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Barbara Pieper, PhD, RN; Robert S. Kirsner, MD, PhD; Thomas N. Templin, PhD; Thomas J. Birk, PhD, MPT

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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 . . . [Full Text of this Article]

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Injection Drug Users in the United States, 1979-2002: An Aging Population
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