«One prick and then it´s done»: a mixed-methods exploratory study on intramuscular injection in heroin-assisted treatment.
«One prick and then it´s done»: a mixed-methods exploratory study on intramuscular injection in heroin-assisted treatment.
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DOI：
10.1186/s12954-021-00584-3
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发表时间：
2021-12-18
影响因子：
4.4
通讯作者：
Vogel M
中科院分区：
文献类型：
--
作者：
Meyer M;Eichenberger R;Strasser J;Dürsteler KM;Vogel M
肌内 (IM) 注射药物与注射相关损伤和疾病的高发生率有关。然而，人们对这种给药途径在海洛因辅助治疗中的作用知之甚少。本研究的目的是确定肌内注射二乙酰吗啡的患病率和相关并发症，并探讨患者对此主题的看法和意见以及这种做法的根本原因。研究地点是瑞士一家专门从事海洛因辅助治疗的门诊治疗中心。我们对两名肌肉注射二乙酰吗啡的患者进行了深入访谈。对访谈进行定性分析，并使用新出现的主题来制定包含 38 项的肌内注射调查问卷。然后，我们向治疗中心的所有患者提供了这份调查问卷。深入访谈中出现了五个主题：静脉通路不良、副作用、主观影响、肌内注射程序以及肌内注射替代方案的考虑。这些主题涵盖了使用这种给药途径的基本原理、并发症、肌内注射二乙酰吗啡的主观效果、卫生和安全措施以及替代给药途径。 53 名患者填写了调查问卷。肌内注射的终生患病率为 60.4% (n = 32) 和 34.4% (n = 11) 的患者表示肌内注射是他们的主要给药途径。没有参与者报告使用即时通讯途径贩毒。肌内注射的主要原因是静脉通路不畅。给出的其他原因包括节省时间和减少受伤风险。并发症包括肌肉组织硬结和疼痛，而血栓形成和注射部位感染等更严重的并发症的报道则要少得多。随着阿片类药物依赖人群的老龄化和静脉恶化的可能加剧，肌肉注射的频率也会相应增加。尽管我们的数据表明，在临床环境中肌内注射二乙酰吗啡是一种常见做法，并且似乎相对安全，但仍需要对替代给药途径进行研究，以在海洛因辅助治疗中提供潜在危害较小的替代给药途径。
Intramuscular (IM) injection of drugs is associated with high rates of injecting-related injuries and diseases. However, little is known about the role of this route of administration in heroin-assisted treatment. The aim of this study was to determine the prevalence of IM diacetylmorphine administration and associated complications as well as to explore patients’ views and opinions on the topic and the underlying reasons for this practice. The research site was a Swiss outpatient treatment centre specialised in heroin-assisted treatment. We conducted in-depth interviews with two patients who intramuscularly inject diacetylmorphine. Interviews were analysed qualitatively, and emerging themes were used to develop a 38-item questionnaire on IM injections. We then offered this questionnaire to all patients in the treatment centre. Five main themes emerged from the in-depth interviews: poor venous access, side effects, subjective effects, procedure for IM injection, and consideration of alternatives to IM. These themes covered the rationale for using this route of administration, complications, subjective effects of IM diacetylmorphine, hygiene and safety measures as well as alternative routes of administration. Fifty-three patients filled in the questionnaire. The lifetime prevalence of IM injections was 60.4% (n = 32) and 34.4% (n = 11) of the patients stated that IM injection was their primary route of administration. No participant reported using the IM route for street drugs. The main reason for IM injections was poor vein access. Other reasons given were time saving and less risk of injuries. Complications included induration of muscle tissue and pain, whereas more severe complications like thrombosis and infections of the injection site were reported much less often. As the population of opioid-dependent individuals is aging and the deterioration of access veins is likely to increase, the frequency of IM injecting will equally increase. Even though our data show that the IM injection of diacetylmorphine in a clinical setting is a common practice and appears to be relatively safe, research on alternative routes of administration is needed to provide potentially less harmful alternative routes of administration in heroin-assisted treatment.
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