Nonmedical use of promethazine hydrochloride among heroin injectors in vietnam

Unrecognized risks and unintended consequences

Michael Clatts, Le M. Giang, Lloyd Goldsamt, Vivian Colón-López

Research output: Contribution to journalArticle

Abstract

Background: Surveillance studies have noted intravenous injection of promethazine hydrochloride (PHC) among populations that use heroin in south and southeast Asia. However, little is known about onset and initiation of PHC use and its relationship to habitual heroin use. Methods: As part of a longitudinal study of heroin initiation, a sample of 179 new heroin users, aged 15-27 years, were interviewed between October 2005 and December 2006 in Hanoi, Vietnam. Cox proportional hazard regression analysis was used to characterize age at promethazine initiation and its association with relevant covariates. Results: 76% reported lifetime use of PHC. Mean age of PHC initiation was 21.3 years, on average 6 months following onset of heroin injection. In multivariate analysis, lifetime use of diazepam [HR = 1.69 (1.17, 2.44); p-value = .01] and injecting heroin for more than 1.58 years [HR = 1.46 (1.04, 2.06); p-value = .03] were associated with PHC initiation. Conclusion: Intravenous injection of PHC is a relatively common practice among young injection heroin users in Hanoi, Vietnam who use it on a situational basis to substitute for heroin (when heroin is not available or when heroin is too costly) or to augment the effects of an inadequate heroin dosing (delaying onset of heroin withdraw). Existing drug prevention strategies in Vietnam are focused primarily on heroin and most new heroin users initiate PHC use without prior knowledge of its high risk for serious vein damage. Future research is needed on the PHC use among heroin users, including long-term medical consequences of PHC exposure.

Original languageEnglish (US)
Pages (from-to)515-527
Number of pages13
JournalSubstance Use and Misuse
Volume45
Issue number4
DOIs
StatePublished - 2010

Fingerprint

Promethazine
Vietnam
Heroin
South Asia
Southeast Asia
multivariate analysis
surveillance
Values
longitudinal study
regression analysis
damages
drug
Intravenous Injections
knowledge
Southeastern Asia
Injections
Diazepam

Keywords

  • Drug substitution
  • Hanoi
  • Heroin injectors
  • Promethazine hydrochloride injection
  • Vietnam

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Medicine (miscellaneous)
  • Medicine(all)

Cite this

Nonmedical use of promethazine hydrochloride among heroin injectors in vietnam : Unrecognized risks and unintended consequences. / Clatts, Michael; Giang, Le M.; Goldsamt, Lloyd; Colón-López, Vivian.

In: Substance Use and Misuse, Vol. 45, No. 4, 2010, p. 515-527.

Research output: Contribution to journalArticle

@article{9fd49518046f4bb997b12426bf230ca4,
title = "Nonmedical use of promethazine hydrochloride among heroin injectors in vietnam: Unrecognized risks and unintended consequences",
abstract = "Background: Surveillance studies have noted intravenous injection of promethazine hydrochloride (PHC) among populations that use heroin in south and southeast Asia. However, little is known about onset and initiation of PHC use and its relationship to habitual heroin use. Methods: As part of a longitudinal study of heroin initiation, a sample of 179 new heroin users, aged 15-27 years, were interviewed between October 2005 and December 2006 in Hanoi, Vietnam. Cox proportional hazard regression analysis was used to characterize age at promethazine initiation and its association with relevant covariates. Results: 76{\%} reported lifetime use of PHC. Mean age of PHC initiation was 21.3 years, on average 6 months following onset of heroin injection. In multivariate analysis, lifetime use of diazepam [HR = 1.69 (1.17, 2.44); p-value = .01] and injecting heroin for more than 1.58 years [HR = 1.46 (1.04, 2.06); p-value = .03] were associated with PHC initiation. Conclusion: Intravenous injection of PHC is a relatively common practice among young injection heroin users in Hanoi, Vietnam who use it on a situational basis to substitute for heroin (when heroin is not available or when heroin is too costly) or to augment the effects of an inadequate heroin dosing (delaying onset of heroin withdraw). Existing drug prevention strategies in Vietnam are focused primarily on heroin and most new heroin users initiate PHC use without prior knowledge of its high risk for serious vein damage. Future research is needed on the PHC use among heroin users, including long-term medical consequences of PHC exposure.",
keywords = "Drug substitution, Hanoi, Heroin injectors, Promethazine hydrochloride injection, Vietnam",
author = "Michael Clatts and Giang, {Le M.} and Lloyd Goldsamt and Vivian Col{\'o}n-L{\'o}pez",
year = "2010",
doi = "10.3109/10826080903452520",
language = "English (US)",
volume = "45",
pages = "515--527",
journal = "Substance Use and Misuse",
issn = "1082-6084",
publisher = "Informa Healthcare",
number = "4",

}

TY - JOUR

T1 - Nonmedical use of promethazine hydrochloride among heroin injectors in vietnam

T2 - Unrecognized risks and unintended consequences

AU - Clatts, Michael

AU - Giang, Le M.

AU - Goldsamt, Lloyd

AU - Colón-López, Vivian

PY - 2010

Y1 - 2010

N2 - Background: Surveillance studies have noted intravenous injection of promethazine hydrochloride (PHC) among populations that use heroin in south and southeast Asia. However, little is known about onset and initiation of PHC use and its relationship to habitual heroin use. Methods: As part of a longitudinal study of heroin initiation, a sample of 179 new heroin users, aged 15-27 years, were interviewed between October 2005 and December 2006 in Hanoi, Vietnam. Cox proportional hazard regression analysis was used to characterize age at promethazine initiation and its association with relevant covariates. Results: 76% reported lifetime use of PHC. Mean age of PHC initiation was 21.3 years, on average 6 months following onset of heroin injection. In multivariate analysis, lifetime use of diazepam [HR = 1.69 (1.17, 2.44); p-value = .01] and injecting heroin for more than 1.58 years [HR = 1.46 (1.04, 2.06); p-value = .03] were associated with PHC initiation. Conclusion: Intravenous injection of PHC is a relatively common practice among young injection heroin users in Hanoi, Vietnam who use it on a situational basis to substitute for heroin (when heroin is not available or when heroin is too costly) or to augment the effects of an inadequate heroin dosing (delaying onset of heroin withdraw). Existing drug prevention strategies in Vietnam are focused primarily on heroin and most new heroin users initiate PHC use without prior knowledge of its high risk for serious vein damage. Future research is needed on the PHC use among heroin users, including long-term medical consequences of PHC exposure.

AB - Background: Surveillance studies have noted intravenous injection of promethazine hydrochloride (PHC) among populations that use heroin in south and southeast Asia. However, little is known about onset and initiation of PHC use and its relationship to habitual heroin use. Methods: As part of a longitudinal study of heroin initiation, a sample of 179 new heroin users, aged 15-27 years, were interviewed between October 2005 and December 2006 in Hanoi, Vietnam. Cox proportional hazard regression analysis was used to characterize age at promethazine initiation and its association with relevant covariates. Results: 76% reported lifetime use of PHC. Mean age of PHC initiation was 21.3 years, on average 6 months following onset of heroin injection. In multivariate analysis, lifetime use of diazepam [HR = 1.69 (1.17, 2.44); p-value = .01] and injecting heroin for more than 1.58 years [HR = 1.46 (1.04, 2.06); p-value = .03] were associated with PHC initiation. Conclusion: Intravenous injection of PHC is a relatively common practice among young injection heroin users in Hanoi, Vietnam who use it on a situational basis to substitute for heroin (when heroin is not available or when heroin is too costly) or to augment the effects of an inadequate heroin dosing (delaying onset of heroin withdraw). Existing drug prevention strategies in Vietnam are focused primarily on heroin and most new heroin users initiate PHC use without prior knowledge of its high risk for serious vein damage. Future research is needed on the PHC use among heroin users, including long-term medical consequences of PHC exposure.

KW - Drug substitution

KW - Hanoi

KW - Heroin injectors

KW - Promethazine hydrochloride injection

KW - Vietnam

UR - http://www.scopus.com/inward/record.url?scp=76849102339&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=76849102339&partnerID=8YFLogxK

U2 - 10.3109/10826080903452520

DO - 10.3109/10826080903452520

M3 - Article

VL - 45

SP - 515

EP - 527

JO - Substance Use and Misuse

JF - Substance Use and Misuse

SN - 1082-6084

IS - 4

ER -