Incidence of use of the groin and demographics
The interview took approximately 10 minutes. A total of 92 clients were interviewed as part of the wider review and 47 (51%) of these were currently injecting in their groin. None of those who were not injecting in the groin presently had ever done so in the past. Of those injecting in their groin, 66% (n = 31) were male and 34% (n = 16) were female. The mean age of the groin injectors was 31 yrs (SD = 7.7), with the youngest being 17 and the oldest being 50 yrs. Twelve (26%) of the groin injectors were between 17–24 yrs, 29 (62%) were between 25 and 39 yrs and 6 (13%) were between 40–50 yrs.
Length of time injecting
The mean length of time since first injecting episode was 9.6 yrs (SD = 7.0), with the shortest time since first injecting episode being 6 months and the longest time being 30 yrs. Seventeen (36%) had been injecting 5 yrs or less, 12 (26%) had been injecting between 6 and 10 yrs, 10 (21%) had been injecting 11–15 yrs, 6 (13%) had been injecting 16–20 yrs, one (2%) had been injecting for 25 years and one (2%) for 30 years.
Length of time of groin injecting
The mean length of time since use of the groin site began was 2.6 years (SD = 3.3), with the shortest time being 0.08 years (1 month) and the longest time being 15 years. The mode length of time was 2 years, reported by 6 people (13%).
Time from first injecting episode to first use of the groin
The mean length of time between first injection and first use of the groin for IV access was 7.0 yrs (SD = 7.0). Two people (4%) had been using the groin for IV access since they first began injecting, both were male. One had tried to inject into the arms unsuccessfully prior to using the groin, so switched to the groin straight away. This person was very thin with no visible veins, so chose to use the groin to ensure IV access. The other person had not tried any other injecting sites prior to the groin, as all his associates who were injecting at the time were using the groin, encouraging him not to attempt to try any others first. Twenty five people (53%) had begun using the groin within 5 years from their first injection and 11 (23%) had begun using the groin 5 or more yrs but less then 10 years since their first injection. Eleven people (23%) had begun using the groin 10 or more yrs since their first injection. The longest time between first injection and use of the groin was 23 yrs in a male who had begun injecting 25 yrs ago but only started using the groin 2 yrs ago.
Areas used prior to the groin
People were asked to report which areas they had injected into prior to using the groin. One (2%) person had used no other area for venous access prior to using the groin and had been using this site for 15 years. Nine (19%) people had used one other area and in all cases this was the cubital fossa (inner crook of the arm). Nine (19%) people had used two areas prior to the groin, all of these cases had used the cubital fossa, seven had also used site(s) on the legs, one had used the foot and one had used the neck. Ten (21%) people had used three areas prior to using the groin. Again in all cases the cubital fossa had been used, nine of the ten had used sites on the legs, six had used the feet and five had used the neck. Five (11%) people reported injecting in four areas prior to the groin. All had used the same four areas, which were the cubital fossa, legs, feet and neck. Thirteen (28%) people had used more than four areas prior to the groin and classed themselves as having used 'everywhere'.
Why did you start injecting in your groin?
The main reason given for starting to inject in the groin was that 'no other sites were left'. However as many people had not tried all other sites, this was probed further. Further discussion found that in the majority of cases, no other convenient sites were perceived to be accessible. Many reported that practises such as the rotation of injecting sites, as advocated in many harm reduction publications, were found to be difficult and unreliable. The risk of 'losing' an injection (missing IV access) through poor injecting technique was considered to be too big a risk, presumably because subcutaneous and intramuscular drug absorption does not provide the same euphoria. Use of the non-dominant hand to administer injections was also reported to be difficult and deter rotation of injecting sites between arms, or require third party assistance. The groin site was reported by most to be convenient, provide quick access, with little mess and less pain than smaller more awkward veins. The gradual formation of sinuses in the groin over time was reported to further facilitate continued use of this site.
Drugs injected into the groin and equipment used
The most common drug injected by the group was heroin, used by 46 (98%) of interviewees. Nineteen people (40%) injected crack cocaine and eight (17%) injected amphetamine. Twenty four people (51%) currently injected one main drug only into the groin, with 23 injecting heroin and one injecting amphetamine. Twenty people (43%) injected two main drugs into the groin, for 16 of these people their main drugs were heroin and crack cocaine. The remaining four injected heroin and amphetamine. Three people injected three main drugs into the groin and for all these were heroin, crack cocaine and amphetamine. No other drugs were reported to be injected into the groin within the group.
The most common injecting equipment used to access the groin was detachable 1 ml syringes with orange needles (0.5 × 25 mm, 25G) used by 33 people (70%), 11 people (23%) used the same syringes with blue needles (0.6 × 30 mm, 23G) and one person (2%) used green needles (0.8 × 40 mm, 21G). Seven people (15%) used 1 ml insulin syringes. Numbers exceed 100% as four people regularly used more than one type of equipment for groin access.
Condition of the groin site and history of access problems
Participants were asked whether they were currently or had in the past experienced any problems gaining IV access using the groin site. They were also asked to self-assess the current condition of their groin based on a five point Likert scale: 'very poor', 'poor', 'OK', 'good' or 'very good'.
Approximately one third of people reported never having had a problem gaining IV access at their groin site (n = 16, 34%). This group comprised 11 males and five females. Five described the current state of their groin site as 'ok', five said it was 'good' and six said it was 'very good'. Their mean length of use of the groin site was 1.1 yrs (SD = 1.2). Approximately two thirds of people had experienced problems with IV access at the groin site on one or more occasions in the past, or were currently experiencing problems (n = 31, 66%). This group comprised 20 males and 11 females. When asked to describe the current condition of their groin two said it was 'very poor', seven said it was 'poor', 14 described it as 'ok', three said it was 'good' and five said it was 'very good'. Their mean length of use of the groin site was 3.3 yrs (SD = 3.8).
When asked to describe the types of access and health problems experienced, a common problem reported was hardened scar tissue occluding the site. This was said to be difficult to penetrate and a cause of needles bending and breaking, causing some people to select longer, thicker needles. Another common problem was swellings in the groin area, accompanied at times by pain. Some people reported infections at the injecting site. Some reported having experienced 'blood clots' or 'DVT' (deep vein thrombosis). It is unknown whether these had been medically diagnosed or treated.