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									918                                      A. S. MAHDI and A. J. McBRIDE

                      REPORT OF THREE CASES
                           AMEERA S. MAHDI and ANDREW J. MC BRIDE*
                  Community Addiction Unit, 44–46 Cowbridge Road East, Canton, Cardiff CF11 9DU, UK

                                       (Received 8 June 1999; accepted 10 June 1999)

The injection of psychoactive drugs, usually by the             Case 3 was a 35-year-old single, unemployed
intravenous route, has been recognized for more              man who lived in a hostel for the homeless and who
than a century, and has become more widespread               was admitted to hospital for alcohol and metha-
over recent decades (Golding, 1993; Derricot et al.,         done detoxification. He fulfilled ICD-10 criteria
1999). We have been unable to identify any pub-              for alcohol and opioid dependence. He had injected
lished examples of the recreational injection of             various illicit drugs including heroin and amphet-
alcohol. We describe here three cases in which               amine. When questioned about intravenous injection
intravenous injection of alcohol is reported.                of alcohol, he admitted having used this method over
   Case 1 was a 29-year-old, single, unemployed              a period of 3 years. He said that he had injected
and homeless man, admitted to hospital for alcohol           various alcoholic beverages, including beer, approxi-
and diazepam detoxification. He fulfilled ICD-10             mately once a week. His main reasons for injecting
criteria (World Health Organization, 1992) for both          were the rapid effect and avoiding the smell of
alcohol and diazepam dependence. While review-               alcohol on his breath because his hostel prohibited
ing his history of injecting illicit drugs (heroin and       alcohol use. The only side-effect he described was
amphetamine), the patient mentioned that he had              a burning pain at the site of injection.
been injecting alcohol over the previous 9 years.               Informal discussions with colleagues across the
He injected mainly vodka, sherry or whisky with              UK, in both the alcohol and drug fields, indicate
approximately a twice-monthly frequency. His last            that only a minority of long-experienced clinicians
injection had been 2 weeks before admission. He              remember what they consider rare, individual cases
gave the main reasons for this use as the rapid              of claimed alcohol injection. Combined with the
effect and the enjoyment of the injection itself. The        absence of previous published reports, this suggests
only side-effect he described was a burning pain at          that the injection of alcohol is a rare occurrence.
the site of injection.                                       The spontaneous description of intravenous injec-
   Case 2 was a 29-year-old, unemployed man,                 tion of alcohol by case 1 led the authors to question
married with one child living in rented accom-               a small opportunistic sample of injecting polydrug
modation. He was admitted to hospital for alcohol            and alcohol users. The other two cases were identi-
detoxification. He fulfilled ICD-10 criteria for             fied within 4 weeks. To find three cases so readily
alcohol, opioid and benzodiazepine dependence.               may simply be a coincidence, but in English to
Heroin was the main drug injected. When ques-                ‘drink’ is a synonym for to ‘drink alcohol’. In
tioned about intravenous injection of alcohol, he            practice it is therefore usual to ask questions about
said that he had been using this method for 10 years         alcohol consumption that specify the oral route, for
until 1 year before admission. He injected mainly            example ‘do you drink (alcohol)?’ Such questioning
vodka with a frequency of four times per week. His           effectively precludes discussion of other routes
main reasons for injecting were the rapid effect             of intake and may serve to minimize recognition of
  and enjoyment of the needle, particularly when             this high-risk behaviour.
heroin was not available. He described the only                 The three cases were all male polydrug and
side-effect as redness and a burning pain at the site        alcohol users with histories of injecting drug use
of injection.                                                and current alcohol dependence. All were unem-
                                                             ployed, two were currently homeless and all had
                                                             required admission to hospital as part of treatment.
                                                             Alcohol injection was not the main route of alcohol
*Author to whom correspondence should be addressed.          ingestion for any of the three users, but all had
                                       LETTERS TO THE EDITORS                                                 919

injected alcohol over a relatively long period (3–11       The advantages and disadvantages of oral
years). One possible explanation for initiating and     consumption of alcohol are well-known to both
continuing alcohol injection may relate to needle       the medical profession and the general public (e.g.
fixation. Pleasure from the act of injecting was        Crawford et al., 1985). We hope that this report will
described by cases 1 and 2, who also specifically       stimulate interest among professionals to uncover
described substituting alcohol for heroin. Another      the prevalence and the consequences of taking
client (not reported) said that once, many years        alcohol by the intravenous route.
earlier, he had injected whisky rather than water, to
stave off craving when heroin was unavailable. The
rapid onset of effects was the main reason for                              REFERENCES
continuing with intravenous use in all three cases.
All described burning pain and local inflammation       Anonymous (1999) Fastigheter (Nordic Business Report)
                                                          8.3.99. Cited in Private Eye 974, 17.
as the only side-effects, but other local and sys-      Crawford, A., Plant, M. A., Kreitman, N. and Latcham,
temic hazards are clearly possible.                       R. W. (1985) Self reported alcohol consumption and
   Two other unusual routes of alcohol ingestion          adverse consequences of drinking in three areas of
have been reported in the media recently, snorting        Britain: general population studies. British Journal of
vodka among middle-class English club-goers               Addiction 80, 421–428.
                                                        Derricott, J., Preston, A. and Hunt, N. (1999) The Safer
(Mollard, 1998) and the use of vodka-soaked               Injecting Briefing. HIT, Liverpool.
tampons by teenage girls in Eastern Finland             Golding, A. M. B. (1993) Two hundred years of drug abuse.
(Anonymous, 1999). Intravenous injection has              Journal of the Royal Society of Medicine 86, 282–286.
some common features with these other methods,          Mollard, A. (1998) Don’t be Nosy. Sunday Times,
                                                          8 November 1998, Style Section 10: 8.
e.g. rapid onset of effects, low doses required for     World Health Organization (1992) International Classifica-
intoxication, and the reduced likelihood of recent        tion of Diseases, 10th edn. World Health Organization,
alcohol consumption being identified.                     Geneva.

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