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Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
Wound botulism occurs when soft tissue is colonized by C. botulinum, usually the result of skin trauma, and the organism germinates and elaborates toxin. An emerging cause of wound botulism in the United States is injection drug use, specifically from “skin popping” (i.e. subcutaneous instead of IV injection of drugs).5 It is presumed that the drugs themselves, particularly “black tar” heroin, are contaminated with the organism. Wounds typically do not have the cardinal features of cellulitis, such as erythema, warmth, or purulent drainage, and they may appear to be healing while neurologic symptoms are progressing. Any of these signs, combined with fever, would suggest wound coinfection with another organism.
The Drug Choice
Published in Albert A. Kurland, S. Joseph Mulé, Psychiatric Aspects of Opiate Dependence, 2019
Albert A. Kurland, S. Joseph Mulé
In some individuals, these routes may be by-passed by “snorting” of the powder or cocaine or there may be a recourse to the subcutaneous route, “skin popping.” Eventually, whatever the route, there is a resort to the i.v. injection – “mainlining.” The technique usually employed begins by removing the powder from the capsule or glassine bag. The powder is then mixed with a small amount of water in a spoon. The solution is heated over a small flame and then drawn up into an eyedropper. A hypodermic needle is fitted to the eyedropper, a tourniquet placed around the limb, and the contents injected directly into the vein.
Opiates
Published in G. Hussein Rassool, Alcohol and Drug Misuse, 2017
The most popular of opiates as an illicit drug of misuse is heroin. The drug is swallowed, smoked, sniffed or injected either subcutaneously or intravenously. Diverted pharmaceutical opiates and opioids may be formulated for injection, oral use or occasionally as suppositories. Subcutaneous injection (skin popping) is when heroin solution is injected into the layers of skin – usually in the arms or thighs. Intravenous injection (mainlining) is when the heroin is injected into a vein. Smoking is often called “chasing the dragon”, or “booting”. A small line of heroin is placed on a piece of silver foil, and heated from below. The heroin runs into a liquid, and gives off a curl of smoke, which is inhaled through a rolled tube of paper or foil. Tablets are sometimes crushed and injected. If heroin powder is injected it is generally acidified, using lemon juice, citric or ascorbic acid and heated with water, then filtered prior to injecting. The sniffing of liquefied heroin using a nasal spray bottle, a practice known as “shabanging” has been reported.
On Addiction, Complexity, and Freedom: Toward a Liberation-Focused Addiction Treatment
Published in Journal of Psychoactive Drugs, 2019
“Natalie” was a patient of mine when I worked in a methadone clinic. A lovely woman in her thirties who had been through trauma, suffering, poverty, and heroin addiction, she was also very connected to her two daughters. One day, she told me that she had never injected heroin; she had only been involved with “skin popping” or subcutaneous heroin use. This was quite unusual, especially in that setting. When we explored it, Natalie said that being a mother had always been of central importance to her and that while she did use heroin and was addicted, she felt that intravenous use would be the end of everything, so she refrained from taking that final step. This was a manifestation of role or identity conflict—the mother identity was battling with the addiction identity for dominance. Her desire to be a better mother motivated her to join a methadone program. She did very well in the program, returned to school, and eventually left the clinic in good standing. This is an example of identity extension.