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Editor's Correspondence |

Chronic Venous Disease and Injection Drug Use

Barbara Pieper, PhD, RN; Robert S. Kirsner, MD, PhD; Thomas N. Templin, PhD; Thomas J. Birk, PhD, MPT
Arch Intern Med. 2007;167(16):1807. doi:10.1001/archinte.167.16.1807-a.
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We commend Armstrong1 for documenting the increasing age of injection drug users and relating this to the epidemiology of blood-borne pathogens. We wish to highlight other chronic complications occurring in injection drug users that have been infrequently reported. We have studied one of these conditions, chronic venous disease (CVD), extensively. Chronic venous disease causes lower extremity edema, aching discomfort, skin changes, and refractory and recurrent leg ulcers, resulting in a lifelong, progressively debilitating condition. The development of CVD is influenced by the condition of the veins and/or valves, ankle range of motion as part of the calf muscle pump, and the microcirculation.2 The damage to the veins from injection drug use (IDU) continues to evolve even after IDU has stopped. In our work on injection drug users receiving methadone maintenance treatment, we found an 87% point prevalence of CVD, with 52% of affected persons having the most advanced stages of disease.3 Most damage appears to occur in persons who have injected in the groin, legs, and feet. In injection drug users, CVD occurs in middle-aged persons comparably younger than in the general population in which CVD occurs in the sixth or seventh decade. In a study of human immunodeficiency virus–positive persons, we found that injection drug users had less ankle plantar and dorsiflexion and inversion-eversion than those who did not inject drugs.4 A causal model supported the hypothesis of ankle mobility as a mediator of the effect of IDU on CVD. Significant impairment of quality of life occurred with leg pain causing increased functional impairment with worsening CVD; stair climbing and walking were also adversely affected.5 Leg pain reduced effectiveness of the calf muscle pump function. Low income and educational levels were common in our samples and are associated with less access to care and issues of health literacy. We currently have funding to test specific hypotheses linking leg pain, pump function, and general mobility to CVD progression in 600 persons with a history of drug abuse. We encourage researchers and clinicians to consider the plethora of complications of drug use in addition to blood-borne pathogens as persons who injected drugs continue to age because these complications have an important impact on quality of life and are an economic burden.

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