A few years back I had an outreach-based job doing hepatitis C testing and treatment, with participants who were often in some form of chronic homelessness. Navigating someone all the way from getting tested to getting cured can take more than a year, depending on how chaotic their housing situation is, so you get pretty comfortable with each other. In my case I ended up talking to a lot of people who injected drugs about the circumstances under which they might put drugs up the butt.
Booty-bumping—also commonly known as boofing or plugging—is done using a syringe with the needle removed, or something along those lines. It’s not as euphoric or economical as injecting, but it doesn’t involve the risks of abscesses or collapsed veins or soft-tissue infections. It also doesn’t irritate your nasal passages or lungs or tooth enamel, or come with any of the wear and tear that we often see with chronic injecting, snorting or smoking.
Booty-bumping is generally associated with chemsex and the queer community, and homophobia has kept it shockingly underdiscussed by harm reductionists, given how remarkable it is as a form of harm reduction. We should be willing and able to talk about it with anyone who will listen, but particularly with anyone who’s living outside.
Whenever anyone working in harm reduction is tasked with giving advice about booty-bumping, they often end up suggesting things that are well-intended, but counterproductive. The most common mistake I’ve seen with booty-bump instructions over the years (besides how to physically do it) is that we constantly tell people it’s important to use sterile water. It’s not.
This becomes obvious the moment you start thinking about it, we just have this reflexive “best practices” mentality that makes us say stuff like that. And we figure that even if telling people to use sterile water isn’t entirely necessary, it at least can’t be wrong. But it is, when those people don’t have indoor plumbing. It tells them that without sterile water they’re taking a risk no matter how they do it, so there’s no reason to try booty-bumping instead of the method they’re comfortable with.
The better messaging, and the messaging that really matters for anyone living outside, is that if you’re about to inject and don’t have sterile water, that’s the best time to booty-bump. Your veins benefit from sterile water because they aren’t built to handle bacteria. Your butt will be fine.
In conversations about safer injection, sharing and reusing often get lumped together. Sharing involves risk even if you only do it once, and needles become riskier with each re-use so they sort of come to the same thing. Booty-bumping is different; sharing and reusing need to be separate conversations, especially with people who are living in encampments and/or in and out of jail a lot.
Sharing syringes to inject can put you at risk of blood-borne diseases like HIV and hepatitis C, but with booty-bumping the main risk to be aware of would be hepatitis A—a liver infection that’s typically transmitted when someone ingests microscopic quantities of fecal matter containing the virus. Hep A primarily affects communities where people have little or no access to running water to wash their hands. There is an effective vaccine, but if you do get hep A you’ll most likely pull through without permanent damage. You’ll be sick for a month or two, and then you’ll be immune to it for the rest of your life, like with chickenpox.
Reusing your own syringes to booty-bump doesn’t come with any added risks. Even in harm reduction circles, people always hate to hear that any kind of drug use doesn’t have its own special risk—there just has to be something, right? Syringes may start leaking from the back as the rubber seal degrades, and eventually the plunger will snap, but it’ll be months before they get to that point. Without a needle, syringes can and should be reused.
Booty-bumping also needs to be something street outreach workers know how to talk about because it’s particularly conducive to using meth. But any drug that can be injected—anything you can dissolve in liquid—can also be booty-bumped. With meth at least, the potency will remain stable even if you leave it in water for weeks or months before using it.
If you have some you’re saving for later, you can mix the solution in advance so that it’ll be quick and easy to use after dark whether or not you have good lighting. For example, say you’ve picked up half a gram and your booty-bumping dose is about 0.1 grams. Rinse out a small bottle—hand sanitizer, Visine, mouth wash—add your half a gram and then squirt in five syringes’ worth of water. That way when the time comes, you just need to unscrew the bottle cap and draw up. As long as you keep the bottle and a syringe in a pocket where you can easily access them, you can pretty much do it with your eyes closed.
This process can be done in under 30 seconds, which is faster than anyone can safely prepare and inject a shot, no matter how good you are. In addition to not requiring good lighting, booty-bumping can be done safely without cotton filters, alcohol wipes, tourniquets, a flat surface or any exposed skin. Which is one of the most obvious reasons booty-bump education should be aimed at people without housing: It reduces the risk of being criminalized for public drug use.
Despite what almost everyone assumes about rectal administration, booty-bumping does not require you to pull your pants down. With sweatpants and cargo pants, and really any pants that aren’t skinny jeans, if you can fit your hand inside the back of the waistband then you can booty-bump. Shorts and skirts are even easier.
Obviously some discretion is still required if you need bystanders or law enforcement to not notice, but there’s absolutely no setting where someone injecting drugs in public wouldn’t attract less attention by booty-bumping instead. Even from a distance it can be easy to recognize when someone’s searching for a vein, but if you see someone adjusting their pants in a weird way your first thought probably isn’t that they’re in the middle of doing drugs. There’s also the small mercy of not needing to expose your skin to the cold, if it’s winter and you’re sleeping outside.
Booty-bumping is usually described as the injection alternative that’s the next-best thing, which in my experience at least has never interested a single injection drug user in making the switch. But when we talk about how people will continue to inject regardless of the risk, what often gets left out of those conversations is that someone who’s on the verge of their first time injecting with puddle water, or urine, or apple juice, or whatever, is probably very scared. They don’t know what it’ll do and are just hoping they’ll be okay. If there’s a safer way to use the supplies they already have, they might want to know that’s an option.
Image via County of Fresno