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High rates of midazolam injection and associated harms in B angkok, T hailand
Author(s) -
Hayashi Kanna,
Suwannawong Paisan,
Ti Lianping,
Kaplan Karyn,
Wood Evan,
Kerr Thomas
Publication year - 2013
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12094
Subject(s) - midazolam , heroin , medicine , drug injection , confidence interval , odds ratio , logistic regression , anesthesia , drug , psychiatry , sedation
Aims To identify the prevalence and correlates of midazolam injection among injecting drug users in T hailand. Design Serial cross‐sectional mixed‐methods study. Setting B angkok, T hailand. Participants A total of 435 adults who had injected drug(s) in the past 6 months were recruited through peer outreach and word of mouth in Bangkok in 2011. Measurements Multivariable logistic regression was used to analyze self‐reported data collected through an interviewer‐administered survey in J uly– O ctober 2011 ( n = 435). Additionally, qualitative data were collected in J une– J uly 2009 ( n = 10) and analyzed to explore the health problems attributable to midazolam injection. Findings Among 435 survey participants, the prevalence of daily midazolam injection in the past 6 months was 37.0% (95% confidence interval: 32–42). While 75.8% of the daily midazolam injectors identified heroin as their drug of choice, 91.8% of these individuals reported substituting heroin with midazolam when heroin was unavailable. In multivariable analyses, daily midazolam injection was associated with femoral vein injection [adjusted odds ratio ( AOR ) = 4.48], polydrug use ( AOR = 4.94), daily heroin injection ( AOR = 3.25), binge use ( AOR = 1.75) and perceived increase in policing pressure ( AOR = 1.95) (all P < 0.05). Qualitative accounts indicated severe health problems associated with midazolam injection, including nerve and vascular injuries. Conclusion Midazolam misuse is increasing among injecting drug users in Bangkok and appears to be used primarily as a substitute for heroin. Midazolam injection was associated independently with various risk factors for injection‐related complications. Given the many deleterious effects of midazolam injection, novel interventions for midazolam injectors are needed urgently.