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........

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