The route a drug takes into the body can matter as much as the drug itself – and rectal use brings risks that are rarely talked about openly.
Often called “boofing”, “booty bumping” or “plugging”, the practice involves taking drugs via the rectum rather than swallowing, snorting or injecting.
In health settings, this route is familiar through suppositories and enemas, especially when patients cannot take medication by mouth. Outside clinical contexts, however, rectal drug use brings a distinct set of dangers that are widely misunderstood. What matters from a public health perspective is not what people call it but how it affects the body.
Boofing itself isn’t new. Alcohol enemas were documented in early 20th-century medical journals. Opium and herbal preparations were used rectally in ancient China, Egypt and Greece. What is new is the way today’s drug markets intersect with this type of administration.
First, modern illicit drugs are often stronger and less predictable. High-potency MDMA or ecstasy, synthetic stimulants and adulterated cocaine mean people may seek faster or more intense effects from smaller amounts.
Second, boofing is sometimes presented as a way to avoid the perceived harms of snorting or injecting. Third, social media and nightlife networks have made it easier for different drug-taking practices to spread quickly, often without the medical context needed to understand the risks.
What happens when drugs are taken rectally?
The rectum has a dense network of blood vessels. Substances absorbed there can enter the bloodstream rapidly, often bypassing parts of the liver that would normally reduce a drug’s potency when swallowed.
The result can be effects that arrive faster and feel stronger than expected. That also means there is less room for error. A dose that feels manageable when taken orally or nasally may become overwhelming when absorbed rectally, increasing the risk of irritation, injury or potential overdose.
While dangers vary by substance, several risks apply broadly to rectal administration. Overdose risk is higher because absorption can be rapid and unpredictable. People may re-dose too quickly, assuming nothing has happened, only for delayed effects to arrive suddenly.
The lining of the rectum is delicate and easily damaged by caustic substances or repeated irritation. Small tears and inflammation increase vulnerability to infection. There is also a risk of transmitting HIV, hepatitis C and other infections, particularly if equipment is shared or hygiene is poor. Micro-abrasions can make transmission more likely too.
And unlike injecting, rectal drug use leaves no obvious external marks, which can delay recognition of harm when someone is in trouble.
Read more: When did humans start experimenting with alcohol and drugs?
Different substances also carry different dangers. Stimulants such as cocaine, methamphetamine and synthetic cathinones or “bath salts” are commonly linked to boofing-related harms. Rapid absorption can put severe strain on the heart and nervous system, raising the risk of overheating, agitation, stroke or cardiac events.
MDMA brings concerns around dehydration and dangerous changes in body temperature, especially when faster onset of effects leads to repeated dosing. Opioids, including heroin and synthetic variants, can suppress breathing. Rectal absorption may still be fast enough to cause fatal overdose, particularly when combined with alcohol or sedatives.
Alcohol enemas are especially risky. Because alcohol bypasses the stomach, the body loses its natural warning system – vomiting – dramatically increasing the chance of alcohol poisoning.
There are also growing concerns around GHB (gamma-hydroxybutyrate), a powerful depressant with a very narrow margin between intoxication and overdose. In a 2019 Channel 4 documentary, a Prison and Probation Service safeguarding professional warned about cases involving GHB absorbed rectally when mixed with lubricant. The effects can be sudden and hard to detect, raising serious risks of unconsciousness and breathing suppression, and, in non-consensual contexts, drug-facilitated sexual assault.
Who does it and why context matters
There is no single “type” of person who engages in this practice. Research is limited, but people may experiment for different reasons including curiosity, faster onset or avoiding damage to the nose or veins.
Because boofing is highly stigmatised, open discussion is rare. That makes reliable information harder to find. This is a problem from a harm reduction perspective. Non-judgemental, evidence-based advice helps people make safer choices, whatever their circumstances.
Online, boofing is sometimes described as safer than injecting or snorting. That comparison is misleading. While it avoids needle injuries and nasal damage, the lack of visible harm can also create a false sense of security.
Much of the danger does not come from the route alone, but from unknown drug strength, contaminants and inconsistent supply. In illicit markets, changing how a drug is taken can increase risk.
Reducing harm
From a public health perspective, the goal is not to sensationalise this practice, but to reduce preventable harm. The University of Pittsburgh developed a safer boofing guide in 2023 to offer harm reduction advice.
Hygiene also matters. Rectal drug use can interact with sexual health. Invisible injuries can raise the risk of infection, including sexually transmitted infections, particularly if drugs are taken shortly before anal sex. Condoms, regular testing and HIV prevention tools remain central to reducing harm.
Boofing reflects a much older human tendency to experiment with different substances. What has changed is the context. Today’s drugs are often stronger, more adulterated and less predictable. At the same time, practices circulate rapidly online, frequently stripped of medical or public health advice.
Understanding rectal drug use, rather than sensationalising it, allows for more honest conversations about risk. This is not about encouraging drug use, but about recognising reality and reducing preventable harm in an increasingly volatile drug market.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
This article was originally published on The Conversation. Read the original article.
