. STUDY DESIGN: Using a crossover design, 40 subjects randomly received, in a double-blind manner, P-ASA injections of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine and 1.4 mL of 3% mepivacaine, at 2 separate appointments. The P-ASA injection was administered, utilizing the Wand Plus system, 6 to 10 mm into the incisive canal located lingual to the central incisors. The pain of needle insertion, needle placement, solution deposition and postinjection pain were recorded on a Heft-Parker visual analog scale for the 2 P-ASA injections. Eighty injections were randomly administered in the study, 40 using topical anesthetic gel and 40 using a placebo gel. RESULTS: For needle insertion, 30% of the subjects reported moderate/severe pain with the lidocaine solution and 43% reported moderate/severe pain with the mepivacaine solution. There was no significant difference (P > .05) between the topical and placebo groups. For needle placement into the incisive canal, 54% of the subjects reported moderate/severe pain with the lidocaine solution and 58% reported moderate/severe pain with the mepivacaine solution. For anesthetic solution deposition, 8% of the subjects reported moderate pain with the lidocaine solution and 12% reported moderate pain with the mepivacaine solution. There were no significant differences (P > .05) between the lidocaine and mepivacaine solutions. Regarding postinjection pain, when anesthesia wore off on the day of the injection, 20% of the subjects reported moderate/severe pain with the lidocaine solution and 14% reported moderate/severe pain with the mepivacaine solution. Pain ratings decreased over the next 3 days. There were no significant differences (P > .05) between the lidocaine and mepivacaine solutions. Postinjection, 12% and 18% of the subjects experienced temporary numbness/paresthesia of the incisive papilla with the lidocaine and mepivacaine solutions, respectively. Twenty percent and 28% of the subjects had incisive papilla swelling or soreness with the lidocaine and mepivacaine solutions, respectively. There were no significant differences (P > .05) between the lidocaine and mepivacaine solutions. CONCLUSIONS: The P-ASA injection of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine or 3% mepivacaine, administered with the Wand Plus, has the potential to be a painful injection. The use of topical anesthetic did not significantly reduce pain of needle insertion when compared to a placebo. The incidence of postinjection pain, temporary numbness/paresthesia, and incisive papilla swelling or soreness would indicate that some pain and problems occur with the P-ASA technique, regardless of whether 2% lidocaine with 1:100,000 epinephrine or 3% mepivacaine is used.

Adult↗

PubMed1998

Corticosteroid injections for trigger digits: is intrasheath injection necessary?

Ninety-five patients with 107 trigger digits were divided into 2 groups and studied prospectively to evaluate steroid injection placement and efficacy. In 1 group, an attempt was made to deliver 1 injection into the tendon sheath at the A1 pulley. In the other group, 1 injection infiltrated the subcutaneous tissues overlying the A1 pulley. Radiopaque dye provided contrast to the injection medium, and postinjection x-rays identified the true delivery site of the steroid solution. Of the 52 digits into which intrasheath injection was attempted, 19 digits (37%) received all the injection within the sheath, 24 (46%) received medication into both the sheath and the subcutaneous tissues, and 9 (17%) received no medication within the tendon sheath. The results were analyzed to determine whether injection placement influences the efficacy of steroid injection. The confirmed all-sheath injection group exhibited a 47% good response, the mixed sheath and subcutaneous group had a 50% good response, and the all-subcutaneous group had a 70% good response. The results of this study suggest that true intrasheath injection offers no apparent advantage over subcutaneous injection in the treatment of trigger digits.

Betamethasone↗

PubMed1991

Activity of urokinase diluted in 0.9% sodium chloride injection or 5% dextrose injection and stored in glass or plastic syringes.

The effects of the diluent, the container, the i.v. set, and the drug concentration on the adsorption of urokinase to i.v. administration systems were studied, along with the compatibility of urokinase with plastic and glass syringes. Solutions of urokinase 1500 and 5000 IU/mL in 0.9% sodium chloride injection and 5% dextrose injection in glass and polyvinyl chloride (PVC) containers were sampled at 2 and 30 minutes. Administration sets were attached to PVC containers containing the urokinase-5% dextrose injection solutions, and samples were collected at 90 and 150 minutes. Glass and polypropylene syringes containing urokinase 5000 IU/mL in 0.9% sodium chloride injection or 5% dextrose injection were sampled at 0, 4, 8, and 24 hours. Urokinase activity was measured by an in vitro clot lysis assay. No urokinase diluted in 0.9% sodium chloride injection adsorbed to glass or PVC containers. For urokinase 1500 IU/mL in 5% dextrose injection, a loss of 15% to 20% occurred almost instantaneously in PVC containers; additional losses to the infusion sets were minimal. However, for urokinase 5000 IU/mL in 5% dextrose injection, no losses were observed in the PVC systems. No drug loss to glass bottles was seen for urokinase 1500 or 5000 IU/mL in 5% dextrose injection. Urokinase potency remained constant in polypropylene and glass syringes for 24 hours. To minimize urokinase sorption to PVC containers, higher concentrations of urokinase diluted in 5% dextrose injection should be used, provided that clinical safety and efficacy are not compromised. The use of 0.9% sodium chloride injection as a diluent also prevents sorption losses.

Adsorption↗

PubMed1996

The effect of intracorporeal injection plus genital and audiovisual sexual stimulation versus second injection on penile color Doppler sonography parameters.

PURPOSE: We assessed whether genital and audiovisual sexual stimulation following 1 or 2 intracorporeal injections caused the greatest changes in penile hemodynamics as recorded by color Doppler sonography. MATERIALS AND METHODS: A total of 50 impotent patients underwent multiphasic color Doppler sonography of the cavernous arteries before and after intracorporeal injection (phase 1), subsequent genital and audiovisual sexual stimulation (phase 2), a second injection (phase 3) and repeat genital and audiovisual sexual stimulation (phase 4). Peak systolic velocity, end diastolic velocity, resistance index and erectile response were studied. RESULTS: Penile erection after injection 1 was upgraded in 41 patients (82%) by genital and audiovisual sexual stimulation. Further upgrading due to injection 2 with stimulation was noted in 11 patients (22%). Among the patients who completed the 4 phases of the test the maximal peak systolic velocity was noted after 1 and 2 injections in 20 (59%) and 14 (41%), respectively. The resistive index was always increased by genital and audiovisual sexual stimulation compared to post-injection values. The maximal resistive index occurred after initial and repeat genital and audiovisual sexual stimulation in 15 (48%) and 16 (52%) patients, respectively. After injection 1 with genital and audiovisual sexual stimulation, impotence was diagnosed as nonvasculogenic in 14 patients (28%), arteriogenic in 9 (18%), venogenic in 17 (34%) or mixed arteriovenogenic in 10 (20%). After injection 2 with stimulation these results were noted in 18 (36%), 9 (18%), 13 (26%) and 10 (20%) patients, respectively. Thus, there were 4 false-positive cases (8%) of venogenic impotence. CONCLUSIONS: To study cavernous artery inflow and veno-occlusive function, color Doppler sonography should be performed after injection plus genital and audiovisual sexual stimulation. When the erectile response does not equal the maximal physiological erection reported by the patient, a second injection with stimulation should be given.

Audiovisual Aids↗

PubMed2004

Hepatitis C virus among self declared non-injecting sexual partners of injecting drug users.

While much is known about hepatitis C virus (HCV) among injecting drug users (IDUs), there is scant information about the risk of HCV infection to non-injecting sexual partners of injecting drug users; it is possible that such individuals may have a greater risk of acquiring HCV than any other group barring injecting drug users. This study examines the prevalence of HCV among a population of non-injecting sexual partners of injecting drug users. Unlinked anonymous testing for anti-HCV of residual sera stored following the named HIV testing of specimens originally from persons who had indicated to their attending clinicians that they were non-injecting sexual partners of injecting drug users. The prevalence of anti-HCV among the sexual partners was 4.1% (25/611) overall, 6.4% (13/202) among heterosexual male and 3.0% (12/397) among the heterosexual female partners. None of the homosexual/bisexual partners were HCV antibody positive (0/12). Although we cannot be sure how non-injecting partners of injecting drug users acquire their HCV infection, having a relationship with someone who injects drugs may place an individual at appreciable risk of being infected; such individuals should consider being tested for HCV.

Adult↗

PubMedDate not supplied

Medial canthus single-injection peribulbar anesthesia: a prospective randomized comparison with classic double-injection peribulbar anesthesia.

BACKGROUND AND OBJECTIVES: The authors report the first prospective randomized comparison of the medial canthus single-injection peribulbar anesthesia (also called caruncular anesthesia) with the classic double-injection peribulbar technique. METHODS: One hundred patients scheduled for cataract surgery were randomly assigned to either a single medial canthus injection or a double peribulbar injection of mepivacaine 2%. The amount of anesthetic agent injected was clinically adapted to each patient. Akinesia, volume injected, pain, reinjections, and complications were assessed after the procedure. RESULTS: The medial canthus single-injection peribulbar anesthesia was significantly less painful and required less anesthetic agent than the double-injection peribulbar anesthesia. Akinesia score and the reinjection rate were similar in the 2 groups, whereas chemosis was significantly more frequent in the double-injection group. CONCLUSIONS: Medial canthus single-injection peribulbar anesthesia appears to be an effective alternative to the usual double-injection peribulbar anesthesia.

Aged↗

PubMed2003

Injection frequency mediates health service use among persons with a history of drug injection.

Drug injectors are known to have high rates of hospital and emergency room (ER) use. We hypothesized that out-of-treatment injection drug users (IDUs) have higher rates of health service use than methadone-maintained persons, and that heroin injection frequency mediates health service use among drug injectors (IDUs). HIV-negative individuals with a history of drug injection were recruited from a needle exchange program (NEP) and a methadone maintenance treatment program (MMT) in Providence, RI. ER visits, outpatient visits, and hospitalizations in the last 6 months were the dependent variables with number of heroin injections the hypothesized mediator variable. The 472 participants were predominately male (60.6%) and white (82%) with a mean age of 37. NEP clients were more likely than MMT clients to visit an ER (39.2% vs. 29.8%; P=0.03). NEP participants were somewhat more likely to report a hospital admission (16.0% vs. 10.6%; P=0.08). Relative to non-injecting MMT participants, the odds of visiting an ER were 1.80 and 1.67 times higher for subjects recruited through NEP and actively injecting MMT participants, respectively. Additionally, subjects recruited through NEP (OR=2.2) and actively injecting MMT participants (OR=2.3) were over twice as likely to report a hospital admission than non-injecting MMT participants. Each increase of one heroin injection per day increased the expected odds of injection-related infection by a factor of 1.92. NEP clients are more likely to have ER visits and hospitalizations than methadone clients. We describe a pathway by which injection frequency influences health service use.

Adult↗

PubMed1998

Multi-site samples of injecting drug users in Edinburgh: prevalence and correlates of risky injecting practices.

AIMS: To estimate the frequency of injecting and prevalence of equipment sharing and other risky injecting practices among intravenous drug users (IDUs) and to identify correlates of these behaviours. DESIGN: Three cross-sectional surveys of IDUs by face-to-face interview in the years 1992-94. SETTING: Multiple treatment and non-treatment sites throughout the city of Edinburgh, Scotland, UK. PARTICIPANTS: Six hundred and thirty-four interviews of 480 IDUs who reported having injected a drug in the previous six months. MEASUREMENTS: Self-reports of drug-taking behaviours, service contact, sexual behaviour and HIV knowledge, and anonymous testing of saliva for HIV antibodies. FINDINGS: Only 18% had injected at least daily. Thirty-five per cent had accepted or passed on used equipment. Eighty-five per cent of subjects recruited from non-treatment sites were receiving treatment for their drug taking. Multivariate analyses indicated that risky injecting was associated with a consistent history of sharing, polydrug injecting, injecting in prison, having recently started injecting, and recent experience of methadone detoxification. CONCLUSIONS: Injecting frequency and equipment sharing have declined substantially in Edinburgh during the past 10 years and are low compared to other cities in the United Kingdom and elsewhere. These improvements have occurred in the context of remarkably high levels of drug treatment service contact. Our findings support the international evidence indicating that IDUs have modified their injecting habits significantly without completely eliminating this form of HIV risk. High levels of service contact in Edinburgh provide ample opportunities to instigate further HIV prevention measures which target identifiable subgroups of IDUs who persist in risky injecting.

Adolescent↗

PubMed2003

Post-Vietnam heroin use and injection by returning US veterans: clues to preventing injection today.

AIMS: To seek clues in the Vietnam study of 30 years ago that might shed light on which previous users of heroin are at special risk of relapsing and, among relapsers, to identify those likely to begin or return to injecting heroin. DESIGN: To analyse information in military records and in two interviews given in the first 3 years after return from Vietnam to find predictors of post-Vietnam injection by soldiers who had used heroin while in Vietnam in 1970-71. PARTICIPANTS: A total of 374 Vietnam veterans who had used heroin while in Vietnam and had been interviewed twice since their return from Vietnam. MEASUREMENTS: Post-Vietnam heroin injection was determined in either of two post-Vietnam interviews. Possible predictors came from interviews and military records and describe pre-Service and in-Vietnam status and behavior. Included are region of residence, race, antisocial behavior, type and level of drug use and association with illicit drug users. Possible post-Vietnam correlates of heroin injection were no job or school enrollment, alcohol problems, depression, absent or transient marriage, association with illicit drug users and other Vietnam veterans. FINDINGS: Only a minority of those who used heroin in Vietnam had ever injected it there. Most smoked or snorted it. After their return, most of the men who had used heroin in Vietnam used it very occasionally or not at all. Among those who did use heroin more than five times after their return, most had tried injecting it. Significant predictors of post-Vietnam injection included living on the east or west coast, deviant behavior both before and in Vietnam, opiate use before Vietnam, serious involvement with heroin in Vietnam, use of non-opiate drugs before and in Vietnam, and associating with drug users before Service. The variables that increased significantly the probability of injection among men who relapsed to heroin use after return to the United States were living on the east or west coast and having a history of using non-opiate illegal drugs before they entered Service. Blacks who returned to heroin use after return were less likely to inject than were non-blacks. CONCLUSIONS: These results suggest that a high-risk group for intervention to prevent future injection would consist of people with a history of past heroin use who are currently either in remission or using without injection and who reside on either coast, have a history of antisocial behavior and have used a variety of illicit drugs other than heroin.

Adult↗