Groin injecting in the context of crack cocaine and homelessness: From 'risk boundary' to 'acceptable risk'?

Drawing on data from recent surveys and pilot qualitative interviews among injecting drug users (IDUs) in England, we highlight the potential 'normalisation' of the use of the femoral vein (groin) as a site of injection. We estimate that 45% (428/952) of IDUs in English cities report groin injecting in the last 4 weeks, rising to over 50% in some areas. We also note transitions towards the injection of crack cocaine among poly drug injectors in some UK locations. We estimate that 40% (381/952) of IDUs in English cities report crack injection in the last 4 weeks, rising to over 70% in some cities. Findings from pilot qualitative interviews among homeless injectors in London are suggestive of groin injecting being situated as an 'acceptable risk'. We emphasise the need for research to explore the potential interplay between unstable housing, groin injecting and crack injecting. We call for renewed emphasis within harm reduction interventions advising injectors how to maximise the health and longevity of arm and other peripheral veins, and for greater preparedness to advise known groin injectors how to minimise health risks associated with groin injecting.