title: Injection-site vein loss and soft tissue abscesses associated with black tar heroin injection: A cross-sectional study of two distinct populations in USA.
abstract: 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.
authors: 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. Electronic address: phillip.summers@mail.harvard.edu.
authors: Phillip J
authors: PJ
authors: Summers
authors: University of California, Davis School of Medicine, Sacramento, CA 95817, USA.
authors: Isabelle A
authors: IA
authors: Struve
authors: University of California, Davis School of Medicine, Sacramento, CA 95817, USA.
authors: Michael S
authors: MS
authors: Wilkes
authors: Center for Global Tobacco Control, Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
authors: Vaughan W
authors: VW
authors: Rees
mesh_terms: D000038:Abscess / Q000150:complications*; D000328:Adult; D001900:Boston; D002140:California; D003430:Cross-Sectional Studies; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D000075662:Injection Site Reaction / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D003932:Heroin
keywords: Black tar heroin; Harm reduction; Injection drug use; Injection-site vein loss; Skin and soft tissue abscess; Skin popping; Soft tissue injection