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918 A. S. MAHDI and A. J. McBRIDE INTRAVENOUS INJECTION OF ALCOHOL BY DRUG INJECTORS: 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. 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