Flushing, rituals and needle fixation among heroin addicts: implications for policy

John Wooldridge studied for his undergraduate degree at the University of York, England and is currently studying for a PhD at the University of Leeds about synthetic cannabis use in UK prisons.

John’s paper, Flushing, rituals and needle fixation among heroin addicts: implications for policy, is published in the 2017 edition of The Public Sphere, available to read online here. This piece is part of a series of articles contributed by authors featured in this year’s issue.


I embarked on this study following earlier research into needle fixation1, which involved interviewing health professionals about their views on the issue. That study found that needle fixation is an issue present in some heroin users, with participants highlighting real life examples they had encountered in their work with drug users. Other studies in this area have focussed on defining the problem and attempting to measure needle fixation with a number of indicators, so for this study I thought it would be valuable to speak directly to heroin users who had the problem to ascertain their thoughts on the matter.

My study sought answers to questions around why some heroin users develop needle fixation and how needle fixation, flushing2 and other rituals3 develop over time. By analysing the information collected in interviews with drug users, I developed policy suggestions around how to improve heroin addiction treatment for those with needle fixation. I chose this focus, as previous research in this area is fairly limited; there appeared to be a real gap in understanding why these practices develop and most other studies had relied mainly on the views of medical professionals, rather than giving a voice to drug users themselves.

Through my research, I found that drug users with needle fixation often had other obsessive traits such as hand washing and cleaning, irrational superstitions and what appeared to be insecure attachments when they were children, which may have played into their subsequent behaviours. I also found that rituals develop incrementally, with new steps added gradually and then maintained as part of an evolving routine. Extensive rituals seemed to develop because of ideas that they improve the experience of the drug hit and make administration of drugs easier, and are often initiated based on advice given by friends and professionals.

These new insights allowed me to develop policy recommendations around ways to improve treatment for heroin addiction, some of which were offered directly by the study participants themselves. For example, some advocated for a reintroduction of injectable methadone as opposed to the oral methadone that is prescribed to the overwhelming majority of users seeking treatment. This substitute was prescribed frequently in the 1980’s, but has, more recently, been deemed too harmful to use in treatment due its intravenous administration. Participants in the study argued that even if their heroin cravings were tempered by orally administered methadone, they still have the strong urge to inject due to their needle fixation.

The decentralisation of drug services in the UK means different organisations are responsible for different parts of the country, often resulting in contradictory advice, being given to users seeking treatment and rehabilitation. (Picture credit © Irish Examiner Ltd.)

Despite the widely recognised distress associated with opiate detox, another policy recommendation suggested by the majority of interviewees was to increase the number of places available for residential rehabilitation detox. These are rarely used in the UK due to their cost; it is approximately double the price to treat with non-residential detox treatment at £8,000 per year, but my study revealed an appetite among users for such treatment, which could play an important role in helping them make sustainable transition from long-term drug use.

Another discovery I made during the process of this study is the confusion created for drug users relating to minimising the harm caused by their drug use because of the many different agencies, quangos and charities involved in drug monitoring and treatment, such as the National Drug Treatment Monitoring System (NDTMS), Advisory Council on the Misuse of Drugs (ACMD), National Treatment Agency (NTA), National Health Service (NHS), Public Health England (PHE) etc. This, coupled with the devolved process of drug treatment, whereby local authorities ‘buy in’ the service from external contractors, meant that there was often contradictory, misleading information, given to drug users by groups with conflicting motives. I also found that some of this information could have harmful results, as users were advised towards administration practices that have been shown to be dangerous. Because of this, I recommend consolidating drug rehabilitation services to ensure clarity in terms of advice, accountability and to ensure that best practice procedures are followed consistently.

1 Needle fixation: Repetitive puncturing of the skin with or without the injection of psychoactive drugs via intravenous, subcutaneous or intramuscular routes, irrespective of the drug or drugs injected or the anticipated effects of the drugs.

2 Flushing: The process of repeatedly pulling and pushing blood through the syringe after the drug had been administered but whilst the syringe is still in the vein.

3 Rituals: Having a defined set routine and process in the preparation, and administration of drugs.

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