The first time I ever got cotton fever, I thought it was just bad dope that had left me in withdrawal. It was summer but I got so, so cold. I put on every jacket I had—like seven jackets—and was still shivering. Passed out in a cold sweat. And then woke up just fine.
Cotton fever is a kind of short-term bacterial infection that generally comes from reusing old cottons to inject drugs, though most people associate it with opioids specifically. When you can feel withdrawal coming on and you don’t have any opioids, or money, and you’re checking all your pockets and looking everywhere but can’t find any, often what you do have lying around is a cooker or other container with used cottons. AKA the miniature cotton balls used as filters to keep unwanted particulates from getting inside a needle and thus inside your veins. Now those old cottons are like tiny dried-out sponges, which you can rehydrate to squeeze out the dregs of whatever they’d previously soaked up.
That’s when people get cotton fever. If bacteria have grown in the cottons since the last time they were used, injecting can be unpleasant. Vicious nausea, fever, chills, all that, but it won’t kill you; it’ll be over in a couple of hours, or by the next morning. But a lot of good cottons go to waste because of cotton fever, and it doesn’t have to be that way.
The general advice that people give is if you know you’re going to reuse your cottons at some point, throw them in the freezer to cut down on the amount of bacteria that can grow in the intervening time. This can help, but it’s no guarantee.
For years, I tried everything under the sun to beat cotton fever. I would take cottons that I knew had to be full of bacteria and I’d save them in the freezer anyway, then guinea-pig myself by putting them in a cooker with 400cc of water and boiling it all the way down. Which takes several minutes of continuous boiling to do. Guess what? Still gave myself cotton fever.
I can’t say whether this is the absolute best method, but I can say that I haven’t had cotton fever since I started doing things this way.
The last time I ever got cotton fever, I was in a bad spot. Not with my drug problem, but with my running-out-of-money problem. So it was the sort of situation where I was just rounding up every old cotton I could find. No idea how old they were, whose they were, what used to be in them. Within about 10 minutes of doing the shot I felt the leg cramps coming on. That’s often an early warning sign.
I could tell this was going to be a bad one, and that in another 10 minutes I probably would be in the fetal position, in withdrawal on top of the cotton fever. Hobbled out the door and down to the apartment of a neighborhood supplier, and of course in addition to having no money I’d also neglected to charge my phone, so I had to knock on his door, which he despises. At first he wasn’t going to front me anything, but then I threw up in his doorway kind of close to his shoes, and he gave me two nickel bags and told me to get out.
I sniffed one on the way back, but sadly my tolerance isn’t at a point where sniffing does anything useful for me, plus I was viciously retching the whole way. I actually might have called an ambulance, if my phone hadn’t been dead. It was almost impossible to make the shot but when I finally managed to do it and the withdrawal symptoms were gone, from there I was at least able to get my head on straight enough to take a pile of Advil and Tylenol and start hydrating.
Early in the COVID-19 pandemic, you’d end up with cottons that were yellow or purple or red and you’d remember who’d been selling dope that color.
After that, I decided I was going to do things the right way. The system I came up with has seen me through ever since.
I use a plastic pill organizer, preferably the 30-day kind, that I keep in the freezer. Once I’ve used a cotton—making sure to pull as much of the liquid out as possible—it goes straight in there, one cotton per compartment. That way you can label them so later you have some idea of what they once were.
Early in the COVID-19 pandemic when every color of fentanyl was coming through the neighborhood, that was great. You’d end up with cottons that were yellow or purple or red, and you’d remember who’d been selling dope that color. But in regular times cottons are brown and interchangeable, so you want some sort of system.
Cotton fever won’t kill you, but underestimating the quantity of opioids left in there and using them alone might kill you. It’s not that uncommon for people to overdose and die because someone else gave them their old cottons to help them out. So label the compartments, in whatever manner helps you remember what’s in them.
In addition to labeling, I put the whole plastic container inside a heavy-duty gallon Ziploc, and then throw in about 10 of those little silica gel desiccant packets that come inside shoe boxes or pill bottles. I can’t say whether this is scientifically the absolute best storage method, but I can say that I haven’t had cotton fever since I started doing things this way.
When it’s time to use them, take however many cottons you might need—there’s no correct number because every situation is different—and put them in a cooker with your usual amount of water, plus about 40 percent because it’s going to boil off. As it’s boiling, smush the cottons with the butt end of the plunger to press out as much of their contents as you can. Once said contents are floating around in the water that remains, draw it all back up through each cotton one by one. Once all that liquid is in the syringe, set the syringe aside. Don’t throw away the cottons; they’re not done yet.
Take a second syringe, which you’re basically going to use for parts rather than use it to inject—I call these “working” syringes—and remove the plunger. Then take the cottons from the cooker and put them inside the barrel. In that same cooker, boil up a little more water, maybe 30cc, and once it’s boiling use a third syringe to draw it up and squirt it into the barrel of the syringe with the cottons.
Put the plunger back in, and sloooowly force that boiling-hot water down through the cottons and back into the cooker. When you get to the bottom, squeeze as hard as you can to get those last drops; those are the most valuable. After that you can throw the cottons out. Now they’re done.
Images via Kastalia Medrano
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