Posts Tagged ‘needle fixation’

Needle Fixation

I’m reading an interesting book that covers different aspects of injection drug use: the history of “recreational” drug injection, pharmacological aspects of injecting, social aspects, health complications, infectious transmissions, and something called “needle fixation.” The authors define needle fixation as “the habit of injecting compulsively,” where the process of injecting becomes as important or more important than the drugs. (1)

That chapter was particularly interesting. I’ve heard patients talk about how they are addicted not only to the drugs, but also to the ritual of drawing their drug up into the needle, and the act of injecting it. This chapter says not all addicts who inject develop this sort of intense relationship with the act of injecting. The authors wrote  a list of questions meant to assess the degree of needle fixation.

For each question, the addict can answer “strongly disagree,” “disagree,” “neither agree nor disagree,” “agree,” or “strongly agree.” The more answers under the “agree” or “strongly agree,” the worse the needle fixation, except for questions 6 and 11, which are scored in the opposite direction.

Here are the questions:

  1. I inject water if I have no injectable drugs available.
  2. I enjoy the pain I experience when injecting myself or when injected by others.
  3. I think that I would find it more difficult to give up the act of injecting than to give up my preferred drug.
  4. I find the thought of injecting a partner sexually arousing.
  5. I am attracted to the needle because of the association with pain.
  6. If I could get the same rush without the hassle of using the needle I would give up injecting.
  7. I find the thought of being injected by a partner sexually arousing.
  8. Injecting water has a calming effect on me.
  9. I flush blood in and out of the syringe barrel before/after injecting the drug.
  10. I find injecting sexually arousing.
  11. If someone invented a method of taking drugs that gave me a better rush than the needle, I would give up injecting and use this.
  12. I continue to flush blood in and out of the syringe barrel even if there are blood clots.
  13. The act of injecting has become a substitution for sex for me.
  14. The preparation and process of the injection is more important to me than the drug rush.

The higher the score, the worse the needle fixation.

Apparently there’s sometimes a sexual aspect of injecting, or injecting your partner, about which I was clueless. The above questions indicate such a relationship. The authors of that section of the book talk about the symbolism of the needle (phallus), and the sadomasochistic side of the pain of the needle and the pleasure that follows with the drug intoxication. Part of me wondered about that last part.

I really wanted details about how I can help addicts on methadone or buprenorphine to lose the obsession and compulsion to use a needle. Unfortunately, the authors say no specific therapy or counseling technique has been proven to be superior to others. They do state the obvious, that the dose of maintenance medication (methadone or buprenorphine) should be high enough to prevent physical withdrawal.

Hopefully I can use this information to ask better questions, and get a better understanding about why people inject, particularly after they’re in treatment. Acknowledging the compulsion to continue using needles even when not in withdrawal will at least bring the issue into the open. Maybe it will help to know that other people have had this compulsion, and with counseling and time have been able to overcome it.

1. Pates et. al., editors, Injecting Illicit Drugs, (Mauldin, MA, Blackwell Publishing, 2005) pp 47-58.