Scientific Publications
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General Sequence | Injection Sequence | Paraphernalia | Topics | Year, Country & WebLink | Short Summary | Conclusion | Recommendation |
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Before Administration | Preparing Hands | Alcohol Swab | Injecting Behaviors and Bacterial Infection Risks from Skin |
We performed a comprehensive review of bacterial infections in people who use drugs. |
Most of the bacterial infections in people who inject drugs were a result of:
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Harm Reduction programs should provide skin cleaning paraphernalia and educate. |
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Before Administration | Preparing Hands | Liquid Disinfectant | Impact of Hand Cleanliness and Type of Solutions |
2008, UK, http://www.scotland.gov.uk/Resource/Doc/127313/0057758.pdf |
page 24,
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Before Administration | Adding Acidifier | Citric/Ascorbic Acid | Citric/Ascorbic Acidifiers, Dosage, and Vein Risk |
2008, UK, http://www.scotland.gov.uk/Resource/Doc/127313/0057758.pdf |
Starting at p.26 |
The results show advantages and disadvantages for both citric and ascorbic acids and favour small quantities added stepwise. Which sterile acid presents the least theoretical risk to veins?
What minimum quantities of acid dissolve heroin?
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Acidifier should be added in small quantities such as 'small pinches' and needs to be administered slowly. |
Before Administration | Adding Acidifier | Citric/Ascorbic Acid | Acidifier Introduction and Impact on IDU Attendance |
2007, UK, http://www.harmreductionjournal.com/content/pdf/1477-7517-4-21.pdf |
We examined whether the introduction of citrate in SEPs has altered the number of heroin/crack injectors accessing SEPs, the frequency at which heroin/crack injectors visited SEPs and the number of syringes dispensed. Neither new (first seen in either six months period) nor established clients visited SEPs more frequently post citrate. |
The introduction of citrate did not negatively affect SEP attendance. Longitudinal attenders' visited SEPs more frequently post citrate, providing staff with greater opportunity for intervention and referral. |
Introduction of acidifier increase clients’ frequency visit. |
Before Administration | Filtering | All Filters | Crushed Tablets and Filters Performance |
2009, Australia, http://www.harmreductionjournal.com/content/pdf/1477-7517-6-37.pdf |
Injections of mixtures prepared from crushed tablets contain insoluble particles which can cause embolisms and other complications. Although many particles can be removed by filtration, many injecting drug users do not filter due to availability, cost or performance of filters, and also due to concerns that some of the dose will be lost. Injection solutions were prepared from slow-release morphine tablets (MS Contin®) replicating methods used by injecting drug users. |
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Before Administration | Choosing Needle | Syringe | Needle Licking Prevalence and Potential Germ Risk |
2008, USA, http://www.ncbi.nlm.nih.gov/pubmed/18638706 |
IDUs with poor hygiene practices are at risk for infection with their commensal flora. One example of a poor hygiene practice is licking the needle prior to injecting the drug. There are few published reports addressing the proportion of IDUs who lick their needles prior to injection and no prior studies evaluating the reasons for this practice. |
We conducted face-to-face interviews with 40 IDUs. We collected data regarding whether the subject licked the needle before injecting drugs, whether the subject licked the injection site before or after injecting drugs, and the reasons they report for doing so. 32.5% of IDUs reported licking their needles prior to injecting. Reasons included ritualistic practices, cleaning the needle, enjoying the taste of the drug, checking the "quality" of the drug, and checking that the needle was in usable condition. In our study, approximately one-third of IDUs licked their needles prior to injecting. More data are needed to demonstrate whether the practice of needle licking significantly increases a person's risk for infection with oropharyngeal flora. |
Medical providers should ask patients about specific practices surrounding injection drug use, and educate drug users about avoiding unhygienic injection practices. |
Before Administration | Choosing Syringe | Syringe | Syringe Re-use Behavior and Housing |
2011, Canada, http://www.ncbi.nlm.nih.gov/pubmed/21355916 |
Systematic reviews and meta-analyses show that needle exchange programs reduce HIV and HCV transmission for IDUs but far less is known about the injection practices of IDUs enrolled in these programs. This study adopts a mixed methods approach to quantify high-risk injection practice patterns among IDUs enrolled in a needle exchange program and gather qualitative data to understand underlying injection behaviour rationales and patterns. |
Univariate analysis showed all respondents reporting at least one high-risk practice within the past month. Multivariate logistic regression analysis using input from the clientele confirmed the importance of housing status as a determinant of injection practices. |
The importance of housing status points to the need to combine needle exchange and appropriate housing. |
Before Administration | Choosing Syringe | Low Dead Space Syringe | Factors Affecting Needle and Syringe Preference, Gender |
2002, USA, http://www.ncbi.nlm.nih.gov/pubmed/12365524 |
IDUs, a group at elevated risk for HIV transmission, use syringes manufactured in two styles, one of which (the integral cannula type) retains substantially less blood after intravenous use than the other (the detachable needle type). In this report, we examine some of the factors associated with use of syringes with detachable needles among 500 IDUs in San Antonio, Texas, using data from epidemiological surveys, ethnographic studies, and historical observations. Ethnographic data suggested the following perceived benefits with detachable needle syringes :
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Needle gauge is another factor that influences. Many IDUs, particularly those who began injecting more recently and still have good veins, prefer the smaller 28 gauge needles because they tend to be less painful to use and do less damage to veins. Conversely, some IDUs who have been injecting longer and have poor veins may prefer the larger 25 gauge needles because they do not clog as easily, and they can penetrate thick scar tissue without bending. In cities where syringes are difficult to obtain prefer the larger gauge needles because they are more durable. Fluid can be drawn into larger gauge needles and expelled much more rapidly than from smaller gauge needles. Males reported detachable needle use more commonly (43%, OR=1.37) than females (26%). |
Harm reductsion programs should take these factors into consideration while selecting paraphernelia to be distributed and promoting low dead space syringes. |
During Administration | Selecting Injection Site | Syringe | Femoral Injection Damage and Syringe Specification |
Clinical and behavioural markers of severe femoral vein (FV) damage among groin injectors (GI) by comparison of 67 GIs with severely damaged FV and 86 GIs with minimal/moderate damage. The majority were men (69.3%) and the mean age was 36.2 years with mean duration of injecting drug use of 13.3 years. There were no significant between-group differences in age, gender or duration of IDU. |
Severe FV damage was associated with longer duration of groin injecting, use of thick needles (blue-hub, 23G; or green-hub, 21G), benzodiazepine injection, history of deep vein thrombosis, and recurrent deep vein thrombosis, presence of depressed groin scar, and chronic venous disease. Logistic regression analysis revealed needle size and deep vein thrombosis as the main predictors of severe FV damage. |
Needle and syringe exchange services should consider only supplying appropriate lengths of orange-hub needle (25G) on request from GIs. |
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During Administration | Selecting Injection Site | Syringe | Jugular Injections Prevalence among IDUs, Gender |
2008, Canada, http://www.ncbi.nlm.nih.gov/pubmed/18584397 |
Jugular injection of drugs has been reported, although little is known about the prevalence of and risk factors associated with this behaviour. We evaluated factors associated with jugular injection among a cohort of IDU in Vancouver, Canada. 780 IDU were followed up and 25% reported jugular injection in the previous 6 months. |
In multivariate analyses, factors associated independently with jugular injection included:
Reporting a history of jugular injecting was alarmingly high in the cohort and was associated with several identifiable demographic and drug-using characteristics. |
Given previous reports demonstrating the risk of infection and vascular trauma due to this behaviour, these populations should be considered seriously as a target for safer injecting education. |
During Administration | Selecting Injection Site | Syringe | Femoral Injection Prevalence among IDUs |
Injecting in the femoral vein (FV), often called 'groin injecting', is a serious cause of risk and harm. This study aimed to examine femoral injecting sites and assess venous health, with the intention of developing improved responses. |
A total of 160 groin scans were performed in 84 GIs.
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These findings should further alert clinicians, policy-makers and patients to the urgent need for effective harm reduction responses to groin injecting behaviour. |
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During Administration | Administrating | Alcohol Swab | Skin-Popping and Abscesses and Cellulitis |
2000, USA, http://www.columbia.edu/itc/hs/pubhealth/p8473/misc/binswanger_lec_8.pdf |
The prevalence of and risk factors for abscesses and cellulitis were investigated among a community sample of IDUs. Participants were interviewed, and those with symptoms were examined. Of 169 IDUs, 32% had abscesses, cellulitis (n=5), or both (n=14); 27% had lanced their own abscesses; and 16% had self-treated with antibiotics they purchased on the street. |
IDUs who skin-popped (injected subcutaneously or intramuscularly) were more likely to have an abscess or cellulitis than those who had injected only intravenously. The likelihood of abscesses and cellulitis increased with frequency of skin-popping and decreased with increasing duration of injection drug use. Abscesses are extremely prevalent among IDUs in San Francisco. Skin-popping is a major risk factor, and self-treatment is common. |
Education about safe and sterile injection techniques could help IDUs preserve access to their veins and reduce the risk of infections associated with skin-popping. For the prevention of abscesses and cellulitis, alcohol prep pads alone may not be sufficient to clean injection sites. Alcohol lacks the sustained residual antimicrobial activity of chlorhexidine and iodophors, and prep pads are small. Other antiseptic products and techniques should be explored. |
During Administration | Administrating | Syringe | Injecting Behaviors and Bacterial Infection Risks |
We performed a comprehensive review of bacterial infections in people who use drugs. |
Most of the bacterial infections in people who inject drugs were a result of:
A number of other factors have been linked to soft tissue infection and infection in other parts of the body including
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Harm Reduction programs should provide skin cleaning paraphernalia, educate IDUs about the risks of “booting”, skin popping, use of tap water and saliva and needle licking. |
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During Administration | Administrating | Syringe | Women and Injecting-Related Injuries |
2009, Australia, http://www.ncbi.nlm.nih.gov/pubmed/19167171 |
The process of drug injection may give rise to vascular and soft tissue injuries and infections. The social and physical environments in which drugs are injected play a significant role in these and other morbidities. |
As in previous research, women were more likely to report injecting-related injury and disease. There are several possible explanations for this finding:
Although a report is often cited as evidence that women have smaller veins, this qualitative study provides limited anatomical evidence. Indeed, gender differences in vein size are debated in the broader medical literature. |
Findings support the imperative for education and prevention activities to reduce the severity and burden of these preventable injecting outcomes. |
During Administration | Administrating | Syringe | IDUs, Gender, and Prevalence of Injecting-Related Problems, Injury, and Disease |
2009, Australia, http://www.ncbi.nlm.nih.gov/pubmed/19167171 |
The process of drug injection may injure and infect vascular and soft tissue. The social and physical environments in which drugs are injected play a significant role in these and other morbidities. We estimate lifetime prevalence of injecting-related problems, injury and disease and explore the socio-demographic and behavioral characteristics associated with the more serious complications of self-report data from 9552 IDUs. |
Lifetime history of either injecting-related problems (IRP) or injecting-related injury and disease (IRID) was reported by 29% of the 9552 IDUs;
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Findings support:
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After Administration | Cleaning Equipment | Bleach | Concentrations of bleach on in vivo tissue inflammation and HIV-1 replication |
2000, USA, http://www.ncbi.nlm.nih.gov/pubmed/10773730 |
The use of bleach (hypochlorite) as a disinfectant for drug injection equipment in the intravenous-drug-using population was recommended early in the HIV-1/AIDS epidemic. Epidemiological studies have challenged the use of bleach as an effective measure to prevent HIV-1 transmission. However, in vitro HIV-1 coculture studies have shown that a high concentration of bleach is an effective cytotoxic and potentially virucidal agent. Low concentrations of oxidants have been shown to enhance tissue inflammation, in vivo, as well as HIV-1 replication in vitro. |
The likelihood of an injection drug user contracting HIV-1 through the sharing of a bleach-cleaned blood-contaminated syringe may be increased by the cotransmission of residual bleach and its localized tissue-inflammatory effects; however, this has not been statistically proven in epidemiological studies |
Bleach migh enhence tissue inflammation. |
After Administration | Caring for Soft Tissue | Ointment | IDUs, Gender, and Prevalence of Injecting-Related Problems, Injury, and Disease |
2009, Australia, http://www.ncbi.nlm.nih.gov/pubmed/19167171 |
The process of drug injection may injure and infect vascular and soft tissue. The social and physical environments in which drugs are injected play a significant role in these and other morbidities. We estimate lifetime prevalence of injecting-related problems, injury and disease and explore the socio-demographic and behavioral characteristics associated with the more serious complications of self-report data from 9,552 IDUs. |
Lifetime history of either injecting-related problems (IRP) or injecting-related injury and disease (IRID) was reported by 29% of the 9552 IDUs;
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IRPs and IRIDs were common. Findings support:
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