Abstract
BackgroundWithin the UK, injecting in the femoral vein (FV), often called 'groin injecting', is a serious cause of risk and harm. This study aimed to use ultrasound scanning as a means to engage groin injectors (GIs), examine their femoral injecting sites and assess their venous health, with the intention of developing improved responses.MethodsBetween September 2006 and March 2009, GIs attending a network of community drug treatment centres in South East England were invited to attend an ultrasound 'health-check' clinic. This paper provides a narrative account of the scanning procedure and operation of the service, with descriptive statistical analysis of GIs who attended. The analysis uses a structured, specially-developed clinical data set that incorporates a categorisation for the severity of FV damage. Case studies using ultrasound images and a link to a video are provided to illustrate the range of presentations encountered and the categorisations used for severity.ResultsA total of 160 groin scans (76 bilateral and 8 unilateral) were performed in 84 GIs. The majority were men (69.0%) and the mean age of the sample was 36.8 years. The mean duration of drug use and injecting drug use was 19.7 years and 13.8 years, respectively. FV damage at the injecting site in the right groin was graded as minimal in 20 patients (25%), moderate in 27 (33.8%), severe in 16 (20.0%) and very-severe in 17 (21.3%). Corresponding figures for left FV were 24 (30.0%), 22 (27.5%), 18 (22.5%) and 16 (20.0%). Wide variation was observed in the time to the development of these grades of FV damage.ConclusionsModern, portable ultrasound scanners make it possible to examine the venous health of GIs in community treatment settings. Ultrasound scanning identified extensive FV damage, much hitherto-unrecognised in this population. These findings should further alert clinicians, policy-makers and patients to the urgent need for effective harm reduction responses to GI behaviour. Images of damaged FV in this paper might prove to be a useful resource for discussions about GI risks.
Highlights
Within the UK, injecting in the femoral vein (FV), often called ‘groin injecting’, is a serious cause of risk and harm
Much of the FV damage and functional impairment identified among our sample of symptomatic and asymptomatic groin injectors (GIs) remain underappreciated in terms of its magnitude and impact on drug users
Future studies should examine the factors associated with more rapid FV damage in view of the wide variation in the time to FV damage observed among GIs in this study and by other authors [3]
Summary
Within the UK, injecting in the femoral vein (FV), often called ‘groin injecting’, is a serious cause of risk and harm. Investigations of samples from this population suggest that between a third and one half use the femoral vein (FV) in the groin as their main injecting site [3,4,5]. Groin injectors (GIs) are often unaware of these risks and tend to present late for treatment of injecting complications [5]. Cessation of GI is related to greater treatment retention, but is a function of more severe venous disease [12]. This suggests that innovative approaches are needed, which can better engage people who inject in the FV, so that problems can be recognised and responded to more quickly and earlier cessation of GI can be promoted
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