# Presentation: 431276

## Speedball and crack injection in London groins, veins and injecting environment

**Tim Rhodes**
- Jo Kimber, Daniel Briggs, Vivian Hope, Greg Holloway, Steve Jones

##    		 crack and groin injecting

*	*
- 	*Six City Study in England, n=952, 2003/2004, Hope et al*
-  n=952, six locations
-  45% groin injecting
-  40% crack/speedball injecting
-  > 70% crack injection Bristol & Manchester, and > 50% London [Judd et al., 2005]
-  crack injectors more likely to be groin injectors (49% vs 34%)
-  groin injectors more likely to have an open wound infection (26% vs 18%) and DVT in last year (28% vs 8%)
*	**Rhodes et al. (2006) “Groin injecting in the context of crack cocaine and homelessness”, *_*International Journal of Drug Policy*_*, 17: 164-170**.*

## Slide 3

##    				 	qualitative study

*	*
- 	*speedball injectors (n=44), Bristol and London, 2006*
- median age, 33 (range 23-53)
- male, 75%
- homeless in past year, 69%
- speedball in past month, 80%
- mean years speedball, 7 (<1-23 years)
- current groin injection, 61%
- groin injection as main site, 43%

## 	      speedball

*crack is the buzz, heroin the medicine*
- 	You can buy gear all day long, buy heroin all day long, but there’s that urge that you want that lick or that hit. You just want that buzz. The crack gives you a buzz, a high. The heroin, it doesn’t give you a buzz no more, it just makes you feel normal. [#9, male, 30 years]
- 	The fact that I’m physically dependent on heroin, that is my main drug of choice, that is the drug I actually need. But still, the fact that, you know, the snowballs, you know, is such a lovely buzz, and intense buzz. [#8, male, 31 years]

## 	      speedball

*only one with the other*
- 	I’ve got to have both together. So dealers have actually said to me ‘So you don’t want to buy my gram?’, and I said ‘No, cos you’ve not got the white’. I cannot do one without the other... If I have a tenner and I am proper clucking then I know I want to wait until I have another tenner to get the white so I can do the two together. You can’t have one brother until the other brother comes along. [#6, male, 46 years]

## 	      speedball

*never looked back*
- 	I used to smoke the heroin on a foil, and I smoked a stone on the pipe... So someone conveniently said to me it would be better if you was to inject it both together. And the first time I tried it that was it. I never ever went back to the foil and I never ever smoked a stone again. [#6, male, 46 years]

## 	      vein damage

*crack destroys your veins *
*	*I’m trying not to snowball at the moment cos it seems to be making my veins collapse. There’s bruising, and it seems to be making them collapse... Crack does destroy the veins anyway like, like the veins in my arms as well are really sore. And that’s mainly when I’m snowballing. When I’m just using gear it doesn’t seem to, doesn’t seem to bruise the vein up so much. [#3, male, 34 years]

## 	      vein damage

*missed hits*
*	*You won’t know that you’ve missed it. You just won’t get no buzz from it. And then the next day you’ll wake up and you’ll probably have a great big lump there [around the femoral vein], and won’t hardly be able to walk. Whereas if you’re missing with gear, you know straightway and you know to stop. [#7, male, 25 years]

## 	      vein damage

*crack as a ‘useful’ anaesthetic*
- 	Now if it’s just gear on it’s own, I’ll push it in and the pain is that unbearable I can’t push it in. Whereas if I’ve got crack in there, I’ll push the first bit in, the pain will be, it’ll really hurt, but then the crack numbs it so I can push the rest in and it’s OK, but without the crack I wouldn’t be able to push it in, I’d be in trouble.  I’d end up pulling the pin out, I can’t do it, it hurts so much. So that’s another reason I use the crack as well. [#1, male, 31 years]

## 	      vein damage

*flushing*
*	*With the snowball you never know because when you inject, you put it in, draw it back, put it in again and it numbs the pain and it looks as if you are missing and sometimes I can’t tell, so I am drawing it back to and forth. [#28, male, 28 years]
- 	That’s another thing as well. The more you flush, the more you kill your veins off. [#29, male, 29 years]

## 	      vein damage

*citric powder *
*	*Citric will close your veins up quick. That is why it is better to use vitamin c or lemon salts... We use citric because that is what is available. [#30, female, 38 years]
- 	The crack annihilated my veins. But then again, in the 90’s I used vitamin c powder a lot more. It’s really hard to get now, so I use citric, and citric fucks your veins really badly. That burns, burns them.  [#17, male, 26 years]

## 	      vein damage

*citric powder *
*	*And you go “Oh, you don’t need to put that much in”, and they go “Oh, I always put that amount in”. So then when you have a dig, you don’t miss, but you feel that citric and it burns. And you think that never happens when I do it, cos I only puts a little bit of citric in.. When you share your drugs with somebody, and they cook up, they put in more citric than you would use.  [#6, male, 46 years]

## 	      groin injection

*accepted as a last resort** *
- 	I was concerned I had used up nearly all my veins that I knew about. On my arms, the rest of my body. I’d even done my chest and my breast bone, and all that...Put it this way, I would sit there for sometimes a good 2-3 hours. And obviously ending up with a clotted hit. *[So you were wasting hits?].* Yeah, I would literally be in tears... I mean I’d go out and make money. I’d go and score. I’d go home ill, and basically mess it up, and then I’d be back to square one again. [#9, male, 30 years]

## 	      groin injection

*generational differences*
*	*The young kids in Bristol that start using, they’ve got this huge thing, they go straight to the groin, you know what I mean, and its insane, its fucking insane, man... [#17, male, 26 years]
- 	The older generation... They see it [groin injection] as completely different to the younger generation, whereas the younger generation seem to think that is the right place to go, it’s like the ‘in thing’... The younger generation I’d say prefer it, the older generation sort of like need to, *[**And yourself?]* I prefer it.  [#8, male, 31 years]

## 	      groin injection

*preference** *
- 	I could have used [other veins] but it’s just easier to just go in the groin. [#3, male, 34 years]
- 	I started using the groin is because of the convenience. For quickness I mean... [*You could have gone into your arm*?]. Oh yeah, yeah, yeah. I could have gone anywhere. I mean even though I’m using my arms occasionally, I can still get myself, I’ve still got my veins in my feet. [#6, male, 46 years]
- 	I know of people that could quite easily inject in their arms, who have got massive veins in their arms, and they inject in their groin knowing that you do get a better hit. [#7, male, 25 years]

## 	      groin injection

*better rush*
- 	It’s crazy me saying this, but it’s a better hit. You tend to feel it more harshly than you do if you go somewhere else... The overall effect is sort of bigger and quicker. [#8, male, 31 years]
- 	People always want to know how to get the best hit. My mate suggested it because I was complaining about my arms. I said what was the difference and he said it was a quicker rush because when I was injecting in my arms it took longer for me to feel the rush, but in the groin, it was immediate. He told me all this. He said you get it quicker and feel it more, that’s why I use my groin. [#28, male, 28 years]

## 	      groin injection

*convenience *
- 	I thought they were crazy. Why risk losing a leg? But they said it was quick, simple and easy... A lot of people are confident and competent to do it. They can whosh-bang-in, whosh-bang-out. I mean it is more convenience. [#27, male, 43 years]
- 	Once it’s in the pin, a few seconds. Draw it back and it’s in. [#8, male, 31 years]

## 	      groin injection

*convenience in context** *
- 	I started using me groin cos I was having all these problems [with veins] and that, and once you get your groin, and especially if you are homeless, you’re outside and that, I mean there’s public walking about and that, so you want to be as quick as possible so no-one can see you. At the worst, if anyone sees you, it looks like you’re having a pee or something. Once you’ve got it, you just push it in, draw back. It’s so quick, it’s over in seconds you know. But the trouble is, once you start using the groin there’s no going back cos you can get it so easy. [#20, male, 33 years]

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## 	      groin injection

*relatively safe*
- 	The risks are outweighed by the fact that it’s quicker and a lot of times it’s safer. *[How’s it safer?]* Because like I said, when you use like, you know I’ve been six hours [trying to find a vein]. And that ain’t like in the same site, so I might, I’ve probably used about 15 pins. And I’ve got all them dent marks on my leg, like all these marks. And each time I’ve attempted right, I’ve just run the risk of missing. [#6, male, 46 years]
- 	To begin with, you know, I had thought it was not so safe. But you know, because it’s an actual normal vein, I think, look at the overall picture, there’s not much difference really. If you’re going to get a clot, you’re going to get one you know, whether you inject in the arm, legs or groin. [#8, male, 31 years]

## 	      groin injection

*accepting of risk** *
- 	I can’t get any more veins in my arms. My ankles, but I can’t get them. I go in my groins. *[Both sides?].* Yeah, I find it difficult and scary using the groin *[How come?]* When you see people who have lost their legs and stuff. You know the risk involved is DVT and blood-clotting of arteries, and circulation to the leg. But you are desperate for a hit, and your veins run out in your arms and ankles, and the only place you know where you can go is your groin. [#27, male, 43 years]

## 	      groin injection

*accepting of risk*
- 	It is dangerous. It’s stupid. I have blood clots. I have been in hospital for two weeks. When I started, I used the arms but now I don’t really want to go there because I know the feeling is not as good. [#28, male, 28 years]
- 	It’s just dangerous. I know a lot of people that have ended up nearly losing a leg. A good friend of mine lost his leg. I know it’s dangerous, but it’s a sort of addiction on its own. [#7, male, 25 years]
- 	The damage, its frightening. But you carry on doing it. [#16, male, 32 years]

## 	      groin risks

*hitting the vein*
- 	As far as I was concerned I could use it and use it and use it. And it would never end. Not realising when you batter a vein it sinks, and sometimes burns like mad cos it’s telling you ain’t coming in here. [#9, male, 30 years]
- 	You end up pushing the vein back if you’re using blunt works, you end up pushing it back and back... And now, I’m trying to get it, and I can’t find it. I have to stab it in to get it. Then I went onto long orange for a few months and it got to the point where I’d push it, it would go right through the vein, and I’d have to pull it out a bit to get the hit. [#7, male, 25 years]

## 	      groin risks

*missed hits and damage*
- 	The crack numbs the site. Every time you go in for your next hit if you carry on, your vein will disappear. So you try to manoeuvre to another spot [in the groin]. And that’s when you start to miss and hit the arteries and nerves. You get the other side [of the groin] for a few months, that keeps it going. Speed-balling is dangerous. You start have problems walking. [#29, male, 32 years]
- 	I did it for a couple of years in the groin. And then they just started going. I started hitting arteries. I was missing, hitting nerves. My legs went to pieces. I was in hospital three times. The last time, my legs were so bad, they just told me not to do it. [#29, male, 32 years]

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## 	      groin risks

*hitting the artery** *
- 	I was in the toilet, I’ve pulled it back and I could see blood’s filled up, but it’s one of those ones with the ultra violet lights in, so you can’t see properly. So I just assumed it was in, just went, whacked in the whole lot, and just all of a sudden got this pain. And I just ripped the pin out me leg, and fucking just like bouncing around inside this cubicle trying to be quiet. Fucking painful. [#7, male, 25 years]

## 	      groin risks

*multiple complications** *
- 	I have so much trouble cos my groins packed up. I’ve got multiple blood clots in both legs... I’ve been in and out of hospital so many times, like, and, last time I was in I had six abscesses come up  because of MRSA and a massive ulcer also, on the front of my leg. And now I’m not actually using my groin because both of them have packed up, and I know that I’m going to loose me legs if I carry on, so I’m using half mils and I’m going in real tiny capillaries all over me chest and me thighs and that. So it is hard to get a hit you know. I mean, I’ll get a hit now, I mean I’ll get a bit of it here and a bit of it there, and it’s a waste of time. [#22, male, 30 years]

## 	      groin risks

*after groins, the neck?** *
- 	I just could not get that side of my groin. Anyway, I got that side and where I was trying to find it I was prodding the pin about and I ended up getting an abscess on that side of my groin. So this side was swelled up. I was going back to my arms and that, and my hands, got no veins in my arms at all, and trying to do that. Anyway, what I thought, I thought ‘My neck’... [#22, male, 30 years]

## 	      neck injection

*is the neck a shifting risk boundary?** *
- 	I said I’d never shoot in my neck, I never even thought about using the groin. Never shoot in my neck. But when that time came, like, I got to do it, whole neck went. [#17, male, 26 years]
- 	A lot of people lately have come up to me, when I have been in the same place as them injecting, and have asked me to do their neck... Nowadays there’s a lot of people that are just saying ‘Look, can you get my neck?’. They’re picking anyone. They just want a vein. [#9, male, 30 years]
- 	Now people will talk about going in the neck as they would have talked 15 years ago about going in the groin. [#6, male, 46 years]

##    			   		visual data

*	*
- we live in an interview age
*retrospective story-telling and accounting*
*neglect of naturally occurring observational data*
- forms of visual data
*photographic image and ‘photo-elicitation’; visualisation and mapping; ‘found’ data (photographic and film) *
- status of visual data
*lacks credibility in social science; risk of ‘symbolic violence’; ethics and safety; documentation; analysis of meaning, nuance and affect; analysis of setting; data permanency protects against premature inference and missing infrequent or background occurrences; policy impact (encapsulates a story, evokes emotion, the ‘uh huh’ factor) *

##    			   study conclusions

*	*
- a crack-based speedball injecting culture
*social pharmacology of speedball as drug and heroin as medicine*
- vein damage and groin care
*few receive advice, need for specialist wound care, need for groin risk reduction advice, need for guidance on citric*
- site and drug transitions
*groin and neck injection, smoking crack rather than speedball*