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Additionally, qualitative data were collected in <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>une\u2013<jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>uly 2009 (<jats:italic>n<\/jats:italic>\u2009=\u200910) and analyzed to explore the health problems attributable to midazolam injection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Among 435 survey participants, the prevalence of daily midazolam injection in the past 6 months was 37.0% (95% confidence interval: 32\u201342). While 75.8% of the daily midazolam injectors identified heroin as their drug of choice, 91.8% of these individuals reported substituting heroin with midazolam when heroin was unavailable. In multivariable analyses, daily midazolam injection was associated with femoral vein injection [adjusted odds ratio (<jats:styled-content style=\"fixed-case\">AOR<\/jats:styled-content>)\u2009=\u20094.48], polydrug use (<jats:styled-content style=\"fixed-case\">AOR<\/jats:styled-content>\u2009=\u20094.94), daily heroin injection (<jats:styled-content style=\"fixed-case\">AOR<\/jats:styled-content>\u2009=\u20093.25), binge use (<jats:styled-content style=\"fixed-case\">AOR<\/jats:styled-content>\u2009=\u20091.75) and perceived increase in policing pressure (<jats:styled-content style=\"fixed-case\">AOR<\/jats:styled-content>\u2009=\u20091.95) (all <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Qualitative accounts indicated severe health problems associated with midazolam injection, including nerve and vascular injuries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Midazolam misuse is increasing among injecting drug users in Bangkok and appears to be used primarily as a substitute for heroin. Midazolam injection was associated independently with various risk factors for injection\u2010related complications. Given the many deleterious effects of midazolam injection, novel interventions for midazolam injectors are needed urgently.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.12094","type":"journal-article","created":{"date-parts":[[2012,12,24]],"date-time":"2012-12-24T10:36:13Z","timestamp":1356345373000},"page":"944-952","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["High rates of midazolam injection and associated harms in <scp>B<\/scp>angkok, <scp>T<\/scp>hailand"],"prefix":"10.1111","volume":"108","author":[{"given":"Kanna","family":"Hayashi","sequence":"first","affiliation":[{"name":"Urban Health Research Initiative British Columbia Centre for Excellence in HIV\/AIDS  Vancouver Canada"},{"name":"Interdisciplinary Studies Graduate Program University of British Columbia  Vancouver 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