@article{ref1,
title="High rates of midazolam injection and associated harms in Bangkok, Thailand",
journal="Addiction",
year="2013",
author="Hayashi, Kanna and Suwannawong, Paisan and Ti, Lianping and Kaplan, Kalman and Wood, Evan and Kerr, Thomas",
volume="108",
number="5",
pages="944-952",
abstract="AIMS: To identify the prevalence and correlates of midazolam injection among injecting drug users in Thailand. DESIGN: Serial cross-sectional mixed-methods study. SETTING: Bangkok, Thailand. PARTICIPANTS: 435 adults who had injected drug(s) in the past six 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 July-October 2011 (n=435). Additionally, qualitative data were collected in June-July 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 six 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 independently associated with various risk factors for injection-related complications. Given the many deleterious effects of midazolam injection, novel interventions for midazolam injectors are urgently needed.<p /> <p>Language: en</p>",
language="en",
issn="0965-2140",
doi="10.1111/add.12094",
url="http://dx.doi.org/10.1111/add.12094"
}