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Medical Forum / General / General / October 2006Cotton Fever, Muddy Waters, Water Sickness, and it goes by other names,
The sickness is common. Eventually, every intravenous (IV) drug user gets it. But it's not clear what exactly it is. There are not a lot of answers on the web, and no doctor I've ever asked could give me a good answer. The subject deserves to be re-visited. Typically, it's a very, very unpleasant condition that occurs after the injection of drugs or what's left over from an earlier injection. By "what's left over" I mean the "dregs" or the "wash". Usually a user, to prepare a drug solution to inject, will filter the solution through a small piece of cotton or cigarette filter, (which is cellulose acetate?). Often the user will save these used filters and the material that doesn't make it through the filter. Later, by running more water through these used filters, and maybe by heating again, the user can extract additional drugs from the used filters. The sickness usually follows this extraction procedure from previously used cottons. Thus, the name, Cotton Fever. But it's not clear that cotton is a necessary element. There is a fever, headache, and muscle aches. The victim may vomit or have nausea. The back aches. There may be tremors. Victims often believe they are going to die. The sickness does not come on immediately after an injection, but may develop about 45 minutes after the injection. The sickness might last as much as 3 hours, but I'm not sure if this is always the case. The first symptom is a "cringing" (I don't know a better word) sensation in the palms of hands.Other symptoms follow. A reliable source in Arizona, a dry climate, states that if the cottons are saved in open air, an open pill bottle perhaps, then they are unlikely to develop the CF producing substance. If the cottons are saved in a closed container, a closed plastic bag perhaps, then they will develop it. If some cottons produce CF in someone, then if someone else later uses the same cottons, they also will get CF. Some people say CF is only associated with intravenous (IV) injection, and that CF won't develop with intramuscular (IM) injection. If you have experience to answer this, please respond. If you have any other information, please respond. Treatment: Do not do another shot from the same cottons! You'll make the problem worse. If you go to the emergency room (ER), you may get a shot of Naloxone, a narcotic antagonist, which will also make the problem worse. If you have some drug that will safely calm you down, perhaps that will help. If your stomach is strong enough to handle aspirin, that may help a bit. Otherwise, wait it out. If a few hours, you'll be okay. You'll be able to tell when it's over. I don't think what's on the web on the subject is reliable or well researched. This link is an example: http://www.ndsn.org/novdec97/cotton.htm Cotton Fever in Intravenous Drug Users HARM REDUCTION November-December 1997 "Cotton Fever" is a fever that is sometimes experienced by intravenous drug users. Questions about this condition were posted recently on the Internet. The fever is believed to be associated with an organism called enterobacter agglomerans that colonize cotton and cotton plants. Cotton is used by many heroin users to filter the drug as it is drawn into the syringe from the "cooker." According to a report in the Journal of Emergency Medicine, "Trivial illness accounts for 16% to 26% of such fevers." However, serious illness such as pneumonia must be considered in fevered addicts (D.W. Harrison and R.M. Walls, "`Cotton Fever': a benign febrile syndrome in intravenous drug abusers," Journal of Emergency Medicine, March-April 1990, pp. 135-139; R. Ferguson, C. Feeney, and V.A. Chirurgi, "Enterobacter agglomerans -- associated with cotton fever," Archives of Internal Medicine, October 25, 1993, pp. 2381-2382). Cotton fever is simply this: septicemia aka blood poisoning, meaning that a bacterium or fungus (or possibly a protozoa ) has gotten into your shot. It has the potential to be very serious, even lethal. But one thing it has nothing to do with is cotton, other than cotton is a nice place to grow fungi or bacteria, especially when damp and in an air tight place like an empty baggy . But a piece of cotton itself getting into your shot without the adhering life form will cause you no problems. MobiusDick > The sickness is common. Eventually, every intravenous (IV) drug user > gets it. But it's not clear what exactly it is. There are not a lot [quoted text clipped - 74 lines] > cotton fever," Archives of Internal Medicine, October 25, 1993, pp. > 2381-2382). > Cotton fever is simply this: septicemia aka blood poisoning, meaning > that a bacterium or fungus (or possibly a protozoa ) has gotten into > your shot. It has the potential to be very serious, even lethal. Calling it septicemia doesn't narrow what it is. And apparently, if CF is caused by bacteria, it's not necessarily by currently live bacteria. The old cottons can be vigorously boiled and yet still carry the CF. Perhaps the bacteria, whatever it is, makes a toxin. This toxin survives boiling and causes CF even with the bacteria dead. Also, the time it takes for a victim to feel CF is on the order of a half hour to an hour. That's not enough time for bacteria (or some other live organism) to have much of a life cycle. The actual toxin must be present in shot, or old cottons. What it is must be plenty powerful per unit mass. I'm thinking it must be a nerve toxin. This is the first I've asked in a NG about this, but I've been asking doctors for decades. As I said, I've never got a solid answer. Doctors tend to dismiss the issue. Let's pin-down some particulars: Has anybody ever experienced CF from a non IV shot, that is, an IM shot? Is CF associated with all injectable drugs? Have people gotten it with speed? Coke? I only personally know of CF being associated with narcotics. What happens if CF producing cottons are dried _completely_? Do they then still carry the CF agent? >> Cotton fever is simply this: septicemia aka blood poisoning, meaning >> that a bacterium or fungus (or possibly a protozoa ) has gotten into [quoted text clipped - 27 lines] > What happens if CF producing cottons are dried _completely_? Do they > then still carry the CF agent? 99% of the time, "cotton fever" comes from the syringe itself...NOT THE COTTON... I've gotten cotton fever, then the next day used everything exactly the same, EXCEPT I boiled the rig a few quick washes (let it sit in boiling water, drew up and shot out boiling water..all the way, completely filling up the rig) and there was no cotton fever. "Cotton fever" has nothing to do with the cotton, beyond the ability of the cotton to pass on the sepsis...but a closed rig, with a few small drops of water inside is a much better place for it to develop. And it only happens if you IV. Mike That's another curious part. The common wisdom that I heard was that an IM shot can't carry CF. I'd like to know for sure. If that's true, and it may well be, then the mechanism of CF is hard to explain. I, myself, don't have enough IM experience to weigh-in. > And it only happens if you IV. > Mike > That's another curious part. The common wisdom that I heard was that an > IM shot can't carry CF. I'd like to know for sure. If that's true, and [quoted text clipped - 4 lines] > > And it only happens if you IV. > > Mike Funny, but people who always use new, tightly balled up cottons dont seem to get this, while people who use the same cotton with tiny threads not easily seen by the naked eye, and also getting dirty while the same spoon is used over and over again, never cleaned, and the cotton never changed, see to be the ones who get cotton fever. I think its one of those tiny, dirty threads of cotton that accidentally is drawn up into the rig and shot into a vein that is the culprit as i never heard anyone getting "cotton fever" if they change the cotton after each injection, even if they dont change the sryinge or the spoon. Manny >> That's another curious part. The common wisdom that I heard was that an >> IM shot can't carry CF. I'd like to know for sure. If that's true, and [quoted text clipped - 17 lines] > >Manny In general, we don't use cotton with threads here and getting a dirty hit is something almost all ivdu's experience at some time. The most common filter is a cigarette filter. These are made of spun cellulose acetate or rayon. Very rarely, if cigarette filters are not available (our local needle exchange provides them free of charge in bags containing approximately ten filters), we will use cotton wool, or a rinsed alcohol prep, or something similar. Manny, I don't know where you get the information with regard to using but it is very questionable. I couldn't imagine anyone using the same "cotton" over-and-over again. It just wouldn't work. It's a filter, which means it will eventually, but very quickly, become unusable. Why would anyone bother? It's not like it is difficult to get cigarette filters or something similar. Also, why would anyone use the same spoon over-and-over again, without cleaning it? It's patently silly to think that this happens. Here in NZ, the use of wheel filters is a reasonabley common part of the ivdu's kit. Yet, we still get dirty hits. Not often but ocassionally it happens. How do you explain this? Well, I'll tell you how I do: - There are several reasons for a 'dirty hit' (cotton fever). As I mentioned in my initial reply to this topic, it is because a pathogen, (usually bacterial but not always) or other foreign matter, is introduced into the blood stream in sufficient quantity as to cause an immune response. The pathogen or foreign body can come through any number of ways, but most importantly, some part of the preperation process has been compromised. It may start with the gear itself, or be an unsterile syringe and needle. My point is, there is no single cause for this. Just as there is no single reason why people get sick. Aseptic technique goes some way to making sure that the chances of a dirty hit is minimised but even in a medical setting, there is still potential for such an event to occur. Still, they only use clean spoons and filters so... <g> Your suggestion of a fine thread making its way into a shot is not without precedent, and would almost certainly cause a reaction. However, I have to wonder if the thread would make its way into the bloodstream without blocking the needle. Not impossible though. A friend of mine discovered just such a thing in his hit recently. We talked about it, and decided that it was probably a very fine thread of plastic left over from the manufacture of the syringe itself. A wheel filter was used so unless the object was part of the wheel filter, then it had to have been in the body of the syringe. Bear in mind that only new equipment was used. =JS > >> That's another curious part. The common wisdom that I heard was that an > >> IM shot can't carry CF. I'd like to know for sure. If that's true, and [quoted text clipped - 62 lines] > mind that only new equipment was used. > =JS Julia, Dont ask me why people would use the same cotton over and over and over again, same with using a dirty spoon over and over again. But frrom what I have seen people do do so, and it is more the rule than the exception. Maybe they are just too lazy to change to a new one. As for using ciggy filters, I think you do not live in the US, and i dont know if it is different where you live, but here, cig filters have very very fine shreads of whatever the filter is made from, and these are even more dangerous if they accidentally get into the needle. They are so thin and small just like the fine threads of dirty cotton that can get into a rig, thaat they do not clog the rig, and they get into the bloodsteam. Now I know that this is one way of getting cotton fever. There may be other ways as well, but from what i have experienced the people i know who have gotten the cotton fever that gives people the chills is caused by the cotton or the cig filter getting into the bloodstream. I wouldnt know if it is the bacteria in the thead of the filter or the cotton or the mere fact that there is a foreign object in the blood stream that causes the chills i have seen people suffer. Manny >> >> That's another curious part. The common wisdom that I heard was that an >> >> IM shot can't carry CF. I'd like to know for sure. If that's true, and [quoted text clipped - 69 lines] >what I have seen people do do so, and it is more the rule than the >exception. Maybe they are just too lazy to change to a new one. Manny, are you, in all seriousness, trying to tell me that you've seen people use the same filters and spoons over and over again? Then you're trying to say it is not only a common practice but more common than using clean equipment? Oh for f.cks sake. You've really gone too f.cking far this time. You just made that up and you know it to back up what you're saying. I have been using and around using for nearly thirty years (congratulations - that's a ruby anniversary coming up... or something) and I have only once seen a person use a dirty spoon. Actually, more like a 'half-arsed' cleaned one. So, that's tens of thousands of iv events I've been party to, and I've seen it happen the grand total of once. >As for >using ciggy filters, I think you do not live in the US, and i dont know [quoted text clipped - 4 lines] >into a rig, thaat they do not clog the rig, and they get into the >bloodsteam. Now I know that this is one way of getting cotton fever. The cig filter story is a myth. They do not have fibres that get into a shot. They are not made of fibreglass (that's another myth that I've been doing my best to dispel). The cigarette filters commonly used in the US are the same type we have here. Rayon or cellulose acetate. They were once made of asbestos, which may be where the confusion comes from. As we all know, asbestos is made up of fine fibres that can be a health risk. Perhaps there was a time when these filters were used by ivdu's, you know - back in the day. But not for many, many years. In the US, from what many people have told me, and I've read, they tend to use the insulin type syringes. It would be almost impossible for a tiny fibre to get into one of these outfits. Much more likely to happen here, where we use the seperate needle/syringe combo, and yet, it doesn't happen. The insulin type outfits needle guage is so miniscule that, in the absolutely unlikely event a fibre did get in, it would be most unlikely to get back out again, into the bloodstream. Now, I know you're going to say, "I know it can" but as you're not an ivdu and you're just going by stuff you've read or heard goodness knows where, I'll go with my assertion that this is not a risk for drug users to be losing sleep over. >There may be other ways as well, but from what i have experienced the >people i know who have gotten the cotton fever that gives people the [quoted text clipped - 4 lines] > >Manny No, these people may think they've got it this way but how would they know? I mean, just think for a moment. Does an injecting drug user hold his outfit up to the light and once he spots this teensy-weensy fibre in his outfit (how the f.ck it got there is anyones guess, considering the size of the needle), throw caution to the wind, knowing full well that there's a rumour that says "cotton fever is caused by the very thing I can see right now in my syringe", proceeds to inject? Of course not. =JS > >> >> That's another curious part. The common wisdom that I heard was that an > >> >> IM shot can't carry CF. I'd like to know for sure. If that's true, and [quoted text clipped - 130 lines] > to inject? Of course not. > =JS Yes, Julia, I am saying that most everyone i know uses the same cotton at least several times, and uses a used spoon too. And yes, at least on coke, i dont know about after nodding off on heroin, but the cola shooter does notice almost immediately that they have shot some strand of cotton into their vien. Believe me, i am not making this up. I am not lying or delusional, this is based on as close to first hand experience as you can get. Maybe people are more hygenic where you come from. I know of people who have let a spoon with some sh.t in it lie around after they have dosed off, full of blood and crude,and a really mushy cotton, and upon awakening, they have gotten their old non washed out rig and drawn up that nasty liguid and shot up, and NOTHING bad happened to them with all the bacteria, etc, and mushy cotton, so its not a foregone conclusion that one will have anything go wrong with their system no matter how unhygenic. I did know of one person once who shot a rig full of coke that was full of blood, and the strangest thing happened, they all of a sudeen had a small amount of blood coming up and into their mouth. Pretty strange but absolutely true. I swear I am not nuts, and im not making any of this up either. Manny > > Manny, are you, in all seriousness, trying to tell me that you've seen > > people use the same filters and spoons over and over again? Then [quoted text clipped - 59 lines] > Yes, Julia, I am saying that most everyone i know uses the same cotton > at least several times, and uses a used spoon too. that makes sense, and it also explains why all of your friends have always held your intelligence in such high esteem ("if i really am dumb, why do all my friends tell me i'm smart, huh? ha -- checkmate!"): your friends *truly are* your equals. > the cola shooter does notice almost immediately that they have shot some > strand of cotton into their vien. and how do they know that it was a strand of cotton, you moron? *that* was the question! the question that was meant to show you the (most readily demonstrated) error you are making. and even now, as my words serve to point this out to you for the fourth or fifth time, you *still* don't understand, do you? you don't even understand how to answer this question (which was, again, "how do they know it was a strand of cotton that caused their ill effects?"), do you? amazing. "well i COULD answer that, but since you pointed out that i'm a moron, i'm not going to!" > Believe me, i am not making this up. I am not lying or delusional, this is > based on as close to first hand experience as you can get. absolutely amazing... hey manny, do you ever get the feeling that an entire newsgroup of people is "in" on a joke that you don't even know how to *act* like you "get"? do you ever get the feeling that you *are* that joke? no, of course you don't! > I know of people who have let a spoon with some sh.t in it lie > around after they have dosed off, full of blood and crude,and a really > mushy cotton, and upon awakening, they have gotten their old non washed > out rig and drawn up that nasty liguid and shot up yep, that sounds like the kind of people that would tolerate you as a friend. did you all meet at an amway seminar? or perhaps at a "red rock opium fan club" meeting? > so its not a foregone conclusion that one will have anything go wrong with > their system no matter how unhygenic. uh, care to read that back? lol, add "foregone conclusion" to the long, long list of phrases you don't understand. > I did know of one person once why do so many of your "factual references" begin this way? > who shot a rig full of coke that was full of blood, and the strangest thing > happened, they all of a sudeen had a small amount of blood coming up > and into their mouth. gee, thanks... that proves that, uh... well, i'm sure it "proves" something to you. > Pretty strange but absolutely true. I swear I am > not nuts, and im not making any of this up either. that was close -- for a second there, i thought you were full of sh.t! > > > Manny, are you, in all seriousness, trying to tell me that you've seen > > > people use the same filters and spoons over and over again? Then [quoted text clipped - 119 lines] > > that was close -- for a second there, i thought you were full of sh.t! First of all, all my friends are not shooters, and even if they were and all used dirty outifts that wouldnt necessarily make them stupid except according to you. I know that they knew it was the cotton. That you dont believe me is your problem. Afterall you dont believe a word i say, so what else is new, why do you even bother to respond to my posts since all you ever say is the same thing over and over and over. Why dont you just consider what you think the source is and forget about me. You dont bother me, you just waste your time writing the same old thing again and again. And as for me being the joke of this ng, how can you say that. There is you, there is Eaton, there is Jane, and maybe two other people who dont agree with me. I am sure there are thousands of members to this groups and for you to base your idea that I am a joke based on the type of a few regulars on here is ludicrous, and you know so. Manny >> That's another curious part. The common wisdom that I heard was that an >> IM shot can't carry CF. I'd like to know for sure. If that's true, and [quoted text clipped - 26 lines] > dried, while the water inside a syringe stays wet for months..it's > airtight, allowing bacteria to multiply. I've gotten CF Manny. Then, the next night, done another shot exactly the same, same cotton same cooker...the only difference was I drew up boiling water a couple (3) times into and out of the rig. The way you described is definitely NOT how you get CF..it's just another junkie urban legend. Mike >The sickness is common. Eventually, every intravenous (IV) drug user >gets it. But it's not clear what exactly it is. There are not a lot >of answers on the web, and no doctor I've ever asked could give me a >good answer. The subject deserves to be re-visited. Generally, and it has always been my experience, that which you refer to as 'cotton fever' (no, not from oxycottons <smirk>) is caused through harmful bacteria being introduced directly into the bloodstream. We refer to it here in NZ as a 'dirty hit' or, just plain 'a dirty'. The reason I say 'my experience' is I've headed off 'a dirty' with penicillin type antibiotics and within thirty-forty minutes I'm right-as-rain. Still, I can only remember two ocassions. This, however is a different type of 'dirty' to those caused by (horror-of-horrors) some idiot smoking while they're doing up a hit and a speck of ash (or in one case, the end ash) falling into the spoon/cooker. Those 'dirties' I've seen have resulted in people vomiting blood which was pretty scary. But thankfully, the worst is over within hours. A friend of mine gave himself a 'dirty' a while back from not prepping a ping of poppies properly. (alliteration unintentional) He failed to dry the opium completely, and this resulted in a very bad state of sickness that took around five-six hours to ride out. I regularly save my filters. But I +ALWAYS+ try to keep doing a hit up as sterile as is humanly possible within the constraints of what's on hand. I always used boiled water, usually allowing it to boil in the kettle for up to ten miinutes. I always keep the spoon as clean as possible, including wiping with alcohol preps and allowing to dry and/or heating on the oven element. Actually, the dirtiest thing about doing up a hit for me is the cigarette filters (rayon based here) and the citric acid crystals. Neither are sterile. As soon as I am done, I take the plastic part of the syringe wrapper, place the dregs off the spoon into this, and tightly wrap it. It is then placed in another container in the freezer. I have done this all my using career (spanning almost thirty years), and can in all honesty say I've never had a hit that I can put down to doing this. In fact, the only time I've had a dirty hit was when someone else had prepped it. So, in summation, a dirty hit/cotton fever is caused as a result of non-sterile technique to the point that the body sets up an immune response that is symptom causing. =JS |
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