Groin injecting among a community-recruited sample of people who inject drugs in Thailand

Lianping Ti,Kanna Hayashi,Thomas Kerr,Evan Wood,Karyn Kaplan,Paisan Suwannawong

doi:10.1186/1747-597x-9-4

Abstract

BackgroundUse of the femoral vein for the injection of illicit drugs (i.e. groin injecting) has been linked to various health-related harms, including deep vein thrombosis. However, little is known about the prevalence of groin injecting and factors that predict this practice among people who inject drugs (PWID) in Thailand. We sought to investigate the prevalence and factors associated with groin injecting in Bangkok, Thailand.MethodsData were derived from the Mitsampan Community Research Project in Bangkok between July and October 2011. Multivariate logistic regression was used to identify factors associated with groin injecting in the last six months.ResultsAmong 437 participants, 34.3% reported groin injecting in the last six months. In multivariate analyses, factors positively associated with groin injecting included: having higher than secondary education (adjusted odds ratio [AOR] = 1.59; 95% confidence interval [CI]: 1.00 – 2.56), weekly midazolam injection (AOR = 8.26; 95% CI: 5.04 – 14.06), and reports of having had drugs planted on oneself by police (AOR = 2.14; 95% CI: 1.37 – 3.36).ConclusionsOver one-third of our sample of Thai PWID reported recent groin injecting. Frequent midazolam injection and higher education were found to be associated with groin injecting. That high intensity PWID were more likely to inject in the groin is concerning given the known negative consequences associated with the groin as a site of injection. Additionally, PWID who reported drug planting by police were more likely to inject in the groin, suggesting that reliance on law enforcement approaches may undermine safe injection practices in this setting. These findings highlight the need for evidence-based interventions to address the harms associated with groin injecting, including efforts to alert PWID to risks of groin injecting, the distribution of appropriate injecting equipment, and efforts to encourage use of other injecting sites.

Highlights

Use of the femoral vein for the injection of illicit drugs has been linked to various health-related harms, including deep vein thrombosis
Given previous work suggesting a strong association between drug planting by police and midazolam injecting [18], as a subanalysis, we examined potential interaction effects between drug planting by police and midazolam injection in the previous six months
Studies conducted in Seattle, Washington and six locations in the United Kingdom (UK) (i.e., Manchester, Bristol, Teeside, Plymouth, Exeter, and Wigan) reported that 40% and 45% of people who inject drugs (PWID) in their sample had injected in the femoral vein, respectively [4,24]

Summary

Introduction

Use of the femoral vein for the injection of illicit drugs (i.e. groin injecting) has been linked to various health-related harms, including deep vein thrombosis. There has been growing concern over the use of the femoral vein for intravenous access (i.e. groin injecting) by people who inject drugs (PWID). The low price of midazolam, and the fact that midazolam is easy to acquire as a licit drug, makes this substance an appealing alternative to heroin for Thai PWID [8]. The use of this particular drug may be a concern given that there may be health-related complications (e.g., venous blockage leading to amputation) that could adversely impact the health of PWID [12]

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Results

Discussion

Conclusion