Harm Reduction ⫸CASE STUDIES - It could happen to YOU!⫷

[fairnymph]

How my husband died - a brilliant, just-turned 27 yr old chemist; cross-posted from the Shrine but I may edit for added detail from autopsy. If someone who attended Harvard for grad school in organic chemistry & went on to work for the largest pharmaceutical company in the world working on developing peptide drugs to treat Alzheimer's, who never once reused a needle or suffered prior damage from extensive (ab)use of numerous drugs, can OD accidentally, so can you. DO NOT IV FENTANYL OR ANALOGS! Our story:

I showered after a dinner out with our mutual friend; when I got out, I found my husband Ryan lying unconscious on the ground, cyanotic (totally blue in lips and fingernails), unresponsive, barely a pulse, barely or possibly not at all breathing. Later I found an uncapped syringe, a length of rubber tubing, and an empty, unlabeled vial which I believe contained alpha methyl fentanyl. I never heard back from the drs who were supposed to test the empty syringe & autopsy did not reveal anything but tramadol in his system. In anger, I flushed all the amf & fentanyl down the toilet but it was definitely one or the other that he IVed. Lab made, purified to medical grade.

I called 911, at 3:24 am. I had to drag his body several feet because he had collapsed in front of the entrance to our apartment. I do not know CPR and my attempts did not have much effect (neither did the paramedics', when they arrived). He had a heart attack in the ambulance. His lungs completely failed; he was on a ventilator but still not getting enough oxygen into his bloodstream for 36-48hrs as he continued to worsen in numerous ways. His heart had sustainted considerable damage; his blood pressure was initially very low (80/60) and his heart rate too high (up to 150bpm). He aspirated (vomit got into his lungs) and as a result he developed pneumonia as evidenced by his high fever (over 104F at one point).

48hrs later he was found to be completely brain dead, w/ zero brain activity. No responses or reflexes whatsoever. He had bleeding in his subarachnoid space and severe brain swelling as a result -- I saw the scans myself. He was simply oxygen deprived for too long, possibly up to as many as 30min. Even if he had somehow miraculously escaped brain damage, he would have needed lung and heart transplants due to the extensive damage sustained to these organs.

He was still on the ventilator at this point, but only until he could be transported to a hospital for organ donation. The one silver lining is that his liver was in good condition and both kidneys in excellent condition and they saved 3 people's lives. Unfortunately he won't be able to donate tissue (non-organs) because of his drug (ab)use, despite never having a blood infection or abcess or even having used needles much at all & certainly never injected pills; no diseases, and they wasted the rest of that healthy tissue purely bc I was completely honest with his drs.

In the prior 6 weeks Ryan had undergone withdrawal twice, first from fentanyl, then more recently from amf. I learned that he had IVed fentanyl at least once (the first I have ever heard of him IVing) during his addiction to it. The amf withdrawal was extremely intense and he took some naltrexone for it which made it all the worse. To my knowledge and based on his mood, he had not used for a week before his OD (confirmed by close friends he discussed his use with, which he was hiding from me most of our time together). I do not know why he decided then to IV after being clean for at least a week.

He still had meds that the hospital gave him in his system; until those were completely out of his bloodstream they couldn't legally declare him dead & proceed with organ transfer. Because of his barely functioning heart and his poor gas exchange, he was clearing drugs very slowly from his body, delaying the organ transfer, though that went fine.

Ryan was officially pronounced dead almost 60hrs after the initial amf injection (from cardiac arrest, due to removal of the ventilator). I later received letters from 1 kidney recipient & the liver recipient. All 3 organ recipients tolerated the transplants well & are still living AFAIK now, almost 12yrs later. But I have never found another husband, and his father & I still miss him desperately, along with his numerous friends despite his extreme introversion. 1 hasty decision ended his precious life within minutes.

 

[Troglodyte]

I am so sorry for your loss. Thank you for sharing that with us. I've lost many loved ones too, my 2 best friends, other friends, relatives, and so on, yet i kept using. its crazy. in fact i od'ed and whats the first thing most people, including me, do as the narcan wears off? yup, it's sick. I'm clean now due do a stroke of luck, but my wife isnt quite there yet, and i often think about finding my wife in a situation such as yours. i'm so sorry and my heart goes out to you. Opiates keep good people from thinking clearly and it can end in death far too easily.

 

[fairnymph]

Addiction is extremely powerful, that's for sure. I imagine some people think I'm crazy for using h for pain (or other drugs recreationally) since. I'm sorry for your losses as well, & your OD. I'm REALLY glad I don't enjoy opiates purely for that reason. It's a bit eerie, but 2wks before he died, Ryan told me he was sure he'd have died years ago had he not met & married me. I hope you help your wife similarly & you never lose each other to an OD.

 

[mokele]

Are you also a fast/rapid methadon metabolizer? I am . And as the Doc went in rent who gave us 100mg levomethadone (Polamidon) to inject/ per Day and we had to show up once a week,no tests if you wernt hammerd to pass the door,i had to move to my birth Country and after much fuss was placed on 1200mg MS RETARD. I hope you doing well,bro!!!!

 

[Infiniteloser]

The above post is a good reason why you shouldn't inject into arteries. You shouldn't try to use hand veins as well.

Holy crap I used to love injecting into the top vein running in the middle of my hand but now it rolls and I dont because I get scared I'll fuck up my nerves but that is just horrific, I wonder if micron filtering and using a saline instead of tap water would've made a difference.

 

[dsd]

So I'll add to this thread as I'm enjoying the worst case of a unique injection complication I never had seen before. Non-infectious tissue necrotizing. There's no pain, no swelling, no discoloration outside the dead parts... the dope simply killed the skin for about 4mm deep. +12-24h from missed shot, it starts turning black, then just dies. The shot doesn't even have to be strictly a miss... register, no lump forms, get rush, but it hurt going in, but not in the arterial kind of way (no pain downstream only local). I've had smaller ones before, but this time it took the entire top of my hand out. Will take months to heal and will be scarred forever.
Oh how nice a simple abscess would have been.

Warning: graphic.

NSFW:

All the black is hard, dry dead skin still very much attached to living skin underneath, painful to remove.

Wow, I thought I was going to see a picture of some typical nastiness but ,jeez, I wasn't prepared for that.

Don't know if he still posts but would like to see how it's healed up.

And the other guys post/ pictures just after, are equally shocking.
(2/3 pages back/

 

[svacheme3]

Well the ongoing situation is some hardcore junkie stupidity but anyway...

So my veins are shot. Like, SHOT. No number of hours will result in finding one. So if I want a rush, it's either try to hit something that's *really* going to wind up fucking me (neck, femoral, or penis), or just shoot into whatever results in a weak register and immediate rush but sometimes causes what you saw in the pic. So I figured anywhere else would just get more scarred up and it's bad enough my dominant hand is ruined as it is. But I've found as long as I immediately stop if the surrounding area flashes white, problems are confined to occasional tiny spots. Of course I did that on the finger too now it's permanently curved left and healed in such a way I can't close my fist or really have much motion at all on the proximal joint of my middle digits. Can still write at least. Still no problems with pain or infection.

Discoloration in the center is just dead skin that can be peeled off over healed skin.

 

[CFC]

Allergic reactions to drugs or medications you've used in the past without any problems do happen quite regularly. Always be on the look out for any rashes or unexpected symptoms - they could be an indication of a much more serious auto-immune reaction developing.

In this example, the drug was methylphenidate:

Allergic Reaction to Medication After Years of Taking It: What To Do Next?

https://www.liebertpub.com/doi/full/10.1089/cap.2020.29181.bjc

 

[Livingdeadgrl666]

Case Studies

Necrotising myositis after intravenous methylphenidat (Ritalin) injection

A 30 year old male intravenous drug user was admitted with a swollen painful left thigh after injection of 30 mg methylphenidat (Ritalin). On examination, we found a softball-sized abscess in his left thigh. Striking lab results were a CK of 18 100 U/l, a CRP of 177 mg/l, and a WCC of 20.0x109/l. A CT scan revealed a large abscess that contained multiple pockets of gas, extending from the lesser trochanter to the distal femoral condyle (fig 1). The patient went to theatre and the abscess was excised and drained and an extensive debridement was performed. Macro- and microscopic analysis showed acute necrotising myositis and extensive abscess formation. The patient was re-examined 2 days later and the wound was closed. Thereafter, healing of the wound progressed well. The patient was discharged home 15 days postoperatively.

Exactly why I will never ever go iv with anything ever!!! I dont get how someone could override their sense of self preservation and stick themselves with a needle!!! Yawwwk! I can't even let the doctor do it!!

 

[Seattle User]

A stainless steel pot doesn't have aluminum. . .

Methadose concentrated oral solution (10mg/ml) is not fit for injection.



The above ingredients are what constitute the red, cherry liquid syrup used at most American MMT clinics. I cringe when thinking about an IV injection of that shit. I've listed in other threads what each of the ingredients in most injected oral concentrates do when IV'd, so I won't do so again here. No, it is not even relatively safe to IV Methadose oral concentrate in small amounts, ever.

This article covors the basics well. Though it is specifically describing the Methadone syrup available in Austrailia, some of the same ingredients apply, as do the warnings.


bad link
http://www.saferinjecting.net/injecting-methadone.htm

 

[hotgirls.jpg.exe]

Allergic reactions to drugs or medications you've used in the past without any problems do happen quite regularly. Always be on the look out for any rashes or unexpected symptoms - they could be an indication of a much more serious auto-immune reaction developing.

In this example, the drug was methylphenidate:

Allergic Reaction to Medication After Years of Taking It: What To Do Next?

https://www.liebertpub.com/doi/full/10.1089/cap.2020.29181.bjc

Interesting. I've developed severe allergies to a couple of medications after previous uncomplicated use. Four days of tramadol XR caused a rash covering large parts of my body that looked like suburned chicken pox. It was especially bad on my face, really hurt too. I realised what was happening just after taking the morning dose on the 4th day took some of the prednisone I had lying around (I have an autoimmune disease) and got my ass to a doctor. I'd had tramadol multiple times during the previous 8 years, no idea why it suddenly happened. Same deal with NSAIDs but an anaphylactic type reaction...try being a chronic pain patient and telling docs those drugs will kill you!

Mast Cell Activation Syndrome seems like a likely culprit in my case but I live in fear of developing a sudden allergy to any of my regular meds.

 

[jagman95]

^ And figure 3 is a good reason why people should never IV MS Contin

Ms Contin are as dangerous as injecting any kind of pill
Ive injected hundreds iff not thousands of ms contins,oxycontin,but this way we mix up where im from, Tasmania (80%of worlds poppies are grown here but there is no heroin here atall),Prep,1x 10 mg syringe,1x 5 ml syringe,swabs,25 guage ends,drawing up end,cple cig filters( ones used for rollie tobacco as they are cotton( cig filters from packet are fiberglass), sterile water & a hotplate( candles,lighters,gas flame can be used but hotplate is preferred),all items are given for free at needle exchange places)
Get a 60,100 mg ms contin or oxycontin,Swab spoon,wipe the coating off pill, either crush pill or let dissolve while heating
Put 4 ml water in spoon,heat up on hotplate,use drawup end to help pill dissolve iff not crushed,let it simmer for about a minute,stirring with drawup end,when dissolvd,use a cig filter(cut so its flat,remove paper) ,put few drops water on filter,drop in spoon,use 10 ml fit with 25 guage end,draw up ,put another 3 ml water in spoon,while heating,mix remaining bits of pill,use new filter,draw up,then finish with 1 ml water so nothing left in spoon,u should have 8 ml in 10 ml syringe,iff u want shoot half(30 mg), use draw end to transfer 4 ml into 5 ml syringe,cool it down,find good vein,register & plunge, when close to pulling out,take deep breath,then exhale,u will then get best morph rush

 

[mokele]

I'm going to start posting these "case studies" so everyone can see that what BL preaches is not urban myth. So if it drives the message home even thru heurism availability then it's still serving it's purpose.

I'll start with this one, then will consolidate everything into a sticky sometime in the future.

How can this be received as urban myths is above me!! That is very important!!! I know many dont listen and part of why morphin er substitutìon has been cut down drastically here is cuz idjits wont STOP i.v ing them.
Nice things like microcrystaline cellulose and wax, even through a 0.2micron Sterilisierfilter you get a slimy Solution. But people here cook em, pull trough ciggie filter and inject hot/warm before it can solidify . I talked to a Doctor when i was in cuz of my heart and he said they are pretty pissed at people coming in needing immediate op. cuz the wax has solidified and collected somewhere in the body. I know a guy who got his hand cut off but the unlucky ones have the wax buildup in the brain. Some get by doing this for years, mostly younger ones where the body still fights back strong. Just sad

 

[mokele]

IV Buprenorphine

Subutex® abuse presenting to the emergency department: a case series
Chew, HC Hong Kong j. emerg. med. Vol. 14(3) Jul 2007

A case series of four patients who presented to the emergency department following complications of Subutex? abuse. Local complications included deep venous thrombosis, limb ischaemia, and abscess over injection sites. Systemic complications involved epidural abscess and osteomyelitis of the spine.

Patient 1
A 30-year-old Malay female presented in February 2006 with sudden onset of left lower limb swelling with pain and fever (Figure 1). Clinically, she had evidence of deep venous thrombosis which was confirmed on duplex ultrasonography. She admitted injecting Subutex? into her left femoral vein. She was commenced on anticoagulation but subsequently she defaulted follow-up.

Patient 2
A 35-year-old Chinese male developed left hand pain and numbness after injecting his radial artery with Subutex? in May 2006. Clinically, he had developed left hand ischaemia with absent pulses up to the brachial artery (Figures 2 & 3). Duplex ultrasonography confirmed acute thrombosis of the brachial artery. He underwent successful thrombolysis but subsequently discharged himself against medical advice and defaulted follow-up.

Patient 3
A 40-year-old Malay male presented in May 2006 with complaints of fever and lower back pain. He initially denied any intravenous drug use but needle marks were seen over both his arms. Clinically he had a positive straight leg raising test. No neurological deficit was detected. He was admitted for a presumed diagnosis of epidural abscess which was confirmed on magnetic resonance imaging (MRI) of the spine (Figure 4). This was surgically drained and the patient was treated with a prolonged course of intravenous antibiotics.

Patient 4
A 60-year-old Indian male complained of multiple painful skin lesions over both arms and legs in June 2006 (Figures 5a & 5b). Clinically, he had multiple abscesses over the upper limbs and popliteal fossa with needle marks over the areas. He was admitted for incision and drainage of these abscesses but he discharged himself against medical advice the following day.

Discussion (abridged):

...common features of cellulitis, non-healing wounds as well as vascular complications. These are proposed to be a result of the excipients in the preparation of Subutex?, which is meant to be administered sublingually, causing chemical irritation to the vessel wall resulting in poor healing and increased infective and thrombosis rates. The effect of Subutex on the vessel wall has not been studied but the excipients which act as binders to buprenorphine are likely to precipitate local inflammation causing thrombosis or intimal weakening, leading to either vessel occlusion or pseudoaneurysm formation after several injections. This effect can be aggravated by hot or warm injections as a result of the preparation methods as well as inadequate sterility techniques of injection. Local infections result from the use of contaminated preparations and needles. Common bacteria involved are skin organisms such as Staphylococcus and Streptococcus. These infections present in a myriad of ways from simple cellulitis to necrotising fasciitis, which can be life threatening. Delayed presentation may result in increased severity of the infection.7-12 Treatment of such infections usually requires extensive debridement and may result in loss of tissues and poor functional outcome. Complex reconstructive procedures may be required to restore function, and amputation is occasionally required to control the infection. Limb ischaemia or venous thrombosis occurs when a large vessel is injected, either deliberately or inadvertently. The drug itself or other constituents of the tablet cause inflammation, vasospasm and thrombosis. Incompletely dissolved constituents form micro-emboli, which lodge in the microcirculation, causing widespread end-organ ischaemia. Venospasm and venous thrombosis result in outflow obstruction and may cause the acute compartment syndrome. Intermittent decrease in the arterial vasospasm and opening of collateral vessels can precipitate a reperfusion injury, which translates to significant swelling and compartment syndrome. Treatments with antiplatelet drugs, vasodilators, anticoagulation, corticosteroids, thrombolysis, thrombectomy and hyperbaric oxygen therapy have all been tried. Fasciotomy may be required to relieve compartmental pressure. Failure to salvage limbs is frequently attributed to delayed presentation for fear of prosecution and widespread damage to the microcirculation from micro-emboli.7,8 Pulmonary complications of injection drug abuse include pulmonary infections, interstitial pneumonia, pulmonary vascular diseases, septic embolisation and pneumothorax, among others.

Epidural abscess of the spine threatens the spinal cord by both physical compression as well as vascular infarction of the spinal cord. Complications such as motor dysfunction and sensory problems or even paralysis may occur if this is left untreated. The diagnosis is frequently delayed as the initial presentation may be back pain alone or radicular symptoms. The clinical triad of fever, back pain and neurologic deficit is not present in most patients. Early presentations are usually subtle and atypical presentations are not unusual. Intravenous drug abusers belong to a high risk group and hence this medical emergency, which may require urgent surgical decompression and drainage of the abscess as well as intravenous antibiotics, must be suspected in such patients when they present with fever and back pain.


Figure 1. Left lower limb swelling extending to upper thigh caused by deep venous thrombosis of the femoral vein.

Figure 2. Needle marks as a result of intravenous drug use.

Figure 3. Left hand digital ischemia from brachial artery thrombosis following accidental intraarterial injection.

Figure 4. MRI spine showing osteomyelitis of the lumbar spine with epidural abscess over the L5-S1 region.

Figure 5. Abscess formation seen over the skin of both right and left biceps region following injection with contaminated needles.

Patient 4 left the hospital without having the abscess drained??? What he thinks is going to happen? It going away by itself??? I had one abscess drained ages ago and i was thankfull they treated me so nice. Injektion into ARTERY ON PURPOSE? WITH SUBUTEX EVEN??? Artery Injektion is soo painful, when i hit one in my i.v days i pulled out immediately. Excruciating pain,like electric shock it felt and painful swelling. Some people i dont get smh

 

[mokele]

Fatal intravenous misuse of transdermal fentanyl

Clinical record
A 35-year-old woman with a history of intravenous drug use was brought by ambulance to the emergency department after an intravenous overdose of the contents of a transdermal fentanyl patch.
The ambulance had been called to a private home where there were two people unconscious, a man and a woman. Both appeared to have had acute narcotic overdoses. It was later confirmed that they had shared (and injected intravenously) the contents of a transdermal fentanyl patch (5 mg) found at the scene. Both patients were rapidly assessed by the ambulance officers, and the initial resuscitation concentrated on the male patient, who, at first assessment, appeared to be in a more critical state. He was unrousable and was reported to have Cheyne–Stokes respiration. His blood sugar level was checked (10.5 mmol/L) and he was given 1.2 mg naloxone intravenously. He recovered consciousness within five minutes and subsequently absconded from the scene while the second patient was being treated.
In the interim, the female patient had suffered a cardiorespiratory arrest. Cardiopulmonary resuscitation was commenced, with the assistance of police officers who were also in attendance. According to ambulance records, her initial rhythm was electromechanical dissociation, which subsequently deteriorated into ventricular fibrillation. A direct current countershock (200 J energy) was applied. The patient went into asystole. She was intubated and intermittent positive pressure ventilation with 100% oxygen was started. Naloxone 1.6 mg, adrenalin 10 mg (total dose) and atropine 2 mg were administered intravenously. Subsequently, she developed a narrow complex tachycardia with a rate of 130 beats/minute and had a palpable cardiac output. The total time spent at the scene was 40 minutes, and transport time to hospital took 5 minutes.
On arrival at the emergency department she was unconscious, with a Glasgow Coma Score of 3. Her pupils were dilated and non-reactive to light. She was making occasional attempts at respiration and was ventilated as above with 100% oxygen. Her heart rate was 120 beats/minute in sinus rhythm, systolic blood pressure 55 mmHg and oxygen saturation 97%. One litre of Haemaccel and a noradrenalin infusion were administered, resulting in an initial improvement in systolic blood pressure to 95 mmHg. It was evident that she had vomited at the scene, and clinical signs were consistent with aspiration, which was later confirmed on chest x-ray. Laboratory results for arterial blood, serum and urine are shown in Box 1. She was transferred to the intensive care unit, where she subsequently developed diabetes insipidus, abnormal liver function, disseminated intravascular coagulation and had ongoing haemodynamic instability.
The next day, cerebral computed tomography (CT) scan showed changes in the basal ganglia and mild generalised cerebral swelling consistent with severe hypoxia (Box 2A). A CT scan of her abdomen showed generalised changes in the bowel wall and mesentery consistent with bowel necrosis (Box 2B). Surgical intervention was considered to offer little in view of the severe neurological damage and multiorgan failure. Following extensive discussion with family members, inotropic support was withdrawn and she died soon afterwards.

https://www.mja.com.au/public/issues/177_10_181102/ree10446_fm.pdf

Uggh. Nice friend " immediately leaving the scene "! I wonder who called the ambulance since they probably didnt. I bet he waited outside and legged it when they came. Done same but it was a panic attack after speed. I had done trice the amount and knew he aint gonna die. Dumb thing it was my Apartment. But i was in no state of question answering.

 

[Deru]

I can't believe I just found this thread. What an awesome idea

Damn...what a retard.

Why would you seek medical attention only to disappear? Probably got a call from his dealer. 8)

My first few blood infections were like this. Blood infections made me very, very, very ill and severely confused. The first couple times I had one I honestly believed I was just in terrible heroin withdrawals and literally had no concept of what a blood infection meant. The ER gave me opioids to help with withdrawals, but when they admitted me to the hospital those doctors (specifically the attending) refused, so I left AMA on more than one occasion. Which would typically lead to calls from a doctor begging me to come back, me yelling about how horrible the doctor was for not treating my withdrawals, the doctor agreeing and then hopefully slapping the idiot doctor upside the head for expecting me to have sepsis and be in full blown intravenous heroin withdrawals and refuse to treat my pain. There is so much bias against drug addicts in hospitals it's sickening, and I will forever hate that Attending doctor. If I ever happened to walk by him on the street, I would gladly take an assault charge to just break his nose.

 

[Meth novice 79]

One for the books, even though it’ll unlikely stop anyone from making a poor choice just like it wouldn’t have changed my mind a couple years ago either.
Diagnosed with COPD-emphysema 2 years ago by chance while having a scan done on my abdomen that picked up the bottom section of my lungs.
I heard ‘early stage lung disease’ and thought, early? Pfft that don’t sound too serious I’ll just keep on doing me til it gets worse, then I’ll think about taking things seriously.

Then about 4 months ago something changed. Rapidly.
I was suddenly unable to do the things I usually do without running out of breath. Small tasks would see me break into a sweat and need to sit down for a bit.
Drugs took the life out of me rather than gave me a boost and all I wanted to do was sleep all the time.

So went for my 2 yearly scan.
And I’ve got something called Talcosis-Silicosis As well as the emphysema which has progressed from ‘early’ stage to moderate to severe in that short space of time.
How did I get this? This weird disease that only stone masons or factory workers or people who eat talcum powder get?

Fucking IV drug use.
SPECIFICALLY iv of crushed pharmaceuticals meds. Typically methadone and the like because the fillers in the pills (commonly talc) isn’t cooked out effectively in that process, but it’s also been seen in those injecting methylphenidate pills, and I’m sure the documented studies falls quite short of the endless possibilities because in short, any pill crushed and injected can do this. In a single use.

Apparently it’s some kind of hypersensitive reaction to the talc in the blood stream that causes it but I don’t really quite understand how it’s made it to my lungs.
And the big issue?
I’ve never once knowingly injected a crushed up pill of any kind.
I’ve thought about it. More than once.
But was too scared of what could go wrong.
This means one of two things.
Either a man I trusted my life with, also a heroin addict, was secretly feeding me his methadone so he could take my money for ‘real’ drugs.
OR somewhere along the way I’ve scored a batch of meth from a dickhead backyarder who doesn’t know how to correctly cook his meth.

And those choices have likely just cut another 10 to 15 years from my already shortened life.

know what you’re sticking in your arm guys.
Always.
It’s not just about clean needles, filters and making sure you don’t burn a hole in your vein.
So much can go wrong with this shit.

 

[TweakerBell91]

According to MedPage Today
Drug users who inject the new "abuse-deterrent" version of Opana ER (oxymorphone) may be at risk of developing a serious blood disease, according to Tennessee health officials.

A total of 15 cases of thrombotic thrombocytopenic purpura (TTP) have been reported among injection-drug users in the state since the new formulation of the opioid painkiller was launched in February 2012, David Kirschke, MD, of the Tennessee Department of Health, and colleagues reported in the Jan. 10 issue of the Morbidity & Mortality Weekly Report.

 

[Bropiate_NI]

Has anyone got case study regarding an injecting substance user using a needle exchange?? I have a essay to do

 

[fastandbulbous]

All of a sudden, the administration of drugs via the rectal route (plugging), doesn't seem quite so offputting!