Correlates of Difficult Venous Access Among People Who Inject Drugs Utilizing Medical Services in an Urban Hospital Setting.

Abstract

Background: Injection drug use (IDU) is associated with health risks, including infections, vascular damage, and overdose. Among those who inject drugs, having trouble accessing veins may lead to riskier injection practices and result in higher morbidity and mortality. This study explores patient characteristics associated with difficult venous access, with particular attention to disparities facing women who use drugs.

Methods: Survey data were collected from 120 people who inject drugs who accessed medical services at an urban academic medical center.

Results: Most participants were men (68%) in their thirties (56%), of white race (95%), and had experienced housing insecurity in the last 3 months (77%). Heroin and fentanyl were the most commonly injected drugs (79%). Most participants (77%) reported difficulty with venous access. Those with difficult venous access reported a greater number of years of injection experience (median: 15 vs 11, P = .020). Difficult venous access was significantly associated with female gender identity (92% vs 70%, P = .009), injection by someone else (93% vs 64%, P < .001), injection into subcutaneous tissue (95% vs 56%, P < .001), and injection into the neck (96% vs 73%, P = .024).

Conclusions: Given that difficult venous access is associated with injection behaviors that portend higher risks of health complications, clinicians and harm reduction providers should discuss venous access with their patients who use drugs and provide counseling around safer injection practices. Future interventions should be tailored to those groups at the highest risk of difficult venous access, including women who use drugs, those who are injected by others, and people with a long history of IDU.