A new type of harm reduction: Creating an arteriovenous fistula for a compulsively injecting opiate user

Compulsive intravenous opiate injectors often cause themselves recurrent physical damage, which sometimes threatens life or limb. Unsuccessful attempts to find a vein can occupy several hours of each day, during which blood may clot in the syringe, making injection even more difficult. Adding small amounts of heparin to the opiate in the syringe before injecting prevents clotting but may be only partially helpful. The authors describe the first reported case in which an arteriovenous fistula was created specifically to enable a compulsive injector to inject quickly, easily, and safely.