Chronic Venous Disease in a Methadone Treatment Sample

Purpose: This study examined for illicit drug users the distribution and severity of chronic venous disorders (CVD) and the impact of years of injecting in the lower extremities on severity of CVD. Methods: The study was a cross-sectional, comparative design stratified by age, sex, ethnicity, and 3 types of drug use (non-injection; arm or upper body injection only; and legs with or without upper body injection). Participants (N=713) completed demographic, health and substances abuse questionnaires and were evaluated using the clinical component of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) Classification.

Results: Persons who injected in the groin, legs, and feet had significantly worse CVD than those who never injected and those who injected in the arms/upper body. Thirty-nine percent of leg injectors versus 4.2% or non-injectors or arm only injectors had CVD in the moderate to severe categories. After controlling for age and co-morbid conditions, persons who injected in the legs were 9.14 times more likely to develop venous ulcers than those that injected in the arms and upper body only and 34.64 times more likely as those who never injected. Analysis of the clinical CEAP identified one symptom cluster consisting of vein changes not associated with advanced disease (telangiectasis, reticular veins, malleolar flare and varicose veins) and another consisting of pigmentation, eczema, and lipodermatosclerosis, and active or healed ulcers. Edema was equally associated with both symptom clusters.

Conclusions: CVD is associated with injecting in the groin, legs and feet as compared to other sites. Pigmentation, eczema, and lipodermatosclerosis, and active or healed ulcers were represented the symptom cluster of advanced disease. Funding: National Institute of Nursing Research/National Institute of Health (NINR/NIH), R01 NR009264.