Summary

Needle fixation is frequently missed and dismissed by clinicians and patients. However, ignoring this condition can have severe consequences, such as septicaemia, thrombosis, blood borne viruses, and is associated with an overall poor prognosis of drug dependence.

Here we describe a 37-year-old man who presented with 20-year history of polydrug dependence, drug-induced psychosis and antisocial personality disorder. He was found to also have a 5-year history of intermittent needle fixation. His injecting behaviour and drug use improved significantly with fluoxetine while being on methadone maintenance.

At present there is little evidence for any effective treatment strategies for needle fixation. The current recommended treatment consists of cognitive behavioural therapy and cue exposure. Whether fluoxetine constitutes an effective management strategy remains to be seen.