Keywords

People wash the world. Sweeping, sanitising and making it clinically clean. People like you and me have no place in squares, parks or other public spaces. People like you and me my friend, people like you and me litter. (Adolfsson 2004, p. 39Footnote 1)Footnote 2

As I have argued, knark (drugs) can refer to any drug, but the knarkare (a person who uses drugs) and the knarkträsk (drug swamp) always refer to marginalised social contexts, rather than to anyone or any network of people who use drugs. Still, knarkare seemingly refers to anyone who has ever used a drug, and any person who uses drugs could potentially risk being identified as a knarkare. So what does it mean to be identified as such? How do the women negotiate the symbolically charged figure of the abuser and the knarkare in relation to their own drug use?

The Swedish Tenants’ Association’sFootnote 3 magazine, Hem och Hyra, twice asked its members “What kind of neighbour bothers you the most?” The first time 49% and the second time 33% answered “knarkare”, which thus came first in both surveys, ahead of categories such as “criminals”, “noisy young people” and “motorcycle gangs” (Lundmark 2008; Ljungqvist 2017). Julius von Wright, editor-in-chief of the magazine Alkohol och Narkotika,Footnote 4 criticises the ways in which stereotypes are uncritically reproduced in these articles and questions the purpose of measuring prejudice (von Wright 2017). However, precisely because the surveys do so, they provide information on the cultural meaning of the concept of the knarkare, and how notions of the knarkare influence how spaces are organised. The knarkare is kept at a distance, and it is assumed to make people uncomfortable to be close to them. Self-defined former users of drugs are asked in the articles to comment on how unpleasant they have been as neighbours, alongside quotes from people who have been tormented by neighbouring persons who use drugs. The articles give the impression that the knarkare is a fixed, well-defined character, and that thefts, needles in the sandbox and faeces on the basement floor characterise the kind of environment they create around them—a kind of knarkare, in other words, who is easy to spot because of the damage they cause to their surroundings.

In her article “The Shifting Shapes of The Knarkare”,Footnote 5 historian of ideas Jenny Björkman describes how the “traditional” Swedish image of the knarkare is a “homeless, prostituted, injecting drug user” (2002, p. 43), just like the portraits in Stefan Jarl’s documentary trilogy about socially marginalised people who use drugs.Footnote 6 In this description, homelessness becomes an indication of a further spatial demarcation between the knarkare and others, and based on Hem och Hyra’s articles, it seems anything but strange that the knarkare would lose their home. In Björkman’s definition, however, the knarkare is characterised by their vulnerability and the damage they inflict upon themselves. What both definitions have in common is dirtiness: in the sense of both a lack of hygiene and social taboos which, according to Mary Douglas’ theory of purity and danger, need to be kept at arm’s length (2002/1966). In short, the knarkare poses a threat and is a danger that must be kept at a distance from other people (cf. Ettorre 2015, p. 801). How is this work done by people who use drugs themselves, and their surroundings?

Historian Johan Edman and sociologist Börje Olsson write that drug problems began to be formulated without reference to specific substances after World War II, in Sweden. Drug use then became a coherent problem, and people who use drugs began to be discussed in medical journals as a defined group (Edman and Olsson 2014, p. 508). Author Birgitta Stenberg has claimed that it was she and poet Paul Andersson who came up with the word knarkare in the 1950s, albeit as a definition of people who use amphetamine, just like they themselves did. The reason was that they thought that they made a crunching noise—“knrk knrk”—when they chewed (Lindstrand 2001, p. 49). The word knark was later expanded to include all sorts of drugs, which made it a useful descriptor for the entire group that Edman and Olsson write about. I perceive the contemporary meaning of the word knark as generally synonymous with the terms drugs and narcotics, which primarily refer to illegally purchased substances.Footnote 7

1 Invisible Dirt

Although representations of the knarkare paint a picture of a coherent character that is noticeable and visible, my empirical material shows that the line between knarkare and non-knarkare is unclear. Angela says:

if you say…“I’ve taken speed [amphetamine] today,” people think “Ah! She’s one of those knarkare.Footnote 8 Taking speed all the time.” […] everyone’s kind of afraid to be seen as a drug abuser or something, so it becomes this confidential thing.

In this quote, the person Angela calls a knarkare does not come into being through visible harm to herself or those around her, but through speech. According to Angela, talking about a single occasion of use can be perceived as an implicit message about a long-term relationship with drugs. Angela’s intention, to talk about something temporary, takes on a different meaning for the intended listener, who hears a story about permanence and identity. This shift in meaning can be traced in part to a temporal ambiguity in the word “use”. The person who uses is in a close relationship that could mean they may potentially use again. Use can thus be understood as constant if it is presented as potential (Ahmed 2019, p. 29). In the case of illicit drugs, repeated use is associated with dependency, i.e. compulsive use, and the concept of addiction, which literally expresses the use as improper. A pronounced proximity to drugs can therefore create a shift in meaning to include developed notions of compulsiveness and problems; that is, the person who use drugs becomes an addict/a knarkare. This means that Angela only talks about her use in confidence. The level of trust in a relationship can thus determine whether or not language will turn someone into a knarkare. But what happens, then, in situations in which someone needs to mention that they have used drugs, without having been able to first establish a bond of trust?

Pernilla describes an occasion when she became more affected by cannabis than she had anticipated, at a friend’s house just before she had planned to go home. She describes how it was an unpleasant experience involving feelings of anxiety and dizziness, and when she imagined how she would be treated by those around her if she went out on public transport, she judged that it simply would not work.

[H]ow the hell am I even going to get home on the tube and bus? […] Oh God, that’s not possible. And then I’m not going to go “yeah, I’m wasted and stoned out of my mind [high on cannabis].” How do you ask for help when you’re under the influence of drugs? Yes, because things are different then. You’ve got to consider other risk parameters because you know that you’re under the influence of something that’s not entirely socially accepted in all contexts. So, if things go wrong, I think people might be more likely to ignore you.

If “things go wrong”, that is: if Pernilla had started to feel worse in public space, she would have needed to ask for help and approach another person. However, being a lonely woman in the city, feeling bad, under the influence of drugs, is a provocation, challenging norms and conventions of how femininity should be done (Lupton 1999, p. 165). Pernilla feared that it would not be a good idea to announce that she was on drugs when she was already not feeling well, and decided that she should avoid a situation where she might have to. The question: “How do you ask for help when you’re under the influence of drugs?” encapsulates the way in which different approaches to drug use structure the urban environment and create a gap between the few who use drugs and the majority who do not. Should these drugs make her feel bad, Pernilla expects that people will ignore her. They might view both her and the state that she is in as a threat; if they approached her, they would risk also becoming dirty themselves (Ahmed 2014, p. 87).

Instead, Pernilla decided to sleep on her acquaintance’s sofa. There is relief in her voice when she tells me that, fortunately, he was someone with a lot of experience of drugs himself:

[T]hat person’s really, he’s done all kinds of different drugs and stuff in his life. So he just went “oh, no problem”. You know? “Have a seat. Would you like some water?”

The difference between the expected rejection in public space and the helpful treatment from another person who uses drugs shows how the dirty knarkare comes into being when drugs are revealed to be present in certain social spaces, but not others. As Pernilla had the opportunity to choose which space to be in, she was able to avoid becoming dirty.

Mary Douglas describes how notions of purity and danger are tools of cultural orientation (2002/1966). She uses these terms to highlight that which our society finds acceptable or unacceptable, respectively, and argues that the latter is more about an aversion rooted in fear of the incomprehensible, the disorderly, of things that are in an unexpected place, than the actual characteristics of the condemned substance itself. In the chapter “Secular Defilement” (2002/1966, pp. 36ff.), Douglas describes shoes on the dining table or dishes in the bedroom as examples of misplaced objects that, in their expected places, do not evoke the same feelings of discomfort. The point is that dirt is not intrinsically dirt in and of itself, but it is the beliefs attached to it that make it dirty when in the wrong place (ibid., pp. 44f.).

If this reasoning is transferred to a drug context, an epidural anaesthetic during childbirth or a glass of champagne at a birthday party can be examples of when substances such as opiates and alcohol are considered pure—i.e. culturally accepted—substances, integrated into everyday life. But these same substances become dirty and dangerous in other places, such as a syringe in a public toilet or an alcoholic drink in a plastic cup next to a beggar (cf. Moore and Measham 2013, p. 87). The transformation into dirt occurs irrespective of factors such as the amount of matter or its bacterial count.

Douglas also illustrates that ideas about dirt and impurity forge rules for gendered bodies: women and men are not allowed to freely touch each other, for example. The rules are different in different places, but they exist everywhere, both in legal texts and as social contracts, in the Western world as well as in the “primitive” societies that Douglas studied. These rules serve to maintain order—an order that establishes and preserves power structures by keeping the sexes apart and distinguishing between them, and that legitimises its necessity with the feeling that it is preventing everything from dissolving into chaos.

2 Keeping the Abuser on the Margins

Douglas’ view of order is thus constructed in terms of ideas about dirt and purity: the dirtier something is, the lower it ranks in the hierarchy of power. Knarkare are an example of an impure group, the kind of group that Jonas Frykman and Orvar Löfgren describe as individuals who have been and continue to be marginalised by society: “Ideas of dirt are ever present in our thoughts about people who, for varying reasons, we view as foreign or odd” (Frykman and Löfgren 2019, p. 157). The concept of marginalisation illustrates that ideas about dirt are linked to spatiality. That which is on the margins, on the periphery, is not at the centre, where the starting point is. The person who imagines dirt and the margins is thus looking from the perspective of the centre. If they have used drugs, however, and happen to mention that they did, others might view them as being on the margins.

Katy tells me that she has no problem with these premises. She reflects upon transparency and the laws governing drugs, describing them as things that are not primarily for her and her friends, but are needed for the sake of other people who use drugs. She says:

I don’t feel the need to be some front-line activist […] I don’t need them [drugs] that much that I […] demand the freedom to be more open about it, and talk about it. I don’t. […] I mean, of course using [drugs] is a violation of the law. But we’ve never had to deal with, you know, ending up in a situation in which we, well, end up in court, or, you know, we’ve never, we’ve never had to pay any fines. Because we try to handle it so discreetly that it doesn’t… so that I feel that within the framework I can be quite open. So I’m probably not going to fight for a more liberal drug policy, but I understand the issue. Then again, maybe not everyone is like us…

I interpret Katy as understanding Sweden’s drug laws to be designed for other kinds of people who use drugs, not for her social circle. Nor does she have any issue with the fact that her actions are technically a crime, because she does not expect to have to face any practical penalty. This, according to her, is because she is discreet. Discretion stands in contrast to the non-discreet, the deviant—in this case represented by the knarkare—and requires both material resources and an embodied ability to pass. Ettorre writes:

Regardless of how deviant behavior is defined, it always manifests itself in the substance/materiality of the “deviant’s” body. Simply, individuals who deviate from the ideal, from “consensualized” norms, are seen as being socially and morally inferior and their social and moral trouble making is embodied. (2015, p. 795)

A marked body cannot (any longer) be discreet, and then, the practical application of the law may become necessary, according to Katy. In her view, laws serve to protect society from troublemakers, rather than from drug use. Perhaps she also means that laws are needed to dredge people who have “succumbed” back up from the knarkträsk through legal means, for their own sake. But the moral as well as the legal blame in such reasoning is placed unilaterally on the person who uses drugs who gets into trouble with those drugs, the person who can no longer be discreet and who is therefore considered to need the framework of harsh, criminal measures that is the practice.

Katy’s approach demonstrates how stigma around people who use drugs can be constructed independently of how drugs themselves are viewed. Instead, questions about drugs become questions about people. This shift sometimes becomes a subject for debate, as with the slogan “Knark är bajs” (literally “Drugs Are Faeces”, 2003–2007) of the national campaign Mobilisation Against Narcotics, which urged adolescents to give drugs a pass. In an interview in Vice magazine (Hagman Rogowski 2017), Björn Fries, who served as the government’s Anti-Narcotics coordinator from 2002 to 2007 and was part of the team behind the campaign, says that he feels some people misunderstood it:

I know many thought the campaign didn’t quite strike the right tone – “surely knarkare aren’t faeces?” And no, of course they aren’t. But that’s not what the slogan said. It wasn’t about people who face social exclusion, substance abuse, poverty, perhaps mental health issues. We didn’t view drug users as faeces – but people interpreted it that way.

But can the term knark (drugs) really be separated from “social exclusion, substance abuse, poverty [and] mental health issues”, or is bajs (faeces) an apt synonym for dirt as a way of referring to the interplay of the above factors? The knarkare is not just anyone who uses drugs: they are a dirty representative of the combination drug + human—and a slogan like “Drugs Are Faeces” brings to mind precisely this dirty character.

If the knarkare’s defining characteristic is their dirtiness, then people who use drugs can be expected to engage in negotiations about what is dirty and clean for them; that is, what is order and what is chaos? But how does symbolic dirt work? Can drugs dirt be scrubbed off?

3 Dirt and Freedom

When I ask Carolina what it was like to be a woman in the problem-use context she used to inhabit when she used amphetamines, she chooses the word “dirty” to describe the unpleasantness and panic she felt at the time:

well obviously I am a woman, so I never got to experience it from any other perspective, but it’s… this… intense shame, being incredibly dirty, sort of, and that I felt extremely… whorish.

Using drugs made Carolina feel as though she became a dirty person. But instead of a knarkare, she became a whore—yet another symbol of contagiousness. This is no coincidence; rather, it is in line with the commonly held assumption that women who use drugs also always sell sex (Du Rose 2015; Ettore 1992, p. 78). Carolina stresses that she never did sell sex in the sense of offering sexual services for a certain amount of money. On the contrary: the feeling that this was expected of her was frustrating, because she would rather have been a dealer:

it was really hard for me to, you know, … to do business [deal drugs]; for example, I often wanted to sell things on and stuff, but people never trusted me with that. Because, because I was a girl. Even though I insisted on it. Instead, I was forced to earn my cash elsewhere.

This division of roles in drug-using contexts has been described in detail elsewhere, for example by Lisa Maher in Sexed Work, her 1997 study of drug-dealing on the streets of Brooklyn, NYC. Maher shows how race, class and gender all structure the market and how women, especially racialised women without a safety net, are either excluded from the market or given jobs that pay very little or put them in danger. A large proportion of women therefore sell sexual services to support themselves. Sociologist Torkel Richert (2009), however, who studied the Swedish women frequenting a needle-exchange centre, paints a somewhat different picture. His research shows that the largest proportion of these women’s income derived from legal sources, such as welfare benefits, and that a lower number than predicted sold sex (2009, p. 374). Richert also found that it was more common for women to deal drugs than had previously been assumed, which he believes might mean that male dominance is being eroded in the drug market (ibid.; see also Rosengren 2003, p. 66; cf. Fleetwood et al. 2020).

Carolina describes her feeling of whorishness as stemming from a way of acting that could be described as a strategic performance of femininity (cf. Skeggs 2004, p. 16). Instead of being demanding when negotiating access to drugs, she took on the submissive role that she felt was expected of her as a woman, even though a variety of jobs already provided her with the money she needed. She describes feeling like “a bootlicker” around a dealer who had abused her friend, for example, and that she was often nice to people she despised. She wanted to be angry and hostile towards this abusive dealer, but acted in a friendly way instead because she “was afraid that […] the source [slang for dealer] would be turned off”. It is with anger, sadness and lingering self-loathing that Carolina discusses the dirty feeling of what she calls whoring.

I felt like a terrible person, being like this, very nice […] to sort of go on anyway and socialise and be nice because you, because I wanted…. something.

Her story shows that the feeling of whorishness stuck with her as a woman. This reflects both Björkman’s criteria for what constitutes a knarkare and the cultural assumption that women who use drugs are automatically sexually available (Du Rose 2015). Derogatory Swedish words like knarkarhora (“knark whore”) and sprutluder (“needle hooker”) show that knarkare is not a gender-equal category, but divided into a moral hierarchy, in which women who both use drugs and sell sex are at the bottom. Regardless of whether Carolina had sold sex or not, whoredom seems to have been impossible to escape, given that she wanted to continue using drugs and therefore maintain good relations with the dealers, who according to her interview responses were all men. The sleazy feeling was a gendered consequence of drug use. The feeling of whoredom in her case is related to her demonstrated niceness and stands in direct opposition to Ahmed’s concept of the killjoy (2010, pp. 50ff.). Carolina did not kill joy, not other people’s, and not her own drug-related joy. But she wanted to do so and writhed under the feeling of whoredom that was the alternative.

Ahmed writes that joy and not causing trouble can be ways of avoiding that which we are unable to bear (ibid., p. 64). For years, Carolina felt that being nice was just such an avoidance of something that she did not think she could cope with, to fall out with the “source” and see it “turned off”. But she also felt that she could not cope with allowing the situation to continue. In the interviews, she returns to saying that she wants to be able to approve of what she does, which she is able to do now that she has repositioned herself far away from the sources. But she cannot take back the niceness that has already taken place, and it still feels like a dirtiness she cannot wash away.

Carolina also talks about the hygienic connotations of feeling dirty. During our first interview, she describes a situation a few months after she had tried amphetamines for the first time:

So it was like I suddenly woke up again, sort of, and found myself in this fucking disgusting flat, which I’d been using every day for several months then, and I was absolutely riddled with anxiety and worry and anxiety and heartburn and things, and the place smelt like piss and… well, you can imagine. And I just went, like, “urgh, how the hell did this happen?”

The overwhelming anxiety she describes feeling in that moment makes me unsure whether the smell of urine was a one-off occurrence that she happened to notice, or part of her everyday life at the time. If she was living an everyday life that was dirty, in the sense of smelly, it made me wonder how that worked with her jobs, in terms of employability. I asked her about this during a go-along interview:

She stops and says after a short pause that it was probably more of a feeling, when it came to herself. The smell of pee in a drug den, visits to places full of “food, piss, blood” happened more often at the beginning, she says.

“Filthy on the inside and on the outside, it just became too much. It was about the dirt on the inside. The drugs and the fact that I couldn’t look at myself in the mirror. That I lied, was filled with lies.”

She repeatedly says emphatically that she had so much she wanted to do and that she was always thinking about leaving the drug life. She “didn’t want to do it” and panicked about realising year after year that she was still there. (Field Diary)

So there was a dirty aspect to the drug life that involved smells and “food, piss [and] blood” in the wrong places. But, above all, Carolina emphasises what she calls “the dirt on the inside”, which consisted of amphetamines and the fact that she did not want to do what she was doing and lied about it. It is therefore partly about matter in the wrong place: amphetamines in her body, where they were not supposed to be, which led to (and continues to lead to) an unpleasant feeling of dirtiness. When she talks about dirt during our interviews, it is a multifaceted dirt. Her use of amphetamines, her bootlicking and her lies are all perceived as having taken place in her body, as dirt.

I see what she describes as feelings of anxiety and panic about both wearing the dirt and the time aspect, that she remained in the dirty contexts for so long, as co-constructors of the dirt. Her whole body was matter in the wrong place, moving in the wrong directions. In a way that is well known and widely debated in addiction research, her intention was simultaneously to move away from the amphetamines and to get more (see, e.g., Heilig 2015, pp. 34ff.).

While Carolina was in her long period of daily use, she felt that she was dirty, i.e. labelled as condemned. Now, without illegal drugs in her body, she is clean, but still suffers from having been dirty for so long. She seems to carry her former dirt like a weight, a physical burden that continues to affect her. The cleanliness is upheld through the Twelve-Step Programme, one day at a time. In the present, she is “clean”, but she describes her addiction as a chronic disease that must be constantly monitored and combated in order to be contained (cf. Keane 2002, p. 163). This means that she puts a lot of effort into staying clean, from both drugs and lies. She gives a detailed account of her past mistakes, does not drink alcohol and says that she does not want to use medication, even though an ADHD assessment she is undergoing may lead to controlled medication being suggested. Overall, she gives the impression of being guided by high-held purity ideals (cf. ibid., p. 163). Yet dirt threatens around every street corner. A beer would count as a relapse, into the dirt. Being identified as clean in Douglas’ sense no longer seems to be an option; rather, Carolina views herself as chronically marked by dirt.

Her fragile cleanliness is linked to a specific kind of freedom: being “drug-free”, a state of consciously staying away from drugs in a physical sense. Carolina often uses this term, talking about how she was drug-free before she started using amphetamines, about a former boyfriend who was a “drug-free abuser”, how she later became drug-free, how she stayed (was) drug-free during the treatment period and how she is now still drug-free. The term denotes a strategic approach to drugs, rather than freedom from them.

My interpretation of this is that the “free” in drug-free (similar to the clean in “getting clean”) implies other conditions than those Carolina has to deal with. For her, using drugs is not just about using substances that are nearby, but has taken the form of embodied shame (Campbell and Ettorre 2011, pp. 182, 200). Dirt manifests, not by orienting herself towards drugs—drugs are the starting point to which she actively and continuously needs to relate, while performing cleanliness. If the lines of addiction form circles or loops that keep bringing one back to drugs (see the chapter Negotiating Addiction), then a “clean” line is about continually leaving drugs behind, without losing contact with the starting point. Freedom and cleanliness become conditional ideals, situated beyond the line that is anchored in the knarkare. Carolina’s situation can be compared to having a chronic disease, such as diabetes. As with the diabetes patients in a study by Gabriella Nilsson and Kristofer Hansson (2016, p. 264), who are offered freedom with, but not from, the disease, conditional upon good behaviour and careful medication, freedom from the dirt/knarkare is not an option. The knarkare is the starting point, and a former knarkare can free themselves from drugs but not from dirt.

Madelene describes how her rejection of alcohol is interpreted as such “freedom”, which is based on addiction:

People have a hard time accepting that some people don’t drink, […] they always automatically assume you have an alcohol problem. But… that bothers me. Because I really don’t. [pauses] I’ve never had any problems with alcohol. I just choose not to drink because it’s, it doesn’t taste that great, and it doesn’t make me feel good.

In Madelene’s situation—as a person who uses a large number of anti-anxiety drugs and heroin—the surrounding world’s interpretation, as she perceives it, of her dislike of alcohol leads to frustration. She describes her use of medication and drugs as self-imposed directions, which she occasionally refrains from taking. She therefore feels in control, but repeatedly mentions occasions when such control has been difficult to maintain and is sometimes lost. In other words, she is fighting against the experience of addiction, but she proudly emphasises that she has won the battle and decides for herself about her intake of drugs and medicines.

However, these struggles are hidden from the environment, and instead, her rejection of alcohol in social situations is interpreted as though it was a compulsory direction. She feels misunderstood as unfree.

4 Disgusting Syringes

If particular ways of talking about drugs in certain circles immediately conjure up the spectre of dirty drug use, then syringes are the ultimate material symbol of the knarkare (Lalander 2016, p. 92). Needles in a children’s sandbox connote a violent clash between innocence and danger. The women I interviewed had clear opinions on syringes: those who did not inject drugs immediately shook their heads when I asked whether they ever had. Using syringes was a line they would not cross. The two interviewees who did inject, on the other hand, Hanna and Madelene, painted a complex picture of syringes’ connotations of dirt and purity.

Madelene, who injects heroin from time to time and sometimes dissolved tranquillisers, describes her attitude as a negotiation around methods of introduction, with each alternative having different advantages and disadvantages:

Emma::

What are the negative aspects of heroin?

Madelene::

[considers] Mm, well, it’s the needles, isn’t it? They’re just so disgusting.

Emma::

I see… But you wouldn’t consider administering it in any other way?

Madelene::

Well, I’ve tried [sounds dismissive] smoking it, but that doesn’t do anything for me… I guess that’s the problem. […] I think you fall in love with the feeling that comes after [injecting]. Like, you know it’s coming then. When you smoke, it’s different. It’s like, instead of this [demonstrates how the high hits her], you’ve got to deal with foil and get all dirty and… it feels less discreet as well, in a way.

For Madelene, the different methods are evaluated from the perspectives of discretion and effect. Although she finds the injections disgusting, the rapid and strong effect means that she prefers injections to smoking from sooty aluminium foil sheets, a practice that she describes as less discreet. In the quote, it is smoking that Madelene refers to as dirty. At the same time, the syringes are repulsive to her and she only uses them reluctantly.

The disgust that she describes may seem obvious in relation to the syringe as a symbol of the dirty knarkare, but the meaning of the syringe has changed, in terms of clean and dirty, in relation to time and place.

When the hypodermic needle was invented in the 1850s, it was marketed as a sophisticated, clean and safe way to inject medicines (Plant 1999, p. 6; Berg 2016, p. 66). It became popular to inject morphine, which had been extracted from opium in 1804 but had previously been taken orally. In New York, according to a 1908 magazine article, ornate gold syringes presented in cases were available as morphine kits from the best jewellers (Palmer and Horowitz 2000, p. 72). The swift highs that these new hypodermic needles could bring, coupled with chemical breakthroughs at the time, led to enthusiasm about the potential of injection. Syringes became a symbol of a medical expertise that replaced more non-specific medicines, like opium (Berridge 2013, p. 113). Drug addiction was one of the problems that the injection of other drugs seemed to cure. In turn, doctors tried to cure opium addiction with morphine injections and then tried to cure morphine addiction with cocaine and heroin. It turned out not to work. One example of optimistic belief in drug injections as a cure for addiction was Sigmund Freud’s morphine-addicted friend Ernst von Fleischl-Marxow, who began to inject cocaine, upon the former’s advice, only to become more ill and ultimately die (Freud and Byck 1974, pp. xvii, 117, 155–158; Plant 1999, p. 72). When syringes eventually came to be associated with addiction and degeneracy, they fell off their pedestal. Sven-Åke Lindgren describes syringes’ status in the 1950s:

In terms of iconography, it is the syringe that comes to symbolise drug abuse. Syringes jabbed into tied-off arms, women giving themselves injections into their thighs, loaded syringes, syringes and needles and substances in glass ampoules, jars and pipes… These kinds of illustrations and hand-drawn vignettes are by far the most prevalent. What we have here is a tool that has fallen into the wrong hands: an initially benevolent invention that went astray and became an instrument in the service of the forces of evil. (1993, p. 166)

Lindgren’s analysis focuses on the way in which syringes veered “off line” (cf. Ahmed 2006, pp. 65ff.). The syringe was meant to serve society, but in the wrong hands it was led astray. Lindgren calls the directions that the syringe was meant to take “benevolent”, but the images he studied depict it as being in “the service of the forces of evil”. Between the lines of the above paragraph, there is a sense of regret over the syringe’s unworthy fate. This change must be analysed from a class perspective. It was when the working class started using injectable drugs, in the 1960s, that syringes fell from grace. This led to symbolic, downwards class journeys for syringes as well as for drugs and people who use them (Lindgren 1993, pp. 165ff.).

The experience of manifesting a socially vulnerable injecting drug user in the present day is illustrated by Hanna, when asked about where she uses drugs:

Emma::

Where do you prefer to take heroin?

Hanna::

Well, as far away from people as possible.

Emma::

Alone?

Hanna::

Oh yes. [pauses]

Emma::

Why?

Hanna::

Because, because… you can’t use a syringe among people, everyone… everyone knows that. [Inaudible]

You cannot be seen holding a syringe, Hanna says, because “everyone knows” it is not possible. The knowledge that the syringe is a dirty, stray object—something that a person is not to be seen with—makes heroin injections a solitary practice. They have to be performed in private, as far away from other people as possible. At the same time, they give off no odours and can be more discreet—less dirty—than smoking, for those who have a door to close. Madelene can close her apartment door, but for someone in Hanna’s situation, having a home is less of a given. The only closable doors in the public domain are toilets, which have everything you need: the ability to close the door and be alone, unseen, but also without the possibility of getting help if something goes wrong.

5 Conclusion

As I have shown, Mary Douglas’ theory of how cultural notions of dirty and clean create order can make visible how knarkare and the knark-whore are created and kept at a distance from the rest of society. Class-related conditions and power structures interact intersectionally and create degrees of dirtiness. Various kinds of symbolic, drug-related dirt structure people who use drugs hierarchically. Through utterances, acts and objects, someone who uses drugs can fall, or avoid falling, into the category of the abuser, the knarkare and/or the whore. But dirt is simply matter out of place, and in the right place, something that would be dirty elsewhere can become uncharged, like Pernilla’s cannabis-related sickness or a syringe in a hospital.

On the whole, women who use drugs, and the emotions they express, are on the margins of several of the hierarchical systems that define dirt (Campbell and Ettorre 2011). Without taking class into account, however, these systems make no sense. Knarkaren and the whore can come to define a person, as it did for Carolina, but with the right resources this can be avoided through discretion. Even though the terms “abuser”, knarkare and knarkarhora (“knark whore”) can serve as slurs, they do not refer to just any deviant, drug-using woman, but specifically to people who embody social exclusion, as Björkman (2002) and Hem och Hyra’s articles illustrate (Lundmark 2008; Ljungqvist 2017). Dirt and cleanliness can be located in different places and manifested in different situations, but they take on a spatial character when they become linked to a classed context, what I called the drug swamp in the previous chapter, a place that most of the interviewees sought to avoid.