Nephalim’s Safer Injecting Guide

General Information

Injecting drugs is a method of using drugs that involves directly putting the drug into your body, most commonly non-medicinally into a vein, the most potent and fastest acting method. Injecting drugs is a common practice, although one of the least popular methods of using drugs, most commonly used by addicts. Injecting drugs is also done by people who aren’t stereotypical addicts, and there is quite a bit of stigma involved with the use of needles - even by other drug addicts. People who inject non-medicinal drugs are commonly known as “Injecting Drug Users” or IDUs.

Heroin is the most common drug injected, and this originally became common because it was necessary to achieve a decent potency from what was available on the streets, although it’s history goes back as far as the syringe (hypodermic needle). This is no longer the case with most heroin (No. 4 heroin) - the predominantly available powder kind, and many users, especially new users or the homeless, sniff or smoke it instead. Many other drugs can be injected, although it is not advisable to inject any drug except for legitimate medical purposes, and some illicit drugs can be especially dangerous to inject.

Dangers of Injecting

· Spread of communicable diseases, including especially HIV and Hepatitis C. It is estimated that approximately 70% of heroin addicts are infected with Hepatitis C. Communicable Diseases aren’t always spread by sharing needles, even though that’s the most common cause of getting HIV in this fashion. Sharing cookers, cottons, or anything that can be contaminated by blood, directly or via a used needle, can cause the spread of communicable diseases, especially Hepatitis C, as it is a very hearty virus that can survive for long periods of time outside the body.

· Vein and artery damage (especially with Intravenous Injections (IV).

· An artery blockage, a very dangerous albeit rare condition (especially occuring with Intravenous Injections.

· Abcesses and Gangrene, another very serious albeit rare condition that can result in amputation. Abcesses aren’t too dangerous, relatively speaking, if treated promptly and properly. If you have an abcess, you need medical attention!

· A higher risk of Overdose.

· Risks involved in injecting unknown substances, including drugs that have been cut improperly either with substances that especially shouldn’t be injected, or even with poisons (this has happened on numerous occassions, including strychnine in heroin recently.) Other than the possibility of injecting poison, the risks include kidney and liver damage from badly cut drugs.

How Prohibition Inflames or ignores the Risks of Injecting Drugs

· Due to the illegality of the substances, and until recently (although still not the case in many places,) syringes, Injecting Drug Users (IDUs) are more likely to share needles and practice unsafe injecting.

· Being uninformed to the proper procedure for injecting drugs. stigma also contributes to this.

· The risks of injecting unknown substances as described above are almost solely due to prohibition.

· All three of these problems end many lives.

Harm Reduction Strategies That Have Been Implemented Recently to Deal With the Problem

· Needle Exchanges, places where IDU’s can get clean needles, properly dispose of dirty ones, get clean and safe injection equipment, and recieve addict outreach.

· Syringes have been made Over The Counter in an increasing number of states, meaning anyone can walk into a pharmacy and buy needles. There is often the problem of Pharmacist Refusal despite the laws, however.

· An indirect strategy but still notable, methadone or buprenorphine maintenance, which greatly lowers injecting drug use by heroin addicts.

Nothing has been (nor can be) done to deal with the problem of injecting unknown substances in a system of prohibition, except for occassional notices where addicts frequent (such as needle exchanges if there is a bad batch (i.e. cut with poison) going around.

What to do if you Don’t Have a Clean Needle but are Going to Use a Dirty One Despite the Huge Risk

You can clean a needle with bleach, which will kill many diseases. This is not 100% safe, but it’s better than nothing. With the recent availability of syringes, this really shouldn’t be a problem. Make sure you always have needles! It’s better to use an old one (that you know hasn’t been used by someone else) as opposed to someone else’s.

Commonly Injected Drugs

Virtually any drug can and has been injected, but here are the more common ones:

· Heroin

· Various other opioid/opiate pills and preparations, including hydromorphone (Dilaudid), and oxycodone (Oxycontin)

· Methamphetamine

· Other amphetamine Pills

· Some benzodiazepines, notably Temazepam (reformulated to make this extroadinarily dangerous, no longer commonly done)

· Cocaine, often combined with Heroin (known as a “speedball”)

· Less common, MDMA (ecstacy)

Methods of Injecting

There are three major methods of injecting drugs, |Intravenous Injection (IV), shooting into a vein (”mainlining”), Intramuscular (IM), shooting into a muscle, and Subcutaneous Injection (SQ), shooting just under the skin (”skin popping”.)

Injecting drugs with the now commonly used fine point insulin syringes usually does not hurt, unless you scew up or you are using a very dull (or very old) one.

General Information on Intravenous Injections

One of the three major methods of injecting drug use, an intravenous injection is one directly into a vein. Slang for this includes “mainlining” or “spiking a vein.” This is the most common among addicts, as it provides maximum effect per amount of drug, and is the fastest acting (within 5-15 seconds generally), which is a major factor in the rush that heroin addicts describe.

It is very easy to screw up an intravenous injection. It’s also very easy to do it right. If done properly, while still very risky behavior, the risks can be relatively minimized. If done wrong, major problems such as abscesses, catching HIV or Hep C, and vein damage can be avoided.

Intravenous Injections are the worst for spreading communicable diseases, such as HIVand Hepatitis C. That doesn’t mean that other methods are safe, however, but intravenous injections involve a lot of blood, and direct insertion of an often unknown foreign substance into your bloodstream.

How to Properly do an Intravenous Injection (Harm Reduction Information)

This is Dangerous!

Note that this is for informational purposes only and should not be construed as medical advice. I will not be held liable for any harm arising from your following of this information, and no warranty is given, implied or otherwise, as to it’s accuracy. This information will not include methods of getting a better high or better dissolving the drug.

Obviously, the only things that can verifiably be safely injected are approved preparations for injections. Pills are especially bad to inject, yet people do it anyway. This all applies to all injections. You are taking abig risk by injecting, no matter how perfect you get it.

Probably one of the most important pieces of harm reduction information to provide is that if there is any doubt, you need to seek professional assistance. You could wind up losing a limb or even dying if you do not get proper treatment! Almost every injecting drug user at least knows someone who has had serious complications from injecting. Some IDUs (Injecting Drug Users) are more lucky - and do a better job - than others. You can go to the emergency room anonymously, if you are concerned about your identity. It’s better than not getting what could be life-saving treatment.

Injecting Oxycontin is very complicated, it has little balls of wax in it, and this information is not applicable to Oxycontin or generally any other controlled-release tablet or capsule. Also this is not applicable for “black tar” heroin (the kind of heroin that isn’t powder,) as the water needs to be made acidic for it to dissolve. Note that some pills also have more than one active ingredient, such as Percocet which has oxycodone](the active ingredient in Oxycontin), and acetaminophen (commonly abbreviated “APAP”,) which is poisonous if injected. Some drugs, such as the benzodiazepines, are not water soluble, and the pills can be virtually impossible to inject for this reason. Do not ask me how.

Buddy Up

If you doing injecting drugs for the first time (or the ten thousandth time) you should use a “buddy system,” having someone to watch you and make sure you don’t overdose or urge you to seek professional assistance for a complication. Overdose can happen long after you actually shoot the drug, and someone high on something like heroin isn’t going to be paying a hell of a lot of attention, which is why it is even better to have a clean and sober person keep an eye out.

What is Needed

· A *fresh*, brand new needle (note: needles are often reused by IDUs, but they get dull quickly and can damage veins or cause other problems, including becoming contaminated. If you are going to re-use a needle, be absolutely 100% certain that it is yours and no one else has used it. With the current harm reduction strategies of needle exchanges and over-the-counter needle availability (which are very cheap, a 10 pack of disposable insulin needles costs about $3.00), this really shouldn’t be an issue. HIV isn’t worth it, no matter how sick you are. Remember that, always.)

For street heroin or cocaine, a half (50) or one (100) cc disposable insulin Syringe works fine, one with a long point. These are the common needles. If you are injecting pills, you are going to want a three (300) cc Syringe, and these have a bigger point so as not to get clogged. You can do a smaller pill with a one (100) cc needle, but it might be tough.

· A *fresh* piece of cotton, rolled in to about the size of a tic-tac, bigger for mixtures with more solid matter in them such as pills. Dental cotton is best, the idea is you want cotton that doesn’t break up into tiny fibers. They have cottons at needle exchanges which, obviously, are best. Cigarette filter cotton is worst, it breaks up badly. A Q-tip will work but again is not ideal.

(The danger here is something known as “cotton fever,” a literal fever - body reaction - you get from injecting cotton fibers. Even with this danger, which I do not *think* is life threatening (anyone?), it is better to use a Q-tip than to not use a cotton.)

If you re-use the cotton (this is often done because the cotton retains a (very) little bit of drug in it, and due to laziness,) you run the risk of injecting bacteria which is very quick to grow on a moist piece of cotton. Cottons also will get clogged up, eventually, and if injecting something with a lot of solid matter like a pill even with one use.

· Some *fresh* water. They have water that is the closest thing as possible to “safe” for injecting at needle exchanges, but even that water is marked “not for injections” or something similar for legal reasons. You really want distilled water here, which is available at most pharmacies. Bottled water is OK. Tap water is used commonly and usually without issue, but you should boil it to kill any bacteria which is certainly living in it (and this really goes for bottled water, too.) Even with boiling it, there is still a risk, as tap water can contain contaminates which can’t be “killed”.

· Something *fresh* to do your mixing in, commonly known as a “cooker.” If it’s street drugs, it should be something like a spoon which you can “cook” things in. Even if it’s not street drugs, it’s still best to cook it to kill any bacteria. Cooking pills however can make a real mess, but the goal here is to be safe. Then again, cooking pills might cause certain things to dissolve that shouldn’t. I honestly don’t know what advice to give on that matter, for harm reduction purposes, regarding pills (anyone?)

· A *fresh* tie. Yes, that’s right, you do not want to be sharing ties, you could theoretically get a communicable disease from blood on a tie if it gets near your injection site. Preferrably a proper rubber tie, but a belt is commonly used and does work just fine. Obviously the belt is unlikely to be “fresh”, but do not share them or put them in places where they could get contaminated with blood (anywhere near where someone else is shooting.)

· An alcohol swab and a *fresh* piece of cotton gauze.

Did you notice the word “fresh”? Again, you can catch communicable diseases, most commonly Hepatitis C, from sharing anything involved in the act of shooting drugs (but not generally HIV, it dies very quickly when exposed to air - but that does not include the inside of a needle, however it can survive long enough in left-behind blood to be caught!) Anything that has even a remote chance of being contaminated with blood should not be used without a thorough cleaning involving alcohol (and plenty of water to make sure the alcohol is gone.)

If you do not have a clean needle but are going to shoot anyway (remember, needles are over-the-counter in many states!), you can clean it with bleach. Note, however, that this is still *NOT* 100% safe. Hepatitis C is a very stubborn virus, and bleach is not guaranteed to kill it. To clean it with bleach, suck up fully with bleach three times, wash with water three times, use bleach again three times, clean the plunger in the bleach, and then throughly wash everything with water, I would say at *least* six times, to make sure all the bleach - which is *extremely* poisonous (and potentially fatal) - is gone.

How it is Done

· Put your drug into the “cooker.” If it is a tablet, grind it up as finely as possible.

· Suck up water into your syringe, about 0.3 ccs (the 30 marker) per bag of street heroin. If you cook it properly you will probably evaporate a bunch of this so use about half a cc (50) - although remember that the drug will add more volume to your mixture. I would say about 2 ccs for an average size [[pill]]. Pour the water into your “cooker.”

· You can mix the mixture, and generally speaking any IDU will. The best thing to use would be the cap off of a freshly unsealed (and still uncontaminated) Hypodermic needle. If you don’t have that for whatever reason, remember to use something *fresh* as described above. If you are going to use the plunger, you really should clean it in alcohol. If you aren’t going to do that, at least clean it throughly in (the fresh) water - which will now no longer be “fresh”.

· Cook it, boiling for about 15 seconds. This will help kill any bacteria, but will not assure it. I do not remember offhand how long bacteria needs to be boiled to assure it will be killed (anyone?) Real heroin will make a brown solution.

· Drop the cotton into the mixture. It will soak it in and swell up.

· Insert your needle into the cotton, being absolutely sure that the point is *in* the cotton and not sticking through it or not in it at all. Pull back slowly, sucking up your mixture into the syringe. This is where you will run into some problems with pills. Since there is so much solid matter in the mixture with [[pills]], the cotton will have difficulty filtering the solution without getting clogged. In this case, as was said, a bigger cotton may be necessary.

· Hold the syringe by the end with the needle, and shake it, so that all the air comes together at the top. Push the plunger in to get the air out. When you get towards the end and there is a little bubble, flick at the syringe so that the bubble forms right underneath the needle, and push that out. Contrary to urban legend, you cannot die from a tiny air bubble. That does not mean you shooting them, however.

· Tie off your arm so that you can get a vein. If you are one of those people that has huge veins, then this isn’t necessary. You want it to be tight, but not so tight that you are cutting off circulation - it won’t help and can create problems. I suggest using the tie about 3 inches above (towards your body) your elbow. Pump your fist and tap on your arm with your other hand to help bring some veins to the surface.

You want to use a vein that is big and clearly visible. Avoid the ones near your hand, and others that look similar to those. Besides being a bad place to shoot, they are either too small and can burst, or are covered in too much fat and roll out of the way. Look for a vein on the surface of your upper arm that is at least as big as, say, some thick string. A vein the size of a Q-tip or toothpick is too small and may burst. The commonly envisioned vein in the crook of your arm is actually kind of difficult to get on a first try. Obviously you can use veins on other parts of your body, but the arm is the easiest by far. Avoid the veins your foot as well, despite being visible they are (like some of the hand veins) covered in fat and are known as “rollers” (they roll out of the way when you try to hit them with the needle.)

You also want to avoid valves in the veins, if you run your finger down the vein you should be able to feel them ((someone elaborate this)), and want to avoid where veins come together.

Do *not* under *any* circumstances inject into an artery. This can be (and oftentimes is) *fatal*. Veins are blue and come up to the surface when you tie off. Arteries are red and are usually buried deeper under the skin. Obviously, do not do something ridiculously stupid like trying to inject into your carotid (neck) artery. It will likely result in death.

· Wipe the spot you are going to inject into, along with the point of the needle, as it was just de-sterilized, with an alcohol swab. Skipping this critical step will get bacteria into your bloodstream and/or in a pocket of solution if you “miss”, and can result in infections, even occasionally the “flesh-eating bacteria.”

· Push into the vein with the needle. You do not want to go straight down on it, you want to go in at an angle (but not sideways, either.) Just do it slowly and watch to see if you went in it. With a sharp (i.e. fresh) needle, it should go in smoothly and does not require any special force - and can go right out the other side - something you want to avoid. Contrary to common belief, it doesn’t hurt - if you are using an insulin needle at least, the bigger ones can hurt. When you think you are in the vein, pull back on the plunger just a little. If blood goes into the syringe, you are in the vein. If blood does not go into the syringe, you are not in the vein. Do not over-do it, as blood is thick and can clog the needle (and can occur at less than 50% content by volume with insulin syringes, which is why they do not use the small hypodermic needles such as those on disposable insulin syringes when taking blood.)

If your needle gets clogged with blood and you are determined to do the shot anyway, you can add water and re-filter it through a fresh cotton.

· Technically now you are supposed to take off the tie before shooting. Some people find that doing this results in them falling out of the vein, which then results in a “miss.” You do not want to “miss” - it causes problems like abcessess and many of the other complications that come with the territory (obviously even worse would be popping a vein - a very good reason to avoid the small ones.) For this reason, you might want to go contrary to popular opinion, and leave the tie on - but only if you are in doubt (this can also cause the bursting just described, however.) For this reason you want the tie to be as far away from the vein as possible - as the tie prevents proper blood flow - the reason you would want to remove it before shooting. Either way, you should shoot very slowly. By leaving the tie on, your vein has very little room to fit that liquid in, and if it’s more than .3 ccs or so, you should not leave it on. It’s a tough choice for a beginner.

If you feel a tingling pain when pushing you have likely fallen out of the vein and are “missing” (when you are in a vein an injection is almost always painless.) If you see a bump growing under your skin, you have almost definitely fallen out of the vein and are “missing.” Once again, you do *not* want to miss; It’s the *main* cause of many of the associated complications of injecting, and often causes infections. When you inject into a vein, you are putting the full weight onto your liver and kidneys to clean up the mess, and any bacteria is usually quickly destroyed by your immune system. If you miss, however, you are giving a nice warm wet environment for bacteria to thrive.

It’s a good idea to prevent overdose and be cautious by injecting a little bit or half, waiting a few seconds, and then injecting the rest, especially the first time with a new batch. If the tie is still on, however, you will not feel the full effects of the injection, and need to take it off.

In any case, pull back on the plunger (again, just a tiny bit,) after you inject about half to make sure you are still in the vein.

· If you have not taken the tie off, take it off. Take it off as soon as possible no matter what. Do this *before* pulling out the needle (or the blood will be forced out of the vein and into a pool under your skin, similar to “missing”.) Hold the cotton gauze pad up against where you penetrated the skin and pull out the needle, holding the cotton gauze in place for a minute or so until the bleeding stops, with some pressure to help stop any bleeding. With an insulin syringe, the bleeding should stop within seconds, but it depends person to person. To be safe, you can put on a bandaid (in case there is any blood on the surface so that you do not contaminate and/or stain your clothes.)

And that’s it, you are done. If you are going to reuse the needle (which I made clear you should not), clean it out with water several times (immediately.) Put the needle in a proper sharps container which can be found at your local pharmacy or at a needle exchange. Do not dump needles into the garbage! Some people break off the needle and put it in the Syringe

Note, again, that this procedure does not work for Oxycontin or many other controlled-release pills, or with “black tar” heroin (the type that isn’t powder.)

If you are doing a subcutaneous or intramuscular injection, the above procedure is overall the same. You should generally not do a subcutaneous injection, it is very unsafe with street drugs and impossible with pills. For an intramuscular injection - which is more dangerous in some regards, such as abcesses and other complications, but less so in others, such as poisons in your bloodstream and the danger of overdose - the above procedure is the same, but instead of tying off and injecting into a vein, you inject into a muscle (put the needle in all the way.) Your upper arm or buttocks are the best places to do this (keep in mind however they will likely get sore.) If you do an intramuscular injection, you should not use more than .25 cc’s of liquid, however, and the same applies for subcutaneous. Less is best in that in those situations, and in general too, in case you miss the vein.

External Links

* How to Shoot Heroin (Lycaeum)