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Safer Injecting Guide
The aim of this guide is not to show you how to inject drugs or to say that injecting or using drugs is good – but to reduce the risks for people already injecting. I have had emails in the past condemning me for having this page, saying that by telling people how to inject I am encouraging them to use and to inject. This is not the case. The page is designed so that people that are already injecting can do it safely, thereby reducing the risk of them catching Hepatitis or HIV and also reducing the risk of them passing it on to others. If someone who has never injected uses this page to learn how to do it, at least they will be doing it safely. People know that they shouldn't use drugs and shouldn't inject, but they are going to do it anyway if that's what they want to do. I knew it was wrong but that didn't stop me. At least by reading this page they will be doing it safely.
The 5 rules of Safer Injecting are: 1. Use your own equipment, this includes:
Check that the syringe and needle are new and straight from the packet. Only use them once. Don't even share with your boyfriend or girlfriend or best mate. If you don't have clean equipment, read the instructions further down on this page, on cleaning your equipment.
2. Use the smallest needle possible to inject.
3. Use the smallest amount of water and citric acid possible to dissolve your gear.
4. Don't inject drugs alone. Try to do it with others around.
5. Dispose of your used injecting equipment carefully. Get a sharps safe box from your syringe-exchange scheme. Keep the box out of the reach of children.
Always clean your injecting Equipment Read the Guide to Cleaning used works
INJECTING HEROIN – A Step by step Guide Wash your hands Wash your hands and the injecting site before you start. You could be at risk of catching an infection, causing abscesses and other health problems.
Find a clean surface Use a clean newspaper or magazine as a surface to prepare your hit. Dispose of it safely. Using a surface where someone else has injected is risky. Viruses could be present in tiny amounts of blood.
Check the gear What is the gear mixed with? Is it stronger than usual? Does it look different? Look at the gear carefully, check with other users. If you are suspicious, have a toot (smoke on foil) first to test the strength.
Put the gear on the spoon Has anyone used the spoon before? Use your own spoons. Wash them carefully first in hot water and bleach. Rinse thoroughly. If you cant do this, wipe it with a sterile alcohol swab and rinse with clean cold water.
Crush with another spoon Is this spoon clean? Wash this spoon too. The heroin should be crushed as finely as possible because this will help it to dissolve when it is mixed with water.
Add water Has anyone else used the water or flushed dirty equipment into it? Use freshly boiled water. If this is not possible, use fresh, clean water. Don't share water.
Mix up & add citric acid An acid needs to be added to brown street heroin to help dissolve it. Use ascorbic (vitamin C) or citric acid powders. All acids can damage your veins so use the smallest amount possible. If the gear doesn’t clear, you will need to add some citric acid. Use the smallest amount possible. You can use vinegar or lemon juice but they contain germs and this is very dangerous. You can catch Hepatitis C by using these, as the liquid may be contaminated. Lemon juice can damage your eyes and cause blindness. Citric acid, lemon juice and vinegar all irritate the veins, be careful with how much you use.
Heat the spoon & cool Don't heat the gear for a long time. Once it starts bubbling, it is burning the gear away. Brown gear only needs to be heated for a short time – the more you heat, the more ‘crap’ you will dissolve and draw into your syringe.
Add filter Is the filter clean? Has it been used before? Fibers from cotton wool or clothing can damage your veins. Even cigarette filters can cause problems. Always use a new filter, there is no safe way to use a used one. Avoid storing up old filters as fungus can grow in the cotton resulting in dangerous infections. Make sure you wash your hands or if you are on the street use an alcohol swab if available. Cigarette filters contain glass fibers which can damage veins, so use a corner from an alcohol swab, cotton buds or a piece of tampon. Tear off a piece lengthways in a long strand and drop it into the spoon, do not roll into a ball as this can break into smaller fragments which you inject. An alternative to using a filter is to tip the spoon carefully and keep the ‘crap’ at the opposite end to where you draw up. If you do use a filter, do not cut it - use the full filter so you don't loosen the fibers. If you feel that you have to trim the filter as they are quite large, cut it lengthways and place the cut side down. Then when you draw the liquid into the syringe, place the needle on the side of the filter and not on the cut section.
Draw up into the syringe Is your equipment clean? Do you ever front load or back load? This means sharing a hit by injecting from one syringe into another. The other syringe may not be clean. Always use your own new syringe and needle each time. HIV and Hepatitis have been spread by using dirty equipment to front load or back load – DON'T DO THIS. ALWAYS USE CLEAN WORKS.
Tourniquet on arm (if necessary) If the tourniquet is too tight, the veins will not fill with blood. Tourniquets ensure that the vein is full of blood. Do not leave tourniquets on for more than one minute. If you can't find a vein release the tourniquet and wait a moment before trying again. A hot bath or shower may help bring veins to the surface. Remember to release the tourniquet before you start injecting, as you can balloon the vein, causing scarring and bruising. Try not to use a tourniquet if possible, as they can cause damage to your veins. Use a tourniquet that is easy to release before injecting your gear. Place the belt, band or tourniquet so that it slightly indents the skin. Place it 3 fingers width above the bend in the arm, at the elbow.
Find a vein (See 'Where to Inject' below) Using the same vein every time will cause scarring and other problems. Veins need to rest! Alternate injecting sites. Feel a vein – this increases the change of hitting it.
Eye of the needle facing upwards Remember to use the smallest needle possible – an orange one (0.4 X 12mm, 1ml Insulin). This ensures that the sharp point of the needle pierces the skin.
Go all the way into the vein Don't ‘fish’ around. Repeated stabbing will cause scarring and bruising. Try to always put the needle into the hilt, otherwise it can end up moving, causing you to miss. One clean stab increases the chance of hitting the identified vein.
Pull Back the Plunger to check for blood & Slowly Inject Don't inject immediately. Pull back the plunger to make sure that your in the correct place. If you are - inject the liquid slowly. If mainlining, you are looking for blood to show that your in a vein. If skin-popping or injecting into a muscle, your looking for there to be no blood. (see the Techniques for injecting below)
Release Tourniquet & Inject slowly If you don't release the tourniquet or inject too quickly, this may cause a vein to pop. Some of the hit will be lost. Injecting too quickly can increase the chance of overdose. This ensures that all the hit stays in the vein. The less bruising you have, the more chance you will have of finding that vein in the future. A small toot beforehand will steady your hand.
Withdraw the needle slowly Withdrawing too quickly can cause the vein to collapse. Make sure the tourniquet is released before removing the needle.
Put pressure on the site Ideally use something 'blood proof' like a plaster to press on the site as bleeding causes bruising, making it more difficult to hit that vein next time. This will stop bleeding and bruising.
Wash your hands As soon as you are able to - wash your hands. Blood on your hands can transfer to anything you touch. Don't bleed all over the place – protect your mates!
CLEAN YOUR SYRINGES PROPERLY OR AT LEAST FLUSH THEM OUT A COUPLE OF TIMES WITH WATER BEFORE DISPOSING OF THEM. DISPOSE OF THEM SAFELY IN A SHARPS BOX OR STORE THEM SAFELY, UNTIL SUCH TIME AS YOU CAN GET RID OF THEM. IF YOU CANT GET HOLD OF A SHARPS BOX, ALWAYS BREAK OFF THE NEEDLE AND PUT IT INSIDE THE BARREL OF THE SYRINGE, THEN REPLACE THE PLUNGER. THIS ENSURES THAT NO-ONE ELSE CAN PRICK THEMSELVES OR USE THE DIRTY SYRINGES.
Aseptic Injection This refers to a way of injecting that significantly reduces your risk of getting an infection from shooting up. The basic principle is that no blood gets transmitted between one person and the next. This means not sharing syringes, filters, tourniquets, water, or swabs. Blood can get on the spoon, swab or tourniquet and in the water, that has been used by someone else and this is enough to transmit HIV, Hepatitis B or Hepatitis C.
The blood you can get on your hands is also a problem as it will get into everything you touch. The edge of the table, someone else's arm etc. Even though you may not see it, there is enough blood there to infect someone else if they were to get that blood on an open wound. The problem is that when you are injecting with a group of friends, peoples hands are going everywhere, helping find veins, holding their arm, passing the water etc. and there are plenty of opportunities for the virus to be passed on. If the blood from your hands on the edge of the table gets on the next persons hands which they then use to feel for the vein, then they could be at risk of catching the virus from you. The
basic principle of aseptic injection is :
If you cant find a good vein straight away then try the following:
Remember, its better to spend time looking for a good vein than digging around for one with a needle! Be careful not to hit an artery! If in doubt - pull out!
TECHNIQUE
Intra-muscular injecting & skin-popping
Rotating sites If you have lots of veins you can inject into a different site each time. The longer the veins rest between injections, the longer they will last.
Bruising and Swelling If you regularly notice bruising, it may be that you are doing something wrong when you inject. If you notice a large lump or a red swollen area where you have injected, go to the syringe-exchange scheme or your local accident and emergency unit immediately. Early treatment will prevent dangerous complications later.
Symptoms of infection are:
Infections nearly always get worse if you leave them, so seek medical attention. You can go to a sympathetic doctor or to casualty at your hospital. If you feel generally unwell for any length of time, make sure you see a doctor.
Muscles, Just under the skin & 'Missed Hits' Injecting into muscles or just under the skin can cause very serious problems. Drugs are absorbed much more slowly if you inject in these ways, giving the heroin/acid mixture more time to cause damage at the injection site and to increase the chance of serious infection. 'Missed hits' can cause similar problems.
Heroin contaminated with extremely dangerous bacteria can cause infection, blood poisoning and death very quickly when injected into body tissues rather than veins. If you get swelling, redness or pain around an injection site, seek medical attention immediately.
If you regularly miss veins, inject into muscles or inject just under the skin, ask your drug service for advice about alternatives.
Groin Injecting (Femoral) Injecting in the groin is very dangerous - there is an artery and a major nerve next to the veins. If you hit either of these you can do serious damage and may even lose your leg.
If you inject into the groin, go to your local syringe-exchange scheme or drug service. They will be able to advise and discuss alternatives with you – find out the facts.
Injecting into the neck, armpits and breasts Don't do it! Injecting into these areas is very dangerous as there are often arteries and veins close by. The veins are often small and can be damaged easily. If you have to inject and you have no obvious veins, go to your syringe-exchange or drug service and ask them for their help – there are alternatives.
Mixing drugs Using more than one ‘downer’ drug (alcohol, heroin, methadone, tranquillizers, sleeping tablets) at the same time greatly increases the chance of overdose. Injecting heroin (a downer) and cocaine (an upper) at the same time can be fatal. The cocaine will wear off quicker than the heroin and, if you have injected more heroin than you thought, you could overdose.
Tablets are manufactured to be swallowed and there is no completely safe way of injecting them. So whenever possible, try to avoid doing it.
If you have to inject them, prepare your tablets by crushing them as fine as talc between two clean spoons, mix with a small amount of water (tablets do not dissolve). Adding more water will not make any difference. Inject slowly and carefully.
Because of the way that they are made, it is particularly dangerous to inject Diconal and Tuinal. Many people have lost arms or legs after injecting these, and there is also an increased risk of abscess. The chalk content in tablets is a major cause of vein collapse and blockage. So if you can wait for the hit, swallow them instead and if you cant, try to make sure you don’t draw up any of the powder.
Read more about Injecting Tablets
Injecting Cocaine Cocaine injecting can become compulsive and because pain is deadened around the injecting site (cocaine is a local anesthetic) veins can become damaged very quickly.
Injecting Methadone mixture Methadone mixture is not meant to be injected. It can cause many problems including abscesses. Don't do it!
Injecting Amphetamine (Speed) Street speed (powder) is usually less than 3% pure. If speed is injected the impurities in it can cause a ‘bad hit’ – intense headaches, feeling hot, etc.
Condoms Always use condoms for vaginal or anal sex, even with your closest sexual partner. They may have used dirty works or shared works with someone without you knowing. Its better to be safe than sorry.
What to do if someone Overdoses
TRACK MARKS Over injecting in the same area can produce track (needle) marks. Like the pictures shown below:
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Last updated: 9 November 2003 |
Firstly,
remember that injecting drugs is always risky. Sharing, lending or borrowing
injecting equipment can spread HIV (AIDS) and Hepatitis. Bad technique or dirty
equipment can damage veins and cause blood poisoning and abscesses and put your
life at risk. Dodgy drugs, different street purities or mixing drugs can cause
an overdose. It is safer not to inject at all, but if you must, please read the
following guide. This will help you think about what you do and reduce some of
the risks. 
