Journal of Urban Health

, Volume 89, Issue 2, pp 365–372 | Cite as

Prevalence and Characteristics of Femoral Injection among Seattle-Area Injection Drug Users

  • Phillip O. CoffinEmail author
  • Lara S. Coffin
  • Shilo Murphy
  • Lindsay M. Jenkins
  • Matthew R. Golden


Injection drug use (IDU) into central veins, most common among long-term IDUs with no other options, can lead to severe infectious, vascular, and traumatic medical consequences. To follow-up on anecdotal reports of femoral vein injection and related medical problems in Seattle, we analyzed data from the annual survey of a community-based syringe exchange program. A total of 276 (81%) of 343 program attendees completed the survey in August 2010. Among 248 IDUs, 66% were male, 78% white, and 86% primarily injected opiates. One hundred respondents (40%) had injected into the femoral vein, 55% of whom were actively doing so, and 58% of whom reported medical complications that they attributed to the practice. Most (66%) used the femoral vein due to difficulty accessing other veins, although 61% reported other veins they could access and 67% reporting using other sites since initiating femoral injection. While injecting into muscle was more frequent among older IDUs with longer injection careers, the prevalence of femoral injection was highest among respondents in their late twenties with 2.5–6 years of injecting drugs. Multivariate analysis demonstrated an increased risk of initiating femoral injection each calendar year after 2007. Injecting into the femoral vein was also associated with white versus other race (odds ratio [OR] 2.7, 95% CI 1.3–5.4) and injection of primarily opiates versus other drugs (OR 6.3, 95% CI 1.2–32.9) and not associated with age, length of IDU career, or a history of injecting into muscle. These findings suggest a secular trend of increasing femoral injection among Seattle-area IDUs with a high rate of related medical problems. Interventions, such as education regarding the hazards of central venous injection and guidance on safe injection into peripheral veins, are needed to minimize the health consequences of femoral injection.


Injection drug use Femoral injection Femoral vein Syringe exchange 



Dr. Coffin was supported by National Institute of Allergy and Infectious Diseases training grant (5T32AI007140-33) during the conduct of this research.


  1. 1.
    Kral AH, Bluthenthal RN, Erringer EA, Lorvick J, Edlin BR. Risk factors among IDUs who give injections to or receive injections from other drug users. Addiction. 1999; 94(5): 675–683.PubMedCrossRefGoogle Scholar
  2. 2.
    Ciccarone D. Heroin in brown, black and white: structural factors and medical consequences in the US heroin market. Int J Drug Policy. 2009; 20(3): 277–282.PubMedCrossRefGoogle Scholar
  3. 3.
    Lloyd-Smith E, Kerr T, Hogg RS, Li K, Montaner JS, Wood E. Prevalence and correlates of abscesses among a cohort of injection drug users. Harm Reduct J. 2005; 2: 24.PubMedCrossRefGoogle Scholar
  4. 4.
    Maggi P, Fullone M, Federico M, Angarano G, Pastore G, Regina G. Drug injection in jugular veins: a new risk factor for vascular diseases in HIV-infected patients? A case report. Angiology. 1995; 46(11): 1049–1052.PubMedCrossRefGoogle Scholar
  5. 5.
    Roszler MH, McCarroll KA, Donovan KR, Rashid T, Kling GA. The groin hit: complications of intravenous drug abuse. Radiographics. 1989; 9(3): 487–508.PubMedGoogle Scholar
  6. 6.
    Darke S, Kaye S, Ross J. Geographical injecting locations among injecting drug users in Sydney, Australia. Addiction. 2001; 96(2): 241–246.PubMedCrossRefGoogle Scholar
  7. 7.
    Zador D, Lintzeris N, van der Waal R, Miller P, Metrebian N, Strang J. The fine line between harm reduction and harm production—development of a clinical policy on femoral (groin) injecting. Eur Addict Res. 14(4):213–218.Google Scholar
  8. 8.
    Maliphant J, Scott J. Use of the femoral vein (‘groin injecting’) by a sample of needle exchange clients in Bristol, UK. Harm Reduct J. 2005; 2(1): 6.PubMedCrossRefGoogle Scholar
  9. 9.
    Rhodes T, Briggs D, Kimber J, Jones S, Holloway G. Crack-heroin speedball injection and its implications for vein care: qualitative study. Addiction. 2007; 102(11): 1782–1790.PubMedCrossRefGoogle Scholar
  10. 10.
    McColl MD, Tait RC, Greer IA, Walker ID. Injecting drug use is a risk factor for deep vein thrombosis in women in Glasgow. Br J Haematol. 2001; 112(3): 641–643.PubMedCrossRefGoogle Scholar
  11. 11.
    Kozelj M, Kobilica N, Flis V. Infected femoral pseudoaneurysms from intravenous drug abuse in young adults. Wien Klin Wochenschr. 2006; 118(Suppl 2): 71–75.PubMedCrossRefGoogle Scholar
  12. 12.
    Mackenzie AR, Laing RB, Douglas JG, Greaves M, Smith CC. High prevalence of iliofemoral venous thrombosis with severe groin infection among injecting drug users in North East Scotland: successful use of low molecular weight heparin with antibiotics. Postgrad Med J. 2000; 76(899): 561–565.PubMedCrossRefGoogle Scholar
  13. 13.
    Kaku DA, So YT. Acute femoral neuropathy and iliopsoas infarction in intravenous drug abusers. Neurology. 1990; 40(8): 1317–1318.PubMedGoogle Scholar
  14. 14.
    Mullan MJ, Magowan H, Weir CD. Femoral artery necrosis due to parenteral intravascular drug misuse: a case report and literature review. Ulster Med J. 2008; 77(3): 203–204.PubMedGoogle Scholar
  15. 15.
    Manekeller S, Tolba RH, Schroeder S, Lauschke H, Remig J, Hirner A. Analysis of vascular complications in intra-venous drug addicts after puncture of femoral vessels. Zentralbl Chir. 2004; 129(1): 21–28.PubMedCrossRefGoogle Scholar
  16. 16.
    Hoda Z, Kerr T, Li K, Montaner JS, Wood E. Prevalence and correlates of jugular injections among injection drug users. Drug Alcohol Rev. 2008; 27(4): 442–446.PubMedCrossRefGoogle Scholar
  17. 17.
    Miller PG, Lintzeris N, Forzisi L. Is groin injecting an ethical boundary for harm reduction? Int J Drug Policy. 2008; 19(6): 486–491.PubMedCrossRefGoogle Scholar
  18. 18.
    Higgs P, Dwyer R, Duong D, et al. Heroin-gel capsule cocktails and groin injecting practices among ethnic Vietnamese in Melbourne, Australia. Int J Drug Policy. 2009; 20(4): 340–346.PubMedCrossRefGoogle Scholar
  19. 19.
    Senbanjo R, Hunt N, Strang J. Cessation of groin injecting behaviour among patients on oral opioid substitution treatment. Addiction. 2011; 196(2): 376–382.CrossRefGoogle Scholar
  20. 20.
    Kahn SR. The post thrombotic syndrome. Thromb Res. 2011; 127(Suppl 3): S89–S92.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2012

Authors and Affiliations

  • Phillip O. Coffin
    • 1
    Email author
  • Lara S. Coffin
    • 2
  • Shilo Murphy
    • 2
  • Lindsay M. Jenkins
    • 3
  • Matthew R. Golden
    • 1
  1. 1.Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleUSA
  2. 2.Peoples’ Harm Reduction AllianceSeattleUSA
  3. 3.HIV Prevention Program, Public Health—Seattle and King CountySeattleUSA

Personalised recommendations