Saying goodbye to high-dead-space syringes

Abstract

The respondent above quotes the classic rhythm and blues tune, “Hit the Road Jack” made popular by Ray Charles. He is celebrating his success in finding a good vein to inject into and the ecstatic anticipation of the rush of a mixture of heroin and cocaine, also known as a speedball, hitting his cardiovascular and nervous systems. “Booting and jacking” is a culturally mediated ritual in which an injection drug user (IDU) repeatedly draws blood from their vein into the drug filled syringe (booting) and partially flushes the mixture back into their vein (jacking). This has been described in ethnographic research as reportedly boosting the intensity of the drug rush, usually from cocaine or speedball injections (Bourgois, & Bruneau, 2000), as well as being a symbolic communal celebration (Bourgois, 1998), but at the cost of elevating HIV transmission risk (Koester, 1998). This practice likely evolved as a response to the fact that residual drug solution mixed with blood is trapped in the “dead space” of a high volume syringe and will not come out unless flushed out. It’s a tiny amount, but IDUs don’t typically like to waste any drug.