This is one of those stories I don't like to tell. It happened in the shoddy little one-room apartment I'd been renting week to week with my husband in Longmont, Colorado—Boulder's poorer, browner neighbor. We were both dopesick. It was yet another weekend we had assigned to "getting clean," as though a weekend is enough time to kick years of heroin addiction. The apartment was so small that the toilet was next to the kitchen sink, which was across from the bed, divided by a three-foot plaster wall that resembled a jail cell.
We fought there so loudly and so often that eventually the landlord offered us a bigger apartment at half the listed price just to give us some space from each other. But on the day in question we were quiet and sick. No dope, no money—we'd burned it all, intentionally, on our last blowout run. All we had left were a few crusty cottons, our spoons, and a brimming syringe container.
I don't remember whose foul idea it was. It doesn't matter; we both agreed to it. We decided to break into our safe-drop container, open the old rigs, and swab out the brown residue smudged across the ends, dropped along the plunger, and pooled at the tips. "Does that look like dope or blood?" we checked in with each other, holding the needles to the light when were unsure if the stuff inside was more reddish or brown. We ended up with a horrific, muddy concoction. I look back on this memory and I want to reach out and throttle myself. "You're about to shoot old blood," I want to shout, while overturning that spoon of filth. But it's a memory, so it's indelible. I have to watch while my husband and I draw it into our syringes—the sharpest we can find in the lot—and inject ourselves with something we must have known, in the back of our minds, would bring us nothing but pain. I don't know how we both survived that shot. We spent the next hour contorted on our bed, moaning and sweating through wrenching, twisting pain that engulfed our bodies and felt like it would end us. I have no idea why it didn't last longer, or why we didn't die. Whatever was in those syringes—old blood, straight up dirt, infectious bacteria—was nothing that should have ever been pushed through a needle into our veins. That was the most dangerous non-opiate I've injected into myself, but it was far from the only one. There were times I shot what was effectively water; soaking an old heroin cotton into it first as an excuse. I've shot pills. I've come close to injecting benzodiazepines, which are not water soluble. My husband once shot a Xanax crushed with alcohol (and I was jealous, even though it did nothing but sear his vein). Outside of the addiction community, people probably think these behaviors are driven by an insatiable hunger to get high, but those who've been there will recognize it as a needle fixation. Needle fixation—described as a compulsive desire to inject oneself—does not seem to have much place within conventional treatment models. It’s “not something that is generally accepted to play a significant role in the development or continuation of an addictive disease,” says Mary Jeanne Kreek, who heads the addictive diseases lab at Rockefeller University.
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But I was definitely in love with the ritual of injection. Swirling the dope in the spoon with the end of my plunger. Watching the heroin drain from spoon into barrel. The pinch of insertion. The plume of scarlet blood shooting back into the syringe when I checked that it was in a vein. That slow moment while I pushed the drug into myself, just before the rush set in.
I remember glancing at myself in the mirror while I was lighting the dope, a syringe dangling from my mouth, and thinking, This is the me I love best. I was not only addicted to injecting heroin, I was addicted to injecting. Stanton Peele, creator of the Life Process Program and one of the most controversial voices in addiction sciences today, says that in his opinion, people do not get addicted to substances but to experiences. Rituals play a very important role. He likened the injection ritual to cigarette smoking. "People don't say 'I'm addicted to nicotine.' Smoking is a ritual; it's an activity,” he says. As with smoking, the act of using the narcotics is as important as the effects of the narcotic itself. He stresses the importance of radical harm reduction models, such as safe consumption sites (which do not yet exist legally in the United States, save for one at a secret location) that allow people to inject heroin safely and under supervision. It's obvious that needle fixation is still poorly understood within the addiction community. I don't share Peele's perspective that heroin addiction is largely experiential—certainly chemical therapies like methadone and buprenorphine have done a lot of good for a large number of people, including myself. I also don't agree with Kreek that needle fixation is inconsequential. Understanding needle fixation is important to addiction treatment, says Richard Pates, a clinical psychologist and visiting professor at the University of Worcester. He recalls meeting with a number of patients who reported injecting water and other substances that did not deliver the euphoric high of heroin. He notes the phenomenon has been written about for decades by drug writers like William Burroughs, and lists several languages that have words for it—yet it remains mostly unrecognized by medicine. In his 2001 psychological study, he found that users received a secondary gain from the act of injecting that went beyond the high provided by the drug. The strongest gain, he found, was sexual pleasure. "The act of injecting is an immensely personal thing." Pates says, "If you think about sexual acts, they're intensely personal as well. I don't want to get too Freudian, but there's also the penetrative act." As he describes his theory on the sexual etiology of needle fixation, I think back to the first few months of my relationship with my husband—the way I'd hold his arm in my hands, and trace my finger down the pale flesh of his forearm, seeking a vein. Once I found it, I inserted the needle, pulled back the plunger to check for his blood, then pressed the drug into him before watching him fall back into the pleasurable void of the rush. Often, in those early months together, we'd spend the hours after the rush faded seeking another version from each other's bodies. "[Needle fixation] is complex," Pates tells me. "And it affects a small minority of users. In long-standing needle injectors, I saw maybe 10 percent [meet the criteria for needle fixation]. And even that's maybe too high." He adds that when accounting for the number of injection drug users in the world, that's still a sizable number of people. Scott Hinton, a clinical psychologist who has been treating addiction in Australia for over a decade, believes needle fixation is a behavioral addiction that is rooted in impulsivity. His research, which built upon Pates' study, discovered that those with both needle fixations and substance use disorders showed even less impulse control than those who were only addicted to drugs—already highly impulsive, he notes in his paper. Hinton tells me that cognitive behavioral therapy is his go-to approach for those hoping to curb a needle fixation. He also stresses, however, the importance of harm reduction methods for people who aren’t yet ready to quit. "I want to make sure they have access to clean equipment, definitely providing information about blood-borne viruses, as well as education about safe injection practices,” he says. Hinton notes that Australia has widely available sterile equipment programs. In the United States—which has historically focused on punitive measures over harm reduction—there are only around 200 syringe service programs covering the entire country. From someone who's been there, needle fixation is one of the grimier components of heroin addiction. But that's exactly why it deserves more—not less—attention, and why we need far more focus on harm reduction and mental health care expansions.
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