In The Netherlands two predominant routes of heroin self-administration are prevalent with an uneven distribution; smoking and injecting. In this study 23% of the contacted drug users inject and 77% smoke their drugs. Several other Dutch studies mention similar prevalence distributions (1, 2, 3). From an ethnographic perspective these routes of administration when observed in their social context and meanings can be termed heroin rituals. Injection has been the predominate ritual among heroin users in Western societies while heroin smoking has been the most common ritual pattern in Eastern societies. However, there has been a process of continual crossover with Western heroin rituals appearing in the East and Eastern heroin rituals appearing in the West.
The Netherlands provide a relatively unique social situation because both Western and Eastern heroin rituals appear and are relatively stable. Recently heroin smoking was also reported in the United Kingdom (4, 5, 6). The most common form of heroin smoking in the Netherlands is called chinezen (chinesing or chasing) by users, revealing its Eastern origins. In Hong Kong, this heroin smoking ritual is called chasing the dragon (7).
Injecting, which is the typical western heroin ritual, is in The Netherlands called spuiten or shotten. Shotten is derived from shooting, an American drug subcultural term for injecting. Spuiten is a relatively general term, that can just as easily be used in a medical as well as in a subcultural context. On the basis of sociolinguistics one might predict that chinezen would be considered a more deviant behavior, because it is associated with an exotic culture. However, the opposite is the case, where injecting mostly is preceded by chinezen in a drug use career. Heroin, and most other opiates, can be taken into the body in more, although less efficient, ways. Simple oral ingestion (mixed with food or drink or not), sniffing and smoking in a cigarette, all produce a high. Besides for economic reasons, these routes are not preferred by users because they produce a comparably low flash or rush (the initial physiological impact effect). In the following two sections a detailed description will be presented of chasing and injecting, the two most common administration rituals of Dutch heroin users.
The descriptive term chinezen (chinesing or chasing) refers to the behavior of trying to inhale the curling fumes of heroin vapor with a tube as the heated liquid heroin flows along a piece of foil. It is usually mentioned as a form of drug smoking. However, contrary to the logic of the word smoking, the drug is actually not smoked. Technically, when heated, the drug melts and subsequently vaporizes. The vapors are then inhaled. So the drug is not burned, causing smoke, like with tobacco. For practical reasons the term smoking will be used, as it is most common used. The following fieldnote presents a representative depiction of chasing:
With a small pocket knife she takes a knife tip of heroin from the paper package and puts it on the oblong strip of aluminum foil that lies in front of her on the table. She takes the foil in her left hand and with her right hand she puts a tube with a length of ± 7 cm and a diameter of ± 0.5 cm in her mouth. With the same hand she takes the disposable lighter from the table and lights it. Before holding the flame under the foil she checks the height of the flame. Then she bends a little over and brings the foil at approximately 10 cm from her mouth, a little tilted and parallel to her body. The end of the tube is now ± 1 cm away from the little pile of light brown powder on the foil, slightly behind it. Simultaneously, she carefully positions the lighter, so that the top of the flame is ± 1 cm under the foil where the heroin lies. The heroin powder melts, turns into a dark reddish brown drop and starts to run slowly along the length of the foil leaving a brown track behind. With the tube she carefully follows the drop and inhales the fumes that curl up from the heated liquid. When the drop approaches the end of the foil she stops heating it, while continuing to inhale for a second. The drop solidifies and spreads out a little. She puts the foil back on the table and takes the tube from her mouth. After about 10 seconds she exhales.
This fieldnote shows several important features of chasing heroin. In order to chase heroin one needs, besides the drug, certain distinctive paraphernalia, such as a knife, aluminum foil, a lighter, and a tube-shaped pipe. Furthermore, one needs the knowledge and skills to use these tools in the required manner. Some of these need special preparation. Finally, there are some requirements for the place where chasing takes place.
Both chasers and IDUs habitually carry knives. Although some users may think of their knives as a status symbol or weapon for self defense or robbery, they will find themselves using it mainly in handling drugs. A dealer uses a knife to scoop the drugs from his stash into the balance or to eyeball the smallest sales unit, a halve streep (a half stripe = ± 0.05 gram) at the point of the knife. With a knife the user takes the heroin out of the package and puts it on the foil or, when injecting, in the spoon. The primary function of knives is instrumental in the process of drug use. Therefore, most of the observed drug users use a small, easy to handle pocket knife. Only once a large, dagger type, knife was observed in the process of preparing a considerable amount of cocaine for smoking. In contrast, the blade of the smallest knife observed measured only 3 cm. When a knife is unavailable, users may turn to less preferable alternatives, such as a screw driver, a dining knife or a stanley knife. But, pocket knives are favored as these are more appropriate in handling small quantities of the precious powder.
The aluminum foil from which heroin is smoked is ordinary kitchen foil and can be obtained in any supermarket, where it is sold on roles of 25 meter x 30 cm. The common size of the smoking foil is ± 5-7 x 15 cm, which is half of the width of the roll. Chasers were observed just tearing off a piece of foil to have a quick chineesje. This happens often when they are in a hurry or in withdrawal. But frequently they put relatively considerable time in the preparations of the foil and also the pipe (see below). Then the foil is cut or torn neatly at the preferred size, and stretched and rubbed to take out the wrinkles. Before putting the drug on it, first the user heats the foil with a lighter until some vapors come off:
He takes the role of aluminum foil that lies on the table, tears off a piece (± 15 by 7 cm), heats it first, puts some heroin on it and starts chasing.
These vapors origin from a coating on the foil. Heating the foil prior to chasing is meant as a health precaution, preventing the inhalation of gasses suspected to be harmful. When regular aluminum foil is not available, users will look for alternatives, such as the foil from cigarette packs. However, not all brands are suitable; Pall Mall and Caballero are preferred. The foil of these brands is glued to a paper foil, but can be made easily into a smoking foil by burning of this layer of paper. Any other metal packing foil (e.g. from chocolate bars, sweets or other food products) will serve the purpose, as long as it is thick enough and can be used right away or made usable by simple action.
The lighter is an important tool for a chaser. Although one young user was observed heating his foil with an expensive Dupont lighter, most smokers prefer a transparent disposable lighter with an adjustable flame. The flame that is needed to heat a spoon has to be rather big, but when chasing, the flame necessary to melt and vaporize the drug may not be too high, as the aluminum foil could be damaged or the drug could catch fire. It has to be disposable for more than one reason. Most lighters are not designed to stand heat for periods much longer than the time it takes to light a cigarette. When chasing for prolonged time the mechanism can be deranged or damaged by the heat. For that reason, chasers prefer disposable lighters that can be taken apart and then be readjusted beyond the standard range of the flame adjustment mechanism. Likewise, chasing takes a lot of gas and a chaser with an empty lighter has a serious problem. This also accounts for the preference for a transparent type; the gas level can be monitored and a new lighter can be purchased in time.
The tube-shaped pipe is another important piece of equipment. In 1975, when chasing was just emerging as a heroin administration route, the author often observed (in particular novice) chasers using a rolled up ¦10.- bill to inhale the fumes. Since then, the genuine chasing pipe has developed into an ingenious piece of craftsmanship, although any tube- shaped object, such as pens, straws or any rolled up piece of paper will do in emergencies. Normally paperboard or thick paper that keeps it's shape when rolled up is used. The preparation of a pipe (and a smoking foil) varies, depending on several factors. The time, concentration, and care put into the construction of a pipe seems to depend on variables such as craving, the availability of time and materials, the setting of use, as well as the skills and experience of the user. For example, a clear relationship between craving and the functionality and esthetics of the design can be observed. High craving mostly results in a fast made pipe. As one user said: "Don't care how it looks now, I'm sick, I need a smoke fast" and he tore off a piece of a magazine cover. In the following fieldnote two users rushed into a dealing place, bought a quarter gram of heroin and sat down at the table designated for using:
The customer prepares for chasing. He does not have a knife and borrows one. With the knife he takes some heroin from the pack and puts it on his friend's aluminum foil. ... Then he makes a pipe of a piece of paperboard of ± 7 cm. His friend uses a rolled up packing of a cookie, which comes with a cup of coffee in a bar. He says they are in a hurry because they are sick, otherwise he would have taken more time to prepare a good pipe like the others at the table use.
The pipe this user refers to has a number of distinctive, prescribed specifications. It is made of aluminum foil, paperboard from a cigarette paper pack and a cigarette paper. In The Netherlands it is common to smoke hand rolled cigarettes and the slip of the cover of the cigarette paper (± 7 x 3 cm) has just the right format for a pipe. The cover slip is wrapped in a piece of overlapping aluminum foil. The overlaps are folded around the paper and then the whole thing is rolled up (e.g. around a pencil) so that the folds are on the outside. Finally the aluminum foil-covered pipe is rolled in a cigarette paper to keep it together. Users often make little pieces of art of their pipes. However the design is not just art for art's sake, but, as can be witnessed in the next excerpt, highly functional:
Boris is chasing cocaine and heroin. When he has finished the dose on his foil, he opens up his pipe. It is made of aluminum foil, a piece of paperboard from a cigarette paper pack and a cigarette paper. The foil is carefully wrapped around the paperboard. Then it is rolled up with the foil towards the inside of the tube and kept together with a cigarette paper. It has the size of a filter cigarette. After taking off the cigarette paper, Boris folds back the foil. On the foil that was on the inside of the pipe is a light brown film of a heroin and cocaine mix residuum. First Boris constructs a new pipe like the old one. Then he chases what is left from the old tube.
The foil covered pipe has thus an important instrumental function. While inhaling the vapors through a pipe, some of the drug will deposit on the inside of the pipe, covered or not. However, when an aluminum foil-covered pipe is used, this deposit is 100 % re-usable without performing complicated procedures. It depends on the quality of the drug and on the smoking technique how big the deposit is. Observations indicate that this quantity may go as high as up to 40% of the drug vapors that have passed through the pipe. Users have a specific name for this deposit:
The man looks into his pipe, he has put tin-foil inside. He says: "Let me see, how much interest there is inside".
Some users report they save the pipe to smoke the interest in the morning when they have neither drugs nor money. A few users are able to get their interest even out of a paperboard pipe. This, however, requires more skills:
Some moments after the man finishes chasing the other takes his paperboard pipe from the table. He folds it open and puts it on a piece of aluminum foil. He carefully heats the paperboard so that it won't burn. This way the deposit of the heroin vapors runs from the paperboard on the foil. When he is finished he chases this bit.
It is clear that chasing is a complex practice that requires a distinguished level of knowledge and skills. This can also be observed in the smoking technique of users. Contrast the following fieldnote with that of the woman at the beginning of this chapter:
On the first floor Jack is busy scraping out the last remains of heroin from a plastic sandwich bag. With his thumb he rubs the heroin from the plastic. Then with his knife he scrapes it of his thumb and throws it on a aluminum foil. He gives the foil to the blonde guy who starts chasing through a rolled up piece of paperboard. He does not heat the foil carefully and misses many of the fumes.
Experienced chasers dose the flame carefully and keep the end of the tube right behind the drop, as close as possible. Their lighter and tube move almost simultaneously. When the drop runs over the foil it leaves, depending on the cuts and impurities, a light to dark brown track behind. By adjusting the distance of the flame to the foil and the angle of the foil, the speed, path and number of tracks of the drop are influenced.
He keeps the lighter very close to the foil, causing the heroin to burn quickly. The heroin drop makes only a short trail because of this.
The amount of vapors, the speed with which the drug runs across the foil and consequently how many chineesjes come out of each dose depend to a large extent on how much heat is added.
Finally, the place where heroin is chased is of importance. Although people were observed chasing on the streets, the best results are obtained in a sheltered place, where wind cannot influence the vapors.
Theoretically, there are three ways one can inject a drug: subcutaneous, intramuscularly and intravenously. Most injecting heroin users prefer intravenous injecting (mainlining) --the most direct way of ingesting any drug. The next fieldnote gives a good impression of the intravenous self-administration of heroin:
The man starts to prepare a shot. He puts his spoon on the table and throws in a knife tip of heroin. He adds some lemon juice and with his syringe he gets some water which he carefully squirts in the spoon, around the heroin powder just under the edge of the spoon. He heats the spoon and when the stuff has dissolved he stirs and draws the solution in the syringe through a piece of cotton. After checking the syringe for air bubbles, he puts his syringe on the table. Then he takes his belt and puts it around his left arm. Making a fist he pumps up his veins. He looks carefully at his arm and then sticks in the needle. When he pulls the piston back, blood immediately runs into the syringe. then he pushes the piston about halfway. Then he draws up some blood and pushes the mixture into his vein. He moves the syringe a little, draws ± 1.5 cc. blood and pushes it in again. All the time his hand is a fist. Then he unties the belt, pulls the needle out, puts it down and waits about two minutes, concentrating on the rush.
This observation shows that, as is the case with chasing, before heroin can be injected the user must perform a determined sequence of activities and in this sequence a number of prescribed paraphernalia and ingredients are essential. The paraphernalia that are necessary to prepare and administer a heroin injection are a knife, a lighter, a cooker, a filter, a syringe, and a tourniquet. Furthermore, specific ingredients are necessary, water and an acid. In the following, these will be discussed in the order in which they are generally used.
Like chasers, IDUs use a knife to scoop the heroin from the pack and eyeball the dose, before putting it into the cooker. With only one exception, all the cookers observed were spoons, both diner spoons and tea spoons. The spoons are bent so that when put down they rest stable and level. Normally, first the heroin is put into the spoon followed by a little water and an acid. Water is an important ingredient for IDUs as it is necessary to dissolve the powder drugs. When available IDUs will generally take water from a tap. However, not all observed self-injections were administered at places with running water. When an injection is taken at a place without running water, like some squatted houses, the water is often stored in cups, bottles or a canister. IDUs that inject outside mostly carry a little bottle of water on them or fill a syringe with water, e.g. at the place were they bought their drugs but were not allowed to inject. Although some IDUs reported knowing other users that had used water from a water closet, a puddle or the gutter, this was not observed in this study.
Dutch IDUs must use an acid to dissolve the base-heroin, which is designed for smoking. In the late 1970s, South West Asian base heroin was introduced in large quantities, substituting South East Asian heroin-HCl. First many IDUs had problems with cooking up this new sort of heroin as they did not know how to prepare it. However, soon the necessary knowledge spread. IDUs commonly use lemon juice in little, sometimes lemon-shaped, plastic bottles. Sometimes the juice from a fresh lemon is used. On a small basis the use of crystalline ascorbic acid was observed. In one of the networks observed, this was introduced by Harrie, one of the key-informants:
I learned to use it from a pharmacist in Limburg where I lived at that time. He told me it was safer to use ascorbic instead of fresh lemons or vinegar. He knew I was shooting because I always bought my syringes in his pharmacy.
Most users put in the heroin, acid and the whole amount of water at once. Others boil the heroin first with the (liquid) acid only or with only a part of the water:
After Mohammed has cleaned the cup with his jacket he puts in the heroin. Out of his jacket he takes a lemon and cuts it in two, keeps one half above the scale and by pressing it he puts a couple of drops of lemon-juice into the cup, enough to cover the Heroin that he put in just before. He then adds a few drops of water from the plastic bottle. "I first boil it with much lemon and little water, it dissolves better this way". He puts his lighter under the scale and boils the contents.
The reason for this preference is that the base heroin is believed to dissolve better in a strong acidic solution. When all ingredients are in the spoon, it is heated from the bottom, normally with a disposable lighter. IDUs seem less meticulous regarding their lighter than chasers as they only use them to cook the heroin. Sometimes other heat sources are used, such as stoves or, as can be witnessed in the next field observation, the alcohol swabs that are dispensed by the needle exchanges to clean the injection site prior to injecting:
Back home Richard and Chris start preparations to shoot up. ... Richard puts the spoon in front of him and ... opens the heroin package, holds it above the spoon and empties it. He adds some lemon and water. Meanwhile Chris opens two injection swabs and puts them on the edge of the ashtray. When Richard is ready he nods, which Chris understands as a sign to set the swabs on fire with his lighter. This produces a flame from ± 4 cm high, above which Richard now holds the spoon to boil the contents.
In the argot of the Rotterdam heroin users injection swabs are sometimes called vlammetjes (little flames).
The time the mixture of heroin powder, acid and water is heated varies. In some observations the cooking took less than a minute, in others more than four minutes. This seems to depend on drug quality (particularly on the cuts), quantity of acid and also idiosyncratic differences. Some users boiled the drug mixture once, other users boiled it a few short times. Sometimes when not satisfied with the result, users add a little extra acid and, when necessary, water and boil it again. When the heroin is dissolved, the solution is given time to cool off a little, as injecting the hot liquid may cause intense irritation and pain.
Subsequently, a filter is put in the spoon and through this filter the solution is drawn into the syringe. The most widely used type of syringe in The Netherlands is a 2 ml with a detachable needle (25Gx5/8" - 0.5x16mm). These are most popular and dispensed at most Dutch needle exchange programs. A minority of users prefers the 1 ml insulin type (27-28Gx1/2" - 0.36- 0.4x12mm). IDUs use several materials as filters; most commonly cotton wool. A little pluck is rolled into a ball. Another frequently used material is the filter from a cigarette:
He picks up a cigarette from the table and breaks off the filter. Then he tears some fibers from it and rolls them between his thumb and point-finger into a small ball, that he puts into the spoon. Ensuing, he takes the needle from his syringe and puts it in the needle cap. Then he puts the syringe on top of the filter, holding it with one hand and using his other hand to draw the plunger.
When these two materials are not available users resort to less preferable alternatives, such as a piece of tissue or clothing fibers:
Mohammed asks Abdul for a filter. Abdul says "I've forgot to buy cigarettes". "Well, then I have to do it like this" Mohammed responds, and he pulls some lint from his socks, rolls them into a small ball and puts it in the solution.
Tissue and clothing fibers are less favorable because the former can easily fall apart and then the fibers may be drawn into the syringe and the latter may be dirty; both causes for, at minimum unpleasant, infections. Now the injection is ready for use. However, some persnickety users are not satisfied yet:
When the spoon looks empty, Doug adds some drops of water. He puts the syringe back on the cotton-ball, pushing lightly, and drives the ball through the spoon gathering the last remainings. He stops in the middle of the spoon and draws the plunger again, emptying the spoon finally. After finishing this he picks up the spoon and checks it for remnants.
Now the solution is in the syringe, it is checked for air bubbles, which are expelled by tapping the barrel. When finally everything is ready for the injection, most users use a tourniquet to bring the veins to the surface. IDUs were observed using belts, ropes, electrical wires and medical devices especially designed for this purpose. Before the injection site (mostly one of the arms) is tied off, often some exercise is undertaken; bending and stretching the arm rapidly, swinging it around or making a fist. Sometimes users rub and tap the injection site. These actions are all intended to make the veins swell to the surface:
Freek used the same electric wire as Harrie did. He tied it around his right arm and searched for a vein. With his forefinger he palpated his skin. He seemed tense. It took him some time to locate a suitable vein and more than once he took up the syringe but put it back on the table again because he was not sure. He changed the wire to his other arm and repeated the procedure. Then he found a good spot and pushed in the needle. He drew up some blood and pushed the piston down, then he drew up some blood again, pushed again and repeated this sequence several times. When he finished he rubbed some Hirudoid ointment on the needle wound.
Not all IDUs use a tourniquet. They have veins that are thick enough or just under the surface of the skin, to hit easily, without tying them up. Richard presents a good example:
Richard sits down on the sofa to take his shot. Richard doesn't have to tie off his arm. Chris says he's jealous of Richard's veins; Kabels he calls them. Richard hits the vein he wanted to use in one try and presses the contents out of the syringe into the vein without interruption. ... After booting two times he takes the syringe out of his arm, opens an alcohol swab and puts it on the injection site.
The argot word kabels (cables) signifies the importance for IDUs of the condition of the veins. Some users have great problems hitting a vein, even when using a tourniquet. Such was the case with Chris, Richard's running partner:
Chris needs much more time and efforts to hit a vein. First he tries his left hand. With a belt he ties off his hand. The belt is placed around the under arm. With his other hand he taps upon the intended injection site to swell the veins. Then he inserts the needle, pulls back the plunger and looks into the syringe to see if blood is entering. It is not. Chris moves the needle under the skin probing for a vein. Three times he pulls up the plunger but without success. After the third attempt he pulls out the needle and puts it down. With toilet paper he cleans his hand because there is a lot of blood on it. Then he starts again at about the same spot, but again he fails. Now he tries his left underarm. He first puts the belt higher around his under arm. He inserts the needle and moves it around under his skin. Pulls up the piston but fails again. He takes it out and puts it back in again, some 2 cm from the last spot. Again a failure. He takes out the syringe again and cleans his arm from the blood. There is also some blood in the syringe. "I have to hurry now otherwise my needle gets clogged". He now tries his right arm, at the wrist on the inside, near where normally the pulse is taken. He puts the belt around his right underarm. Before he sticks the needle in, he first looks closely to see how the veins run under his skin. He thinks, considers and then tries again. Finally he has a hit and takes of the belt right after. Then he wants to boot, which isn't easy to do at this spot. Only with much trouble he can manage to do it. Now he takes out the syringe, takes a swab from the table and cleans the spot. The whole operation took him about 6 minutes.
Six minutes may seem like a long time for one injection. However, during the fieldwork users were observed that were sometimes busy for more than an hour, trying to inject. In the last three fieldnotes two additional aspects of the injecting ritual are observed. The first is, that all users were booting (drawing blood back into the syringe and reinjecting one or more times). Booting is a common practice among the injecting research participants. However, a pattern could not be distinguished in this behavior. Sometimes, users boot and at other times they do not. The second aspect that these three fieldnotes indicate is that many IDUs take an interest in maintaining their health status. One uses Hirudoid ointment, a topical preparation for the prevention and treatment of embolisms and other venous damage, and the others use alcohol pads, although not prior to injecting.
Most heroin users, both chasers and IDUs, have developed quite fixed sequences of drug ingestion during their careers. In the foregoing, it is demonstrated that these sequences are subject to a great deal of patterning and stylization; important conditions for ritualization. A heroin user, when observing another user at any point in the drug administration sequence, will definitely know what has preceded and what comes next. He will probably have a good sense of what the observed person is thinking and feeling and the observation may even elicit similar thoughts and feelings.
These stereotyped patterns are, partly, dependent upon the setting in which the drug taking takes place. There is inevitably a big difference between shooting up in a back alley and at home, or smoking heroin in a group at a house address. The Rotterdam heroin scene is characterized by a relatively calm climate and most drug use and dealing is located indoors. However, it is not only the setting of drug use that influence the patterns of ingestion. The drugs themselves can play a role also. This becomes apparent when investigating the use of cocaine among the heroin users in this study, which is the subject of the next chapter.
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