Deadly doses and the hardest of hard drugs

Nearly all of the drugs involved are addictive and they all result in fatality if the dose is too high. Supplies may be adulterated or ‘cut’ with inferior fillers. Skin lesions and open wounds can lead to infection and disease. The accidental injection of air into a blood vessel (embolism) can be fatal. And using unclean or shared needles or other paraphernalia can spread viruses such as hepatitis C or HIV.

Experiments and breakthrough discoveries

Intravenous drug abuse via syringe is a fairly modern phenomenon; the first recorded cases appeared in 1925, although some reports suggest that needle sharing was occurring in China as early as 1902, and could have been responsible for outbreaks of malaria in Egypt, the United States and China between 1929 and 1937. But that’s because the hypodermic syringe as we know it today only appeared in the late 19th century.

However, the delivery of drugs directly into the bloodstream may have a history that goes back thousands of years, as our ancestors placed extracts from healing plants onto open wounds and lesions, or poured them into specially made incisions.

We know that Sir Christopher Wren, best known as the architect of St Paul’s Cathedral in London, injected dogs with alcohol, opium and other substances to see what effect they had on the animals while he was at Wadham College, Oxford in 1656. His apparatus was a quill attached to a bladder containing the drug. To gain access to a vein, he had to make a cut in the skin.

He also attempted to inject a human subject, the “delinquent servant of a foreign ambassador”, but reported that “the victim either really, or craftily, fell into a swoon and the experiment had to be discontinued”. I can’t say that I blame him.

Experiments continued throughout the 17th and 18th centuries but with mixed results. Part of the problem was the suitability of the substances injected, which, depending on the illness being treated, might include things like cinnamon or arsenic.

Another problem was a poor understanding of how the circulatory system works; the English physician William Harvey may have first described the system in 1628, but it was many years before his ideas were fully accepted. A general belief persisted that the effects of an injected drug stayed local to the point of injection and that the drug didn’t travel around the body. It was also widely believed by medical practitioners that a person’s ‘craving’ for opiates was akin to the hunger we have for food, and that you could not become addicted to opium unless you swallowed it. Therefore, they were quite indiscriminate in injecting people for even minor ailments, thus creating new addicts by accident.

This particular belief was shared by Alexander Wood, a 19th-century president of the Royal College of Physicians in Edinburgh, who is credited with being the father of modern hypodermic syringe use. However, it was his contemporary Charles Hunter, a house surgeon at St George’s Hospital, who first realised that drugs administered by intravenous injection do indeed circulate in the blood. He discovered this after he was forced to move an injection site due to the formation of an abscess but found that his patient still benefited from the pain relief administered.

What followed was “a period of sustained and acrimonious debate between Wood and Hunter” but, ultimately, the truth couldn’t be argued with.

Misusing a life-saving invention

The arrival of modern syringes undoubtedly saved lives but also led to a rapid growth in their popularity among drug abusers.

“In the early 20th century addicts were taking doses that were enormous by today’s standards and mostly had overdose experiences when they accidentally hit a vein,” writes Richard Pates in the 2008 book ‘Injecting Illicit Drugs’. “But when narcotics started to become more difficult to obtain and the doses became smaller, communication in the drug subculture facilitated the diffusion of the intravenous technique. [Intravenous] injecting is more economical and the enjoyable rapid effect, or ‘rush’, contributed to the quick diffusion.”

Some of the health issues surrounding IV drug abuse – particularly needle sharing or contamination – can be alleviated by the use of needle exchange schemes and with colour-coded syringes that prevent users mistaking which are theirs. Another solution is to introduce medically supervised injecting facilities (SIFs) or drug consumption rooms (DCRs). These now exist in at least eight different countries.

But, ultimately, the best way to prevent people from causing injury to themselves with intravenous injection is to get them to stop using needles altogether. And that means dealing with the underlying reasons why people use them, a situation beautifully summed up by the American writer Wendell Berry in his 2003 book ‘The Art of the Commonplace’:

“People use drugs, legal and illegal, because their lives are intolerably painful or dull. They hate their work and find no rest in their leisure. They are estranged from their families and their neighbours. It should tell us something that in healthy societies drug use is celebrative, convivial, and occasional, whereas among us it is lonely, shameful, and addictive. We need drugs, apparently, because we have lost each other.”

During my career as police officer I met a great many needle-using drug addicts. Some worked in the sex industry to maintain their habit. Some had taken to street robbery or shoplifting. Many were homeless or chaotic sleepers. A few had fallen from a great height, having lost well-paid jobs and their families. One or two were literally born with the craving as their mothers had been addicts during pregnancy.

I never once met a happy user.