Getting To The Point – Could You Have A Needle Fixation?


Definition – A person with a needle fixation enjoys and often craves the act of injecting a drug, as much as the drug itself – often the two pleasures go hand in hand.

Such an IV user will often crave the actual injection and associated “rush” that tends to follow shortly after they have injected their substance into their veins. The user may also resort to other substances just to satisfy this urge, quite often collapsing veins, impeding circulation, increasing their risks of infections and damaging surrounding tissue in the process.


What Is A Needle Fixation?

Needle fixation occurs when the actual act of injecting the drug into their veins becomes compulsive, rewarding and equal to, or more important than the actual act of using the drug itself. Certain experts actually consider needle fixation to be a separate addiction, with some referring to it as a behavioural addiction, or as part of a ritual that they follow every time they use their substance of choice. Those with needle fixations may also inject water or other substances when their drug(s) of choice aren’t available to satisfy their psychological need to inject. A needle fixation can increase the already present risks which accompany injecting drugs, such as infection, transmissible/blood-borne diseases and possibly even death.

Not every individual who injects drugs will develop a needle fixation. But those who do, entertain thoughts and engage in behaviours increasingly shaped by this compulsion.

Estimates suggest that needle fixation is observed among a quarter of injecting heroin users.

The Public Sphere

 So how does a person develop a needle fixation and what does it entail?

A more technical definition, sourced from a research report published in the journal Addictioncites that it is “Repetitive puncturing of the skin with or without the injection of psychoactive drugs via intravenous, subcutaneous or intra-muscular routes, irrespective of the drug or drugs injected, or the anticipated effects of the drug.”

Considering the fact that addiction, especially an addiction to hard drugs like heroin and crack cocaine, overrides a person’s desire for almost anything else, this is pretty extreme. This is why some experts refer to a needle fixation as an addiction in itself.

The Public Sphere notes that three themes lead certain people to develop “an addiction to the injecting process” which include:

  • Previous obsessive traits
  • Irrational superstitions
  • Insecure attachments

These individuals harbour perspectives and reactions to needles and needle use which can endanger their health and even those around them.


Intravenous (IV) Drug Use: The Basics

Injecting drugs is the most invasive and risky way a drug user can administer a drug. To do this, an individual fills a needle or syringe with the desired drug of use once it has been prepared prior, an injecting site is then located and the drug administered. Intravenous drug users (IDUs) inject drugs in the three following ways:

  1. Intramuscularly (IM) – Into the muscle and not into a vein
  2. Intravenously (IV) – Directly into the vein
  3. Subcutaneously AKA “Skin-popping” – Directly underneath the skin, above the muscle layer
Free Vector | Types of injections diagram

Some of the most addictive drugs known to man are used this way, including heroin, crack cocaine, methamphetamine and morphine among others.


What Behaviours & Thoughts Are Associated With A Needle Fixation?

Like other harmful behaviours surrounding substance use, a needle fixation is steeped in some very unhealthy and negative thoughts and behaviours, such as those outlined by the Addiction report:

  • Ritualisation: A person becomes obsessed with preparing the needle and syringe for injection.
  • Relishing The skill Of injecting: User’s claim that their skill at injecting increases their self-esteem.
  • Substitution Of Other Drugs For Water: Some people may fixate on the injection so much that they turn to these substances if their drug isn’t available, just so they can inject.
  • Pleasure At Injecting: The injection itself creates a sense of well-being and enhances the rush of the drug.
  • Pursuit Of Pain: Certain individuals report liking the pain associated with the injecting process (masochism).
  • Linked To Deliberate Self-Harm: Some individuals inject as a means to purposely harm or punish themselves. This tends to occur in those with mental health conditions, although not always.
  • Association With Sex: Injection can also be linked to sexual pleasure, and as a way to create intimacy.

Specifically, a person with a needle fixation may:

  • Feel a rush or “buzz” simply by using the needle, even before the drug hits their system.
  • Become sexually aroused by injecting, or being injected by their partner.
  • Find that they replace sex in increasing instances with the ritual of injection.
  • Believe it would be harder to give up injecting than the actual drug of use.
  • Feel the process of preparing the needle and injecting equipment as, or more important than the actual “high” that the drug may provide.
  • Feel calm or more relaxed after they inject water.
  • Enjoy the pain that results from the injection (either when injecting their self, or when being injected by others.)
  • Become infatuated with the needle because of how it can be associated with pain.
  • Pull blood in and out of the syringe prior to or following injection, also known as “flushing” or “flash back”.

These behaviours can put a person in harm’s way. For instance, when a person is injecting a partner, especially if they equate a sexual feeling to the act, they are more apt to share needles with others. This practice drastically increases the risks associated with injecting. As these behaviours accompany drug use, comprehensive treatment should be sought which addresses both concerns.


What Are The Dangers Of Injecting Drugs?

Harm Reduction Decade | Harm Reduction International

A needle fixation can jeopardise an IDU’s health and life. When this desire becomes so strong, coupled with the already overwhelming urge or craving to use, a person may resort to sharing needles with others, using dirty needles or using old needles that has been used by themselves or others previously, all of which increase the risk of infection, transmissible diseases such as HIV and Hepatitis and as a secondary effect, death.

4 broken needles were found under this persons skin that broke off under their skin during their prior IV drug use.

Broken Off Needle Under This Person’s Skin.

Injecting Drugs Can Lead To:

  • Abscesses
  • Addiction
  • Cellulitis
  • Collapsed veins
  • Cotton Fever
  • Hepatitis B and C
  • HIV/AIDS
  • Limb amputation
  • Necrotising fasciitis
  • Organ failure
  • Sepsis
  • Track marks
  • Circulatory damage
  • Nerve damage
  • Blood clots
  • Overdose

Many of these conditions can accelerate into critical stages and lead to death quickly.

Recognising a needle fixation and educating an IDU on it, is key to preventing these risks and opening the conversation up for treatment options.

HRI launches 10 by 20 campaign | Harm Reduction International

Why Is It Important To Understand Needle Fixations?

Some findings illustrate that individuals with a needle fixation are more impulsive than their IDU counterparts who don’t have a fixation. Some research even posits that a needle fixation should be classified as a behavioural addiction of it’s own, and treated as such.

Safer injection | CATIE - Canada's source for HIV and hepatitis C  information

In keeping these concerns in mind, treatment options should address any issues which relate to impulsive and/or ingrained negative behaviours. Effective treatment should treat both the drug addiction and the associated dysfunctional thoughts and behaviours that are linked to the needle fixation. Also, having the best clinical evidence, education and treatment options will also help addicts to overcome their fixation towards needles. Harm reduction strategies have been around for some time now, and now, it’s needed more than ever with the constantly increasing numbers of people who are using substances recreationally, or to cope daily, ultimately developing full blown addictions. You can find out more about harm reduction in one of our previous articles here.


Elizabeth’s Story Of Needle Fixation – “When There Wasn’t Any Heroin Left, I Shot Up Random Crap…”

This is one of those stories I don’t like to tell. It happened in the shoddy little one-room apartment I’d been renting week to week with my husband in Longmont, Colorado—Boulder’s poorer, browner neighbour. We were both dopesick. It was yet another weekend we had assigned to “getting clean,” as though a weekend is enough time to kick years of heroin addiction. The apartment was so small that the toilet was next to the kitchen sink, which was across from the bed, divided by a three-foot plaster wall that resembled a jail cell.

We fought there so loudly and so often that eventually the landlord offered us a bigger apartment at half the listed price just to give us some space from each other. But on the day in question we were quiet and sick. No dope, no money—we’d burned it all, intentionally, on our last “blowout run” as we called it. All we had left were a few crusty cottons, our spoons and a brimming syringe container.

I don’t remember whose foul idea it was. It doesn’t matter; we both agreed to it. We decided to break into our safe-drop container, open the old rigs and swab out the brown residue smudged across the ends, dropped along the plunger and pooled at the tips.

“Does that look like dope or blood?” We checked in with each other, holding the needles to the light when were unsure if the stuff inside was more reddish or brown. We ended up with a horrific, muddy concoction. I look back on this memory and I want to reach out and throttle myself. “You’re about to shoot old blood,” I want to shout, while overturning that spoon of filth. But it’s a memory, so it’s indelible.

I have to watch while my husband and I draw it into our syringes—the sharpest we can find in the lot—and inject ourselves with something we must have known, in the back of our minds would bring us nothing but pain and problems. I don’t know how we both survived that shot. We spent the next hour contorted on our bed, moaning and sweating through wrenching, twisting pain that engulfed our bodies and felt like it would end us. I have no idea why it didn’t last longer or why we didn’t die.

Whatever was in those syringes—old blood, straight up dirt or infectious bacteria, was nothing that should have ever been pushed through a needle into our veins. That was the most dangerous non-opiate I’ve injected into myself, but it was far from the only one. There were times I shot what was effectively water; soaking an old heroin cotton into it first as an excuse. I’ve shot pills. I’ve come close to injecting benzodiazepines, which are not water soluble.

My husband once shot a Xanax crushed with alcohol (and I was jealous, even though it did nothing but sear his vein). Outside of the addiction community, people probably think these behaviours are driven by an insatiable hunger to get high, but those who’ve been there will recognise it as a needle fixation, compounded by having an addiction to drugs on top.

But I was definitely in love with the ritual of injection. Swirling the dope in the spoon with the end of my plunger. Watching the heroin drain from spoon into barrel. The pinch of insertion. The plume of scarlet blood shooting back into the syringe when I checked that it was in a vein. That slow moment while I pushed the drug into myself, just before the rush set in.

I remember glancing at myself in the mirror while I was lighting the dope, a syringe dangling from my mouth and thinking, “This is the me I love best”. I was not only addicted to injecting heroin, I was addicted to injecting.

I think back to the first few months of my relationship with my husband—the way I’d hold his arm in my hands and trace my finger down the pale flesh of his forearm, seeking a vein. Once I found it, I inserted the needle, pulled back the plunger to check for his blood, then pressed the drug into him before watching him fall back into the pleasurable void of the rush. Often, in those early months together, we’d spend the hours after the rush faded seeking another version from each other’s bodies.

I’m so glad that we are both over our needle fixation habits, as well as our addictions to heroin. It can be done if you want it badly enough. No one said it will be easy, but it will be worth it, even if you can’t see it for yourself at this moment in time. From someone who’s been there, needle fixation is one of the grimier components of heroin addiction. But that’s exactly why it deserves more—not less attention, and why we need far more focus on effective harm reduction strategies and mental health/addiction care expansions.

By Elizabeth Brico – Longmont, Colorado


Does A Needle Fixation Alter A Person’s Treatment Needs?

Yes. A BMJ Journals article explains how a needle fixation can influence treatment.

“When treating injecting drug users, it’s important to simultaneously assess their needle fixation because this would influence their treatment outcomes. Understanding needle fixation as deliberate self harm can encourage testing pharmacological interventions in addition to behavioural therapies.”

British Medical Journal

Any time an individual enlists in rehab or community based treatment to optimise treatment results, the facility’s staff should seek to understand their unique situation as fully as possible. Understanding a person’s perspectives on drug use is important and can help to create and implement an individualised treatment plan.

Prevent hepatitis: Harm reduction | World Hepatitis Alliance

How Do You Treat A Needle Fixation?

The honest answer is to simply stop injecting drugs. However, this may seem much more simple that in reality, it truly is to stop using drugs and live a life in recovery. Many of the same modalities used to treat drug addiction may also benefit a person’s pursuit of overcoming their needle fixation. Behavioural therapies, such as cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT) can be impactful methods for treating matters of impulse control, self-harm, abnormal sexual proclivities and other dysfunctional behaviours.

Treatments will help the addict along the way, however, ultimately it revolves around them ceasing to use substances and implementing other recovery based activities, coping strategies and more to overcome an addiction for the long haul.

On this subject, one paper asserts that “Consequently, current evidence-based treatments for behavioural addictions could be modified to address the inherent difficulties of impulse control in those identified as needle-fixated injecting drug users.”

Therapy and counselling can work well to restore positive and healthy thoughts, emotions and behaviours which build up sobriety/abstinence and undue the damage done from the needle fixation and addiction. Additionally, these behavioural therapies are key components of treatment for any co-occurring mental health disorders, like depression, Borderline Personality Disorder, Bipolar, Schizophrenia, or past traumas like abuse, PTSD or neglect.


Begin Building Healthy Behaviours For Your Recovery Today

A good treatment program can work to treat the needle fixation and, as well as the addiction to drugs and/or alcohol. You can find a range of professional recovery therapies that Drink ‘n’ Drugs provide on our professional services page here.

You can also find a wide range of charities, organisations and groups who can help you on our help and support page here. If you need more help, contact your Doctor, GP, local community based drug and alcohol service (if you have one) or by contacting us and we will help to guide you in the right direction.


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Published by Drink ’n’ Drugs

Providing useful, relevant, up to date information and support for those suffering from active addiction or those who are in recovery.

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