Speedball and crack injection in London groins, veins and injecting environment

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Speedball and crack injection in London
groins, veins and injecting environment
Tim Rhodes Jo Kimber, Daniel Briggs, Vivian Hope,
Greg Holloway, Steve Jones
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crack and groin injecting

• Six City Study in England, n952, 2003/2004,
  Hope et al
• n952, six locations
• 45 groin injecting
• 40 crack/speedball injecting
• gt 70 crack injection Bristol Manchester, and
  gt 50 London Judd et al., 2005
• crack injectors more likely to be groin
  injectors (49 vs 34)
• groin injectors more likely to have an open
  wound infection (26 vs 18) and DVT in last year
  (28 vs 8)
• Rhodes et al. (2006) Groin injecting in the
  context of crack cocaine and homelessness,
  International Journal of Drug Policy, 17
  164-170.

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qualitative study

• speedball injectors (n44), Bristol and London,
  2006
• median age, 33 (range 23-53)
• male, 75
• homeless in past year, 69
• speedball in past month, 80
• mean years speedball, 7 (lt1-23 years)
• current groin injection, 61
• groin injection as main site, 43

5
speedball

• crack is the buzz, heroin the medicine
• You can buy gear all day long, buy heroin all
  day long, but theres that urge that you want
  that lick or that hit. You just want that buzz.
  The crack gives you a buzz, a high. The heroin,
  it doesnt give you a buzz no more, it just makes
  you feel normal. 9, male, 30 years
• The fact that Im physically dependent on
  heroin, that is my main drug of choice, that is
  the drug I actually need. But still, the fact
  that, you know, the snowballs, you know, is such
  a lovely buzz, and intense buzz. 8, male, 31
  years

6
speedball

• only one with the other
• Ive got to have both together. So dealers have
  actually said to me So you dont want to buy my
  gram?, and I said No, cos youve not got the
  white. I cannot do one without the other... If I
  have a tenner and I am proper clucking then I
  know I want to wait until I have another tenner
  to get the white so I can do the two together.
  You cant have one brother until the other
  brother comes along. 6, male, 46 years

7
speedball

• never looked back
• I used to smoke the heroin on a foil, and I
  smoked a stone on the pipe... So someone
  conveniently said to me it would be better if you
  was to inject it both together. And the first
  time I tried it that was it. I never ever went
  back to the foil and I never ever smoked a stone
  again. 6, male, 46 years

8
vein damage

• crack destroys your veins
• Im trying not to snowball at the moment cos it
  seems to be making my veins collapse. Theres
  bruising, and it seems to be making them
  collapse Crack does destroy the veins anyway
  like, like the veins in my arms as well are
  really sore. And thats mainly when Im
  snowballing. When Im just using gear it doesnt
  seem to, doesnt seem to bruise the vein up so
  much. 3, male, 34 years

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vein damage

• missed hits
• You wont know that youve missed it. You just
  wont get no buzz from it. And then the next day
  youll wake up and youll probably have a great
  big lump there around the femoral vein, and
  wont hardly be able to walk. Whereas if youre
  missing with gear, you know straightway and you
  know to stop. 7, male, 25 years

10
vein damage

• crack as a useful anaesthetic
• Now if its just gear on its own, Ill push it
  in and the pain is that unbearable I cant push
  it in. Whereas if Ive got crack in there, Ill
  push the first bit in, the pain will be, itll
  really hurt, but then the crack numbs it so I can
  push the rest in and its OK, but without the
  crack I wouldnt be able to push it in, Id be in
  trouble. Id end up pulling the pin out, I cant
  do it, it hurts so much. So thats another reason
  I use the crack as well. 1, male, 31 years

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vein damage

• flushing
• With the snowball you never know because when
  you inject, you put it in, draw it back, put it
  in again and it numbs the pain and it looks as if
  you are missing and sometimes I cant tell, so I
  am drawing it back to and forth. 28, male, 28
  years
• Thats another thing as well. The more you
  flush, the more you kill your veins off. 29,
  male, 29 years

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vein damage

• citric powder
• Citric will close your veins up quick. That is
  why it is better to use vitamin c or lemon salts
  We use citric because that is what is available.
  30, female, 38 years
• The crack annihilated my veins. But then again,
  in the 90s I used vitamin c powder a lot more.
  Its really hard to get now, so I use citric, and
  citric fucks your veins really badly. That burns,
  burns them. 17, male, 26 years

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vein damage

• citric powder
• And you go Oh, you dont need to put that much
  in, and they go Oh, I always put that amount
  in. So then when you have a dig, you dont miss,
  but you feel that citric and it burns. And you
  think that never happens when I do it, cos I only
  puts a little bit of citric in.. When you share
  your drugs with somebody, and they cook up, they
  put in more citric than you would use. 6,
  male, 46 years

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groin injection

• accepted as a last resort
• I was concerned I had used up nearly all my
  veins that I knew about. On my arms, the rest of
  my body. Id even done my chest and my breast
  bone, and all thatPut it this way, I would sit
  there for sometimes a good 2-3 hours. And
  obviously ending up with a clotted hit. So you
  were wasting hits?. Yeah, I would literally be
  in tears I mean Id go out and make money. Id
  go and score. Id go home ill, and basically mess
  it up, and then Id be back to square one again.
  9, male, 30 years

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groin injection

• generational differences
• The young kids in Bristol that start using,
  theyve got this huge thing, they go straight to
  the groin, you know what I mean, and its insane,
  its fucking insane, man... 17, male, 26 years
• The older generation They see it groin
  injection as completely different to the younger
  generation, whereas the younger generation seem
  to think that is the right place to go, its like
  the in thing The younger generation Id say
  prefer it, the older generation sort of like need
  to, And yourself? I prefer it. 8, male, 31
  years

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groin injection

• preference
• I could have used other veins but its just
  easier to just go in the groin. 3, male, 34
  years
• I started using the groin is because of the
  convenience. For quickness I mean You could
  have gone into your arm?. Oh yeah, yeah, yeah. I
  could have gone anywhere. I mean even though Im
  using my arms occasionally, I can still get
  myself, Ive still got my veins in my feet. 6,
  male, 46 years
• I know of people that could quite easily inject
  in their arms, who have got massive veins in
  their arms, and they inject in their groin
  knowing that you do get a better hit. 7, male,
  25 years

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groin injection

• better rush
• Its crazy me saying this, but its a better
  hit. You tend to feel it more harshly than you do
  if you go somewhere else The overall effect is
  sort of bigger and quicker. 8, male, 31 years
• People always want to know how to get the best
  hit. My mate suggested it because I was
  complaining about my arms. I said what was the
  difference and he said it was a quicker rush
  because when I was injecting in my arms it took
  longer for me to feel the rush, but in the groin,
  it was immediate. He told me all this. He said
  you get it quicker and feel it more, thats why I
  use my groin. 28, male, 28 years

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groin injection

• convenience
• I thought they were crazy. Why risk losing a
  leg? But they said it was quick, simple and easy
  A lot of people are confident and competent to do
  it. They can whosh-bang-in, whosh-bang-out. I
  mean it is more convenience. 27, male, 43
  years
• Once its in the pin, a few seconds. Draw it
  back and its in. 8, male, 31 years

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groin injection

• convenience in context
• I started using me groin cos I was having all
  these problems with veins and that, and once
  you get your groin, and especially if you are
  homeless, youre outside and that, I mean theres
  public walking about and that, so you want to be
  as quick as possible so no-one can see you. At
  the worst, if anyone sees you, it looks like
  youre having a pee or something. Once youve got
  it, you just push it in, draw back. Its so
  quick, its over in seconds you know. But the
  trouble is, once you start using the groin
  theres no going back cos you can get it so easy.
  20, male, 33 years

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groin injection

• relatively safe
• The risks are outweighed by the fact that its
  quicker and a lot of times its safer. Hows it
  safer? Because like I said, when you use like,
  you know Ive been six hours trying to find a
  vein. And that aint like in the same site, so I
  might, Ive probably used about 15 pins. And Ive
  got all them dent marks on my leg, like all these
  marks. And each time Ive attempted right, Ive
  just run the risk of missing. 6, male, 46
  years
• To begin with, you know, I had thought it was
  not so safe. But you know, because its an actual
  normal vein, I think, look at the overall
  picture, theres not much difference really. If
  youre going to get a clot, youre going to get
  one you know, whether you inject in the arm, legs
  or groin. 8, male, 31 years

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groin injection

• accepting of risk
• I cant get any more veins in my arms. My
  ankles, but I cant get them. I go in my groins.
  Both sides?. Yeah, I find it difficult and
  scary using the groin How come? When you see
  people who have lost their legs and stuff. You
  know the risk involved is DVT and blood-clotting
  of arteries, and circulation to the leg. But you
  are desperate for a hit, and your veins run out
  in your arms and ankles, and the only place you
  know where you can go is your groin. 27, male,
  43 years

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groin injection

• accepting of risk
• It is dangerous. Its stupid. I have blood
  clots. I have been in hospital for two weeks.
  When I started, I used the arms but now I dont
  really want to go there because I know the
  feeling is not as good. 28, male, 28 years
• Its just dangerous. I know a lot of people that
  have ended up nearly losing a leg. A good friend
  of mine lost his leg. I know its dangerous, but
  its a sort of addiction on its own. 7, male,
  25 years
• The damage, its frightening. But you carry on
  doing it. 16, male, 32 years

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groin risks

• hitting the vein
• As far as I was concerned I could use it and use
  it and use it. And it would never end. Not
  realising when you batter a vein it sinks, and
  sometimes burns like mad cos its telling you
  aint coming in here. 9, male, 30 years
• You end up pushing the vein back if youre using
  blunt works, you end up pushing it back and back
  And now, Im trying to get it, and I cant find
  it. I have to stab it in to get it. Then I went
  onto long orange for a few months and it got to
  the point where Id push it, it would go right
  through the vein, and Id have to pull it out a
  bit to get the hit. 7, male, 25 years

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groin risks

• missed hits and damage
• The crack numbs the site. Every time you go in
  for your next hit if you carry on, your vein will
  disappear. So you try to manoeuvre to another
  spot in the groin. And thats when you start to
  miss and hit the arteries and nerves. You get the
  other side of the groin for a few months, that
  keeps it going. Speed-balling is dangerous. You
  start have problems walking. 29, male, 32
  years
• I did it for a couple of years in the groin. And
  then they just started going. I started hitting
  arteries. I was missing, hitting nerves. My legs
  went to pieces. I was in hospital three times.
  The last time, my legs were so bad, they just
  told me not to do it. 29, male, 32 years

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groin risks

• hitting the artery
• I was in the toilet, Ive pulled it back and I
  could see bloods filled up, but its one of
  those ones with the ultra violet lights in, so
  you cant see properly. So I just assumed it was
  in, just went, whacked in the whole lot, and just
  all of a sudden got this pain. And I just ripped
  the pin out me leg, and fucking just like
  bouncing around inside this cubicle trying to be
  quiet. Fucking painful. 7, male, 25 years

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groin risks

• multiple complications
• I have so much trouble cos my groins packed up.
  Ive got multiple blood clots in both legs Ive
  been in and out of hospital so many times, like,
  and, last time I was in I had six abscesses come
  up because of MRSA and a massive ulcer also, on
  the front of my leg. And now Im not actually
  using my groin because both of them have packed
  up, and I know that Im going to loose me legs if
  I carry on, so Im using half mils and Im going
  in real tiny capillaries all over me chest and me
  thighs and that. So it is hard to get a hit you
  know. I mean, Ill get a hit now, I mean Ill get
  a bit of it here and a bit of it there, and its
  a waste of time. 22, male, 30 years

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groin risks

• after groins, the neck?
• I just could not get that side of my groin.
  Anyway, I got that side and where I was trying to
  find it I was prodding the pin about and I ended
  up getting an abscess on that side of my groin.
  So this side was swelled up. I was going back to
  my arms and that, and my hands, got no veins in
  my arms at all, and trying to do that. Anyway,
  what I thought, I thought My neck 22, male,
  30 years

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neck injection

• is the neck a shifting risk boundary?
• I said Id never shoot in my neck, I never even
  thought about using the groin. Never shoot in my
  neck. But when that time came, like, I got to do
  it, whole neck went. 17, male, 26 years
• A lot of people lately have come up to me, when
  I have been in the same place as them injecting,
  and have asked me to do their neck Nowadays
  theres a lot of people that are just saying
  Look, can you get my neck?. Theyre picking
  anyone. They just want a vein. 9, male, 30
  years
• Now people will talk about going in the neck as
  they would have talked 15 years ago about going
  in the groin. 6, male, 46 years

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visual data

• we live in an interview age
• retrospective story-telling and accounting
• neglect of naturally occurring observational data
• forms of visual data
• photographic image and photo-elicitation
  visualisation and mapping found data
  (photographic and film)
• status of visual data
• lacks credibility in social science risk of
  symbolic violence ethics and safety
  documentation analysis of meaning, nuance and
  affect analysis of setting data permanency
  protects against premature inference and missing
  infrequent or background occurrences policy
  impact (encapsulates a story, evokes emotion, the
  uh huh factor)

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study conclusions

• a crack-based speedball injecting culture
• social pharmacology of speedball as drug and
  heroin as medicine
• vein damage and groin care
• few receive advice, need for specialist wound
  care, need for groin risk reduction advice, need
  for guidance on citric
• site and drug transitions
• groin and neck injection, smoking crack rather
  than speedball