Injection anxiety

"We all dig our own graves with our teeth"

~Not Benjamin Franklin

The waning of the harvest, temperatures drop, leaves turn and fall. I speculate that more relationships end during this time of year than any other, and so do more people die. The change in weather reminds me of a good friend, a few years passed now.

I was 21 years old when I saw someone inject heroin for the first time. I was working in a factory that made steel security doors between bouts of narcotic medication at Hopkins for a childhood condition that perniciously persisted into adulthood. I was 95 pounds, life had not been easy on my frame, illness had taken its toll. Don was the friend who got me the job, picked me up and drove me to work every day. He painted the doors after I built them. He lost his job to his habit, an all too common occurrence. His brother fired him frequently, and then rehired him.

Don was 23 and had been shooting up every day for more years than we knew. He had become expert at secreting his habit. Why did he have this habit? Lady Opium’s worshippers seek her out so she may destroy and obliterate pain, usually physical pain, but other pain as well. Think about the last toothache you had. That hot electrical pain that starts at the bottom, right at the jaw line and explodes like a mushroom cloud into the rest of your head. It oozes into your brain, cancelling all other impressions except the sound of nerves desperately screaming. The entire body directs its attention to this one single signal.

Don’s teeth were bad, they were worse than bad. He was poor growing up, lived in a trailer. Heredity, a steady diet of soda pop and cheese doodles had destroyed his mouth slowly and painfully. His smile was a row of grey stumps that should, by all rights, have been pulled out of his head years ago. Painful grey stumps, for this reason his lips seldom left each other when he smiled, unless he really let go. He was very quiet, afraid, and ashamed of opening his mouth unless someone see his teeth, or smell his breath. The result was a painful self-awareness to match his physical pain in severity. He sought relief at Opium’s altar. In this respect Don was no different from the typical user. I could no longer demonize him then myself. One toothless smile is all you needed to see to know he was in pain, and it was bad.

We went to a bar after work one evening. We had both been working late, 10 or 12 hours. It was raining on our way to the city, the sun had almost gone down. The sky was purple. Don’s car smelled like old vomit and was littered with empty cigarette boxes and old pop bottles. We stopped in the parking lot, the pitter-patter of rain on the windshield. He reached over me into the glove box of his 1978 dinosaur and pulled out an alligator skin glasses case. Inside was a hypodermic needle, like the ones they give to diabetics, orange plunger, orange cap. Clear and skinny and straight like a dead snake with black measurements on one side. Without looking he deftly plucked a black change purse with a skull and crossbones from the center console, his hand went under his seat and retrieved a spoon, then to his pocket for a lighter, these three objects he laid in a ritualistic row on his lap. Don knew about my history with Hopkins opiates, so he must have felt comfortable. Like attracts like. First the change purse opened, a red-topped glass vial came out with a brownish white powder illuminated by the streetlights. Next a small amount was tapped onto the spoon. Water was pulled into the sharp from a bottle in the cup holder. This then squirted into the spoon and the resulting mixture was heated underneath with the lighter, a spark in the darkness. This was in stark contrast to the dosage I received from doctors at Hopkins. My dose was controlled and measured, they told me what to take and how to take it and here was a good friend of mine eyeballing who knows how much heroin onto a spoon in the dark. When it was cooked, a small piece of cotton was thrown onto it to filter as the needle greedily slurped it up. He was ready now. 

I remember he asked if I wanted to leave like he hadn’t noticed me there for all his concentration on this elaborate ritual. With a break in the action he was aware of his environment. It was raining so I stayed; mostly I felt the need to see this thing through and maybe call 911 if it went south. I wanted to see the end, I told him as much. He told me I was a good friend for that. He put all the players away except for the needle, and took a tourniquet out of the glove box. This strip of rubber he tied tight around the bicep of his right arm and he began to look for a good vein. I could tell the needle was dirty from having been used so often. In retrospect I’m surprised he never got sick from an overused needle, I don’t know that he shared, but he never cleaned them either. He told me that he often injected directly into his arm if he couldn’t find a vein, playing with an outside chance of gangrene and amputation. I have since seen leaking pink and white abscesses on other friends who used. They look bad, but smell worse. Considering how often Don injected, he was very fortunate to still have all his body parts.

He found a vein on the soft underside of his forearm, made a fist and drove the needle home with a gentleman’s precision and delicate attention to detail. It was in, and he pulled the plunger back, a red cloud surfaced and exploded in the needle, he pushed the plunger down a little, his body visibly relaxing. He pulled the plunger back between his fingers again; another red jellyfish swam up into the needle. This time he pushed the plunger all the way down. A silent sigh escaped his lips as his mouth opened. His body slackened and in the light, his pupils constricted, his eyelids lowered. He looked relaxed and content. Time stood still as he stared out of the windshield. I don’t know how long we sat there, quiet. He turned and suggested we go in to the bar now. I agreed and we walked out into the rain.

The average picture of the dope fiend stands in stark contrast to my good friend. He was kind and gentle. I never saw Don raise a hand to another person, unless he was defending someone else, he always treated me with honor. He was always generous with what he had, and considering our consistent close proximity while we worked together, he never stole, at least from me. He was commonly lawful, except for his habit. It was clear even to the casual inquirer that Don was not in the mud for kicks, he was there so that he could scrape together some semblance of comfort from an uncomfortable life. He was too poor to see a dentist, and at this point in his life his mouth was so far gone that it would have cost him a small fortune to fix a lifetime of damage. He was too poor to see a doctor.

A few months later Don had decided to get clean. He looked like a new person for a few weeks, but quickly became very dour, his eyes turned down, constantly rubbing his jaw. The push of society seems to get the addict to recognize he has a problem with drugs without recognizing the underlying condition that causes him to take them, many people who undergo detox for pain killing drugs still suffer from pain 24 months after the detox period which suggests that their pain has some other biological origin besides simple withdrawal (Larson, 2007). About a year later, presumably because he couldn’t take the pain any longer he took his last shot. This shot killed him. He was found dead in a hotel bathtub. 
My friend died because he didn’t have access to medical care for his chronic pain condition. My experience with Don was that his thin, ropy frame contained a mountain of kindness but he was still subject to all of the derision an addict faces. Intravenous heroin addicts tend towards sporadic employment and social withdrawal, and wind up missing the net when they fall out of the window. The picture of the doctor supervised opiod user is in stark contrast. The dosage is regulated, they tend to hold jobs and maintain social networks and normally regularly attend psychological counseling (Sigmon 2006). My friend Don had access to none of those things, just the drugs, and it is the drugs that killed him.

Larson, Mary Jo. "Persistent pain is associated with substance use after detoxification: a prospective cohort analysis." Addiction. 102.5 (2007): 752-760.
Sigmon, S.C. "Characterizing the Emerging Population of Prescription Opiod Abusers." American Journal on Addictions. 15.3 (2006): 208-212