The injection of psychoactive drugs, usually by the intravenous route, has been recognized for more than a century, and has become more widespread over recent decades (Golding, 1993; Derricot et al., 1999). We have been unable to identify any published examples of the recreational injection of alcohol. We describe here three cases in which intravenous injection of alcohol is reported.
Case 1 was a 29-year-old, single, unemployed and homeless man, admitted to hospital for alcohol and diazepam detoxification. He fulfilled ICD-10 criteria (World Health Organization, 1992) for both alcohol and diazepam dependence. While reviewing his history of injecting illicit drugs (heroin and amphetamine), the patient mentioned that he had been injecting alcohol over the previous 9 years. He injected mainly vodka, sherry or whisky with approximately a twice-monthly frequency. His last injection had been 2 weeks before admission. He gave the main reasons for this use as the rapid effect and the enjoyment of the injection itself. The only side-effect he described was a burning pain at the site of injection.
Case 2 was a 29-year-old, unemployed man, married with one child living in rented accommodation. He was admitted to hospital for alcohol detoxification. He fulfilled ICD-10 criteria for alcohol, opioid and benzodiazepine dependence. Heroin was the main drug injected. When questioned about intravenous injection of alcohol, he said that he had been using this method for 10 years until 1 year before admission. He injected mainly vodka with a frequency of four times per week. His main reasons for injecting were the rapid effect and enjoyment of the needle, particularly when heroin was not available. He described the only side-effect as redness and a burning pain at the site of injection.
Case 3 was a 35-year-old single, unemployed man who lived in a hostel for the homeless and who was admitted to hospital for alcohol and methadone detoxification. He fulfilled ICD-10 criteria for alcohol and opioid dependence. He had injected various illicit drugs including heroin and amphetamine. When questioned about intravenous injection of alcohol, he admitted having used this method over a period of 3 years. He said that he had injected various alcoholic beverages, including beer, approximately once a week. His main reasons for injecting were the rapid effect and avoiding the smell of alcohol on his breath because his hostel prohibited alcohol use. The only side-effect he described was a burning pain at the site of injection.
Informal discussions with colleagues across the UK, in both the alcohol and drug fields, indicate that only a minority of long-experienced clinicians remember what they consider rare, individual cases of claimed alcohol injection. Combined with the absence of previous published reports, this suggests that the injection of alcohol is a rare occurrence. The spontaneous description of intravenous injection of alcohol by case 1 led the authors to question a small opportunistic sample of injecting polydrug and alcohol users. The other two cases were identified within 4 weeks. To find three cases so readily may simply be a coincidence, but in English to ‘drink’ is a synonym for to ‘drink alcohol’. In practice it is therefore usual to ask questions about alcohol consumption that specify the oral route, for example ‘do you drink (alcohol)?’ Such questioning effectively precludes discussion of other routes of intake and may serve to minimize recognition of this high-risk behaviour.
The three cases were all male polydrug and alcohol users with histories of injecting drug use and current alcohol dependence. All were unemployed, two were currently homeless and all had required admission to hospital as part of treatment. Alcohol injection was not the main route of alcohol ingestion for any of the three users, but all had injected alcohol over a relatively long period (3–11 years). One possible explanation for initiating and continuing alcohol injection may relate to needle fixation. Pleasure from the act of injecting was described by cases 1 and 2, who also specifically described substituting alcohol for heroin. Another client (not reported) said that once, many years 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 continuing with intravenous use in all three cases. All described burning pain and local inflammation as the only side-effects, but other local and systemic hazards are clearly possible.
Two other unusual routes of alcohol ingestion have been reported in the media recently, snorting vodka among middle-class English club-goers (Mollard, 1998) and the use of vodka-soaked tampons by teenage girls in Eastern Finland (Anonymous, 1999). Intravenous injection has some common features with these other methods, e.g. rapid onset of effects, low doses required for intoxication, and the reduced likelihood of recent alcohol consumption being identified.
The advantages and disadvantages of oral consumption of alcohol are well-known to both the medical profession and the general public (e.g. Crawford et al., 1985). We hope that this report will stimulate interest among professionals to uncover the prevalence and the consequences of taking alcohol by the intravenous route.