A new type of harm reduction: Creating an arteriovenous fistula for a compulsively injecting opiate user

Colin Brewer, MB; Mohammed Sobeh, FRCS

doi:10.5055/jom.2007.0003

Authors

Colin Brewer, MB
Mohammed Sobeh, FRCS

DOI:

https://doi.org/10.5055/jom.2007.0003

Keywords:

arteriovenous, fistula, compulsive, opiate user, injecting, methadone, heparin, harm reduction, addiction

Abstract

Compulsive intravenous opiate injectors often cause themselves recurrent physical damage, which sometimes threatens life or limb. Unsuccessful attempts to find a vein can occupy several hours of each day, during which blood may clot in the syringe, making injection even more difficult. Adding small amounts of heparin to the opiate in the syringe before injecting prevents clotting but may be only partially helpful. The authors describe the first reported case in which an arteriovenous fistula was created specifically to enable a compulsive injector to inject quickly, easily, and safely.

Author Biographies

Colin Brewer, MB

Research Director, The Stapleford Centre, London, United Kingdom.

Mohammed Sobeh, FRCS

Consultant Surgeon, The Royal London Hospital and The London Clinic, Devonshire Place, London, United Kingdom.

References

Al-Adwani A: Needle fixation is as elusive as ever: Comments on McBride et al.: Needle fixation, the Drug user’s perspective: A qualitative study. Addiction. 2001; 96: 1676.

McBride AJ, Pates RM, Arnold K, et al.: Needle fixation, the drug user’s perspective: A qualitative study. Addiction. 2001; 96: 1049-1058.

Brewer C: Recent developments in maintenance prescribing and monitoring in the United Kingdom. Bull N Y Acad Med. 1995; 72(2): 359-370.

Metrebian N, Shanahan W, Wells B, et al.: Feasibility of prescribing injectable heroin and methadone to opiate-dependent drug users: Associated health gains and harm reductions. Med J Aust. 1998; 168(12): 596-600.

Strang J, Marsden J, Cummins M, et al.: Randomised trial of supervised injectable vs oral methadone maintenance: Report of feasibility and six-month outcome. Addiction. 2000; 95(11): 1631-1645.

Guttinger F, Gschwend P, Schulte B, et al.: Evaluating longterm effects of heroin-assisted treatment: The results of a sixyear follow-up. Eur Addict Res. 2003; 9(2): 73-79.

Blanken P, Hendriks VM, Koeter MW, et al: Matching of treatment-resistant heroin-dependent patients to medical prescription of heroin or oral methadone treatment: Results from two randomized controlled trials. Addiction. 2005; 100(1): 89-95.

Brewer C: Ultra-rapid, antagonist-precipitated opiate detoxification under general anaesthesia or sedation. Addict Biol. 1997; 2: 291-302.

Seoane A, Carrasco G, Cabre L, et al.: Efficacy and safety of two methods of rapid intravenous detoxification in heroin addicts previously treated without success. Br J Psychiatry. 1997; 171: 340-345.

Laheij RJF, Krabbe PFM, De Jong CAJ: Rapid heroin detoxification under general anaesthesia. JAMA. 2000; 283:1143.

Foster J, Brewer C, Steele T: Naltrexone implants can completely prevent early (one month) relapse after opiate detoxification. A pilot study of two cohorts totalling 101 patients with a note on naltrexone blood levels. Addict Biol. 2003; 8: 211-217.

Gölz J, Partecke G: Katamnesticher entwicklung opiatab-hängiger nach naltrexon-induzierten entzug unter narcose, naltrex - ongestutzter rückfallprophylaxe und ambulanter psychosozialer nachsorge. [Progress of heroin addicts after rapid opiate detoxification under anesthesia, relapse-prevention with naltrexone and out-patient psychosocial follow-up care.] Süchttherapie. 2000; 1: 166-172.

Gossling HW, Gunkel S, Schneider U, et al.: Frequency and causes of premature termination during in-patient opiate detoxification. Fortschr Neurol Psychiatr. 2001; 69: 474-481.

Strang J, McCambridge J, Best D, et al.: Loss of tolerance and overdose mortality after inpatient opiate detoxification: Follow up study. BMJ. 2003; 326: 959-960.

Brewer C: Serum naltrexone and 6-β-naltrexol levels from naltrexone implants can block very large amounts of heroin: A report of two cases. Addict Biol. 2002; 7(3): 321-323.

Oliver P, Horspool M, Keen J: Fatal opiate overdose following regimen changes in naltrexone treatment. Addiction. 2005; 100 (4): 560-561.

Olsen L, Christophersen AS, Frogopsahl G, et al.: Plasma concentrations during naltrexone implant treatment of opiatedependent patients. Br J Clin Pharmacol. 2004; 58(2): 219-222.

Brewer C, Streel E: Current issues in the use of opioid antagonists. In: Dean RL, Bilsky EJ, Negus SS (eds.): Opioid Receptors and Antagonists: From Bench to Clinic. (Contemporary Neuroscience series). Totowa, NJ: Humana Press, In Press.

Hulse GK, Tait RJ, Comer SD, et al.: Reducing hospital presentations for opioid overdose in patients treated with sustained release naltrexone implants. Drug Alcohol Depend. 2005; 79: 351-.357.

Brewer C: Hair analysis as a tool for monitoring and managing patients on methadone maintenance. Forensic Sci Int. 1993; 63: 277-283.

Baker LRI, Hurst MJ, Rudge CJ, et al.: Long-term vascular access. Practical Procedures in Nephrology. London: Arnold, 2000: 36-44.