Booting and flushing: needle rituals and risk for bloodborne viruses

Abstract

‘Booting’ and ‘flushing’ are terms used to describe an injecting behaviour in which the plunger is pulled back and the fluid (mostly blood and perhaps blood only) is re‐injected. The behaviour differs from ‘registering’, which occurs before the drug is injected. Booting/flushing can produce subcutaneous and venous damage, and increases the risk for the spread of blood‐borne viruses when used equipment is passed on to other injectors. The purpose of the study was to explore the extent of flushing, the context of flushing and IDUs' self‐reported reasons for flushing. Data were collected through semi‐structured interviews with 59 IDUs in Northern Ireland, who were recruited through various strategies. Respondents' ages ranged from 22 to 50 years and females comprised 34% of the sample. Mean length of injecting career was 8.3 years. A total of 46% reported flushing on a regular basis during some or most of the injecting career. The results showed that flushing occurs for different reasons and, in comparison with research conducted elsewhere, is not associated solely with cocaine or speedball injection. Interventions designed to reduce the extent of flushing must take into account the various reasons for the behaviour.

• Booting
• flushing
• bloodborne
• viruses.

Acknowledgements

I am grateful to the individuals who participated in the study. Michele Jordan conducted several interviews for this study and assisted with the recruitment stage of the project. She also assisted in writing the final report for the larger study, of which she is co‐author (McElrath & Jordan, 2005). The research was funded by the (Northern Ireland) Department of Health, Social Services and Public Safety.

Notes

1. The population in Northern Ireland was approximately 1.5 million during this time.

2. Although I use the term ‘borrowing’ in this paper, the term is not technically correct; many IDUs who inject with equipment that has been previously used by another IDU, do not often return the equipment to the lender. We avoided using the terms ‘borrowing’ and ‘sharing’ during the interviews.

3. Unlike other jurisdictions (e.g. United States), there is no government protection of confidentiality for persons who acknowledge the use of illicit drugs in research settings. Although the tapes did not contain the names of respondents, we were concerned that other data, e.g. voice, neighbourhood, could implicate respondents if the tapes were confiscated by police. We prepared for the ‘worst case’ scenario by securing the tapes in a jurisdiction outside Northern Ireland.

4. The availability of heroin in Northern Ireland is limited primarily to brown heroin, which generally must be converted from base to salt form to make it suitable for injecting (Strang et al., 2001). Converting to salt form is generally done by mixing the drug with citric acid or Vitamin C (Scott, Winfield, Kennedy, & Bond, 2000).