Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; University of California, Davis School of Medicine, Sacramento, CA 95817, USA.
University of California, Davis School of Medicine, Sacramento, CA 95817, USA.
Int J Drug Policy. 2017 Jan;39:21-27. doi: 10.1016/j.drugpo.2016.08.006. Epub 2016 Oct 18.
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.
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.
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 (β=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% CI: 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.
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.
注射部位静脉损失和皮肤脓肿给注射毒品者（PWID）带来了重大的发病率。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。很少有研究调查过这些不同形式的海洛因及其对健康结果的潜在影响。
对在美国加利福尼亚州萨克拉门托和马萨诸塞州大波士顿的减少设施寻求服务的 145 名参与者进行了多项选择调查。用于报告一年内出现一个或多个脓肿、六个月内失去注射部位静脉以及软组织注射的多变量回归模型。
萨克拉门托的参与者仅使用黑焦油（99%），而波士顿的参与者使用粉末海洛因（96%）。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），并且更有可能报告脓肿（AOR=7.68，95%CI：3.01-19.60）。软组织注射也与脓肿有关（AOR=4.68，95%CI：1.84-11.93）。一致的静脉通路（AOR：0.088，95%CI：0.011-0.74）和失去更多注射部位（AOR：1.22，95%CI：1.03-1.45）与软组织注射有关。
使用黑焦油海洛因与更频繁的脓肿和更广泛的静脉损失有关。静脉通路不良使注射毒品者容易发生软组织注射，这可能构成黑焦油海洛因注射与脓肿形成之间的因果关系。必须进一步阐明黑焦油海洛因导致静脉损失和脓肿形成的机制，以便制定维护静脉健康和减少脓肿负担的可行干预措施。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、阿片类药物替代治疗以及针对切割剂的供应链干预。
