Injection-site vein loss and soft tissue abscesses associated with black tar heroin injection: A cross-sectional study of two distinct populations in USA
Injection-site vein loss and soft tissue abscesses associated with black tar heroin injection: A cross-sectional study of two distinct populations in USA
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DOI：
10.1016/j.drugpo.2016.08.006
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发表时间：
2017-01-01
影响因子：
4.4
通讯作者：
Rees, Vaughan W.
中科院分区：
文献类型：
--
作者：
Summers, Phillip J.;Struve, Isabelle A.;Rees, Vaughan W.
背景：注射部位的静脉损失和皮肤肿胀对注射毒品的人（PWID）造成了严重的发病率。在美国，两种常见的街头海洛因形式包括黑焦油和粉末海洛因。很少有研究调查这些不同形式的海洛因和他们的潜在影响health outcome.Methods：一个多项选择的调查管理的样本145名参与者寻求服务，在减少设施在萨克拉门托，CA和大波士顿，MA，美国。多变量回归模型报告一个或多个aperesses在一年内，注射部位静脉在六个月内丢失，和软组织injection.Results：参与者在萨克拉门托专门使用黑焦油（99%），而在波士顿使用粉末海洛因（96%）。那些使用黑焦油海洛因的人失去了更多的注射部位静脉（β =2.34，95% CI：0.66-4.03），更有可能报告出血（AOR=7.68，95% CI：3.01-19.60）。软组织注射也与脓肿相关（AOR=4.68，95% CI：1.84-11.93）。一致的静脉通路（AOR：结论：使用黑焦油海洛因与更频繁的吸毒和更广泛的静脉丢失有关。静脉通路不良使注射毒品的人容易发生软组织注射，这可能构成黑焦油海洛因注射和脓肿形成之间的因果关系。黑焦油海洛因导致静脉损失和脓肿形成的机制必须进一步阐明，以制定可行的干预措施，以维持静脉健康和减少脓肿负担。潜在的干预措施包括增加获得清洁注射设备和教育的机会，监督注射设施，阿片类药物替代疗法以及针对切割剂的供应链干预措施。(C)© 2016 Elsevier B. V.版权所有。
Background: Injection-site vein loss and skin abscesses impose significant morbidity on people who inject drugs (PWID). The two common forms of street heroin available in the USA include black tar and powder heroin. Little research has investigated these different forms of heroin and their potential implications for health outcomes.Methods: A multiple-choice survey was administered to a sample of 145 participants seeking services at reduction facilities in both Sacramento, CA and greater Boston, MA, USA. Multivariate regression models for reporting one or more abscesses in one year, injection-site veins lost in six months, and soft tissue injection.Results: Participants in Sacramento exclusively used black tar (99%), while those in Boston used powder heroin (96%). Those who used black tar heroin lost more injection-site veins (beta=2.34, 95% CI: 0.66-4.03) and were more likely to report abscesses (AOR=7.68, 95% CI: 3.01-19.60). Soft tissue injection was also associated with abscesses (AOR=4.68, 95% Cl: 1.84-11.93). Consistent venous access (AOR: 0.088, 95% CI: 0.011-0.74) and losing more injection sites (AOR: 1.22, 95% CI: 1.03-1.45) were associated with soft tissue injection.Conclusion: Use of black tar heroin is associated with more frequent abscesses and more extensive vein loss. Poor venous access predisposes people who inject drugs to soft tissue injection, which may constitute a causal pathway between black tar heroin injection and abscess formation. The mechanisms by which black tar heroin contributes to vein loss and abscess formation must be further elucidated in order to develop actionable interventions for maintaining vein health and decreasing the abscess burden. Potential interventions include increased access to clean injection equipment and education, supervised injection facilities, opioid substitution therapy, and supply chain interventions targeting cutting agents. (C) 2016 Elsevier B.V. All rights reserved.