1. Femoral (‘groin’) injecting David Griffin John Maliphant Jenny Scott Chair: Jon Derricott

2. Purpose and format of session Aim to stimulate discussion around the provision of safer injecting advice on groin injecting Bristol Drugs Project study (JS & JM) ‘Grass roots’ experience and key points for debate (DG)

3. ‘Groin’ injecting Into femoral vein; in close proximity to femoral artery and femoral nerve

4. Bristol Drugs Project study Ref: Harm Reduction Journal (2005), 2:6 www.harmreductionjournal.com/content/2/1/6 Background: observed a perceived increase in number of people using needle exchange who were IV in groin site. Wanted to explore this further to establish statistics on frequency and gather more information on reasons why and problems experienced

5. Bristol Drugs Project study (2) Method: ‘snap shot’ short interview with all willing users of the BDP needle exchange over a one-week period (convenience sample) Results: 98 interviews, 47 injecting into groin (48%). Of these: –66% (n=31) male, 34% (16) female –Mean age 31 yrs (range: 17-50yr, SD 7.7) –Mean length of time since 1 st injection 9.6yrs (0.5-30yr; 7.0) –Mean length of time since 1 st use groin 2.6yrs (1mth -15yr; 3.3) –Most had used other sites first –98% (n=46) inject heroin; 40% (19) inject crack (16 inj both). –Most commonly use detachable 1ml syringes with orange (0.5 x 25mm, 25G) needles (70%, n=33); 23% (n=11) use blue (0.6 x 30mm, 23G) –34% (n=16) no access problems; 66% (n=31) had experienced access problems inc, hard scar tissue, swelling, pain, dvt (Dx?)

6. Bristol Drugs Project study (3) Observations and talking points: –Convenience of groin site perceived –Perceived ‘thing to do’ –Rotating sites is difficult –dexterity issues –Fear of losing hit –Groin sinuses useful for continued access

7. Points for discussion Should we give advice on groin injecting? What should that advice be? How far do we go? What research evidence is there to support our actions? What research needs to be done? What training should workers receive? How should consequence of worker advice be monitored? Insurance by employers?