Drug and Alcohol Dependence 62 (2001) 77–82
Physical injecting sites among injecting drug users in Sydney,
Australia
Shane Darke *, Joanne Ross, Sharlene Kaye
National Drug and Alcohol Research Centre, Uni6ersity of New South Wales, Sydney NSW
2052
, Australia
Received 4 January 2000; received in revised form 6 June 2000; accepted 6 June 2000
Abstract
A sample of 200 injecting drug users were interviewed about their bodily injection sites. The mean number of injection sites ever
used by subjects was 3.1, with a mean of 2.0 sites used in the previous 6 months. Sixteen percent of subjects had injected in five
or more sites. Almost all (99%) had injected in the cubital fossa (crook of the arm). The next most popular site was the forearm
(71%). Other sites included the hand (53%), foot (19%), leg (18%), neck (10%) and groin (6%). There was a clear progression in
sites used, from the cubital fossa at initial injection to the use of sites such as the groin after 10 years of injecting. Females had
used significantly more injection sites than males and reported more injection-related problems. The use of more injection sites was
independently associated with a greater number of injection-related problems and a greater number of drug classes ever injected.
© 2001 Elsevier Science Ireland Ltd. All rights reserved.
Keywords
:
Injection sites; Drug users; Sydney; Health
www.elsevier.com/locate/drugalcdep
1. Introduction
A great deal of research has been conducted in recent
years on the injecting risk-taking behaviours of inject-
ing drug users (IDU), although this research has fo-
cussed primarily upon the risk of blood borne disease
transmission through the sharing of injecting equip-
ment. It has long been recognised, however, that the act
of injecting per se carries health risks (Cherubin, 1967;
Louria et al., 1967; Ostor, 1977; Haverkos and Lange,
1990; Stone et al., 1990; Levine, 1991; Morrison et al.,
1997). Frequent injections may, for example, cause
vascular damage, irrespective of ‘safe’ injecting prac-
tices. Damage to a favourite injection site may, in
course, lead to the use of other, potentially more dan-
gerous injection sites.
It should not be assumed that injections are restricted
to the arm. In a study of IDU presenting to accident
and emergency, Stone et al. (1990) reported injection
site sepsis in sites such as the groin, the feet and the
neck. While injecting in any site carries risks, the risk of
injecting in sites such as the groin and neck is substan-
tially greater than in sites such as the cubital fossa
(crook of the arm). It is difficult for the person to see
what they are doing in such sites, increasing the risk of
damaging the vein or hitting an artery. As the veins in
sites such as these are substantially larger, any damage
to them may result in serious circulatory problems and
an increased risk of life threatening infections such as
endocarditis.
There are also clear health implications regarding the
types of drugs injected into injection sites. The injection
of oral preparations such as benzodiazepines and
methadone syrup is common among IDU in Australia
and elsewhere (Klee et al., 1990; Strang et al., 1992;
Darke et al., 1995, 1996; Ross et al., 1997), and has
serious health consequences. The injection of
temazepam has been associated with amputations and
death (Ruben and Morrison, 1992; Strang et al., 1992;
Ralston and Taylor, 1993). The injection of methadone
syrup, common in Sydney (Darke et al., 1996) has been
associated with fistulas, abscesses/infections in injection
sites and venous thrombosis (Jenson and Gregerson,
1991; Darke et al., 1996).
Given the paucity of data on the physical injecting
practices of IDU, the current study examined these
behaviours. The study aimed to provide a more com-
* Corresponding author.
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