Intravenous Caffeine

If there’s a hole in your body, you can put drugs into it. (Do I have to leave a disclaimer? The blog is still new, so why not: I don’t use drugs and I don’t recommend them to you either, I’m just describing what people do.)

Every drug seems to have a “right” way to take it. You drink alcohol, smoke tobacco, snort powdered cocaine, inject heroin, and booty bump ecstasy [1]. There will always be exceptions, but the route of administration seems to heavily impact the experience of drug use. 

So I was surprised a few months ago when a patient told me about an experience he had with IV caffeine. 

I’d never heard of anyone intentionally mainlining caffeine–and that wasn’t the case for this patient either. He received IV caffeine as part of a medical procedure done under general anesthesia. People are usually completely asleep before they receive caffeine, but for reasons I cannot comprehend, the caffeine hit before he was fully sedated, causing an intense rush of anxiety; one of the worst experiences of his life.

Part of me was horrified. I’ve had anxiety provoking experiences with anesthesia before, and I can’t even imagine being hit with a stimulant right before going under.

The other side of me was curious. If caffeine is so great, why don’t people inject it? Does it always cause anxiety? Don’t get me wrong–I certainly see the downsides to IV caffeine: needles, infections, and the social stigma of taking a prolonged “bathroom break” at work instead of getting coffee for the team. I’m also aware that caffeine is quickly (and almost perfectly) absorbed by the gut. Plus, it’s dirt cheap when not taken in its artisanal forms, meaning nobody needs to squeeze every last drop of benefit out of the drug itself. But somebody must have tried shooting it before, right?

Thankfully, it’s easy to find information on questions like this. I usually turn to one of the many websites which curate the stories of drug users. But as I had heard about this in a medical procedure, I decided to do a literature review instead. And I found what may be one of the greatest scientific papers ever written.

In the study, Johns Hopkins researchers recruited 10 individuals with a history of significant cocaine use and told them “that the purpose of the study was to see how different drugs affect the mood and behavior of people.” They were given a list of IV drugs they might be given, which included–among other drugs–xanax, speed, and cocaine. They were then paid to stay in a research facility for 20 days to receive IV drugs.

Here’s where it gets interesting. The study was not designed to look at hard drugs–the scientists were only interested in IV caffeine. They held oral caffeine from research subjects for several days, and then gathered baseline data by testing whether escalating doses of IV caffeine caused physiological problems. After their initial tests, they randomized each subject to varying doses of placebo or IV caffeine. Doses ranged from 37.5 mg (a touch more than a can of Coca Cola) to 300 mg (which is 4-5 shots of espresso).

Immediately following caffeine injection, subjects were given a battery of questions. My favorites: rate from 0-100 the following: “Do you feel high?” “Have you felt any good effects?” “Have you felt any bad effects?” “Do you like the drug?” and “Have you had a desire for cocaine?” Simply beautiful.

Overall, higher doses of caffeine were associated with positive effects and a euphoric feeling. Negative effects weren’t quite as clear with small amounts of caffeine, but when given the maximum dose, one participant noted a “dull” or “bitter” taste, while most others experienced a scent that was “musty” or reminiscent of Clorox, ammonia, or burning rubber. Does IV caffeine make you want to use cocaine? Only a little, and only at the highest dose.

So what do we learn from this study? First, while I was wearing Red Ribbons and listening to ineffective D.A.R.E. propaganda in Elementary School, the National Institute on Drug Abuse was funding some really fascinating research on what happens when you take IV drugs. (This research group has some other fascinating work I may get around to one day.) Second, when taken in the right context, IV caffeine carries a brief, pleasurable high and a noxious scent. We can’t compare it to any other drug because it wasn’t tested head to head, but it seemed to be a positive experience overall. 

As someone who gets a little jittery when over-caffeinated, I’ll pass.

Footnote:

[1] Most people consume ecstasy by mouth, but I’ve heard from many that anal ecstasy is a more satisfying experience.