Safer Injection Drug Use

Injecting drugs can be a risky business: bad dope, bad cut, abscesses, nerve damage, embolisms, overdoses, & collapsed veins. But you can make injecting safer by following a few simple rules. NCHRC does not encourage drug use, we encourage safer use for active injectors to prevent HIV and hepatitis. Lowering disease transmission saves tax payer money on disease treatment and decreasing the amount of syringes with HIV and hepatitis in the community promotes public safety.

Tips for injectors:

1. A clean surface is important to prevent spread of bacteria. You can put down a fresh newspaper to make a clean surface.
2. Always use clean water: Use sterile water. When injecting in a bathroom do not take water from the toilet bowl; water from the toilet tank is cleaner. Water can be sterilized by boiling it in the cap without the dope.
3. Reduce overdose risk: It is best not to shoot alone and not to lock doors in case of overdose. Always carry an overdose reversal kit (Narcan) if you can get one. Also, if you’re trying out new dope shoot with a friend or if in a establishment tell someone outside the bathroom you feel sick from the flu and to check on you in 10 minutes in case it is stronger than you expect and you O.D.
4. Injection Kit Disposal: Be considerate when you dispose of your rig or syringe or leave blood in the bathroom. Keep a biohazard kit on you to dispose of all materials; that way there is no evidence you were ever there. You can get a biohazard container from medical offices or your doctor, NP and/or PA.  Coffee cans and plastic soda bottles made great biohazard containers too.
5. Think: When choosing a place to inject, evaluate how much seclusion you are willing to risk. If you are more secluded the risk of someone finding you in case of an O.D. is slim, but in a high traffic area you are more likely to be found.
6. If you are out of syringes and you need them: You can buy syringes at pharmacies in North Carolina. We recommend that you use a new syringe for each shot to avoid abcesses, HIV and hepatitis. If you don’t have a new syringe, assume it is contaminated with HIV or Viral hepatitis C. Make sure to bleach your works to avoid disease. This is not 100% safe, but is best if you are in a crunch and going through withdrawal and its all you got.

How to do a safer injection:

1. Use a “new” set for each injection: each time the point penetrates the skin, it gets duller and duller and causes more damage to the vein. If you need to re-use a set, you need to clean it first (even if you’re the only one to use it). This will cut the risk of injection related diseases (Hep, HIV, etc).
2. To clean a set (if re-using a syringe): draw up clean water (all the way) and shake. This will break down any excess blood that is in the set. Do this three times. You’ll want to dump this water that you’ve just used because it’s loaded with bacteria. Then use full strength bleach 3 times and shake for 30 seconds each time, (this will kill the remaining bacteria including HIV). Then draw up clean water again 3 times to get all the bleach out (you don’t want to inject bleach).
3. Never share water, ties, cookers, spoons, sets or points. All of these can pass injection related diseases.
4. Alcohol prep-pad: before injecting clean the skin. Only wipe going one way (not in a circular motion or “back and forth”-this will contaminate the injection site). This will help you avoid infections
5. If you miss your shot: (a) squeeze the shot into a clean cooker; (b) clean the point or use a clean set and draw the shot back up; (c) never reheat blood it can clot the blood and send parasites directly into the blood stream; (d) move the shot up above the previous site and try again.
6. Where to shoot: below the collar bone and above the wrists. If you have to you can shoot in the hip area.
7. Where not to shoot: (a) the back of the hands and wrists (the walls of the veins are thin and damage easily; they are also loaded with nerve endings); (b) legs (the walls of the veins are thin and the circulation is slower); (c) neck and groin (real chance for damage), (d) eyes, forehead, tongue and genitals.
8. Avoid arteries: if you hit one, you’ll know it. The blood will be dark and frothy. It will rush into the set and push the plunger. Pull out and raise arm above heart. Apply pressure to stop the blood flow (if it doesn’t stop see a doctor).
9. To avoid hitting an artery: feel for a pulse, that’s the sign of an artery. Look for a blood vessel without a pulse.
10. Rotate your veins: going into the same spot may callous the vein and cause it to collapse. It can also create abscesses. Always move the shots towards the heart. If you shoot below the previous injection site you may break free an existing scab or blood clot n the vein, which may travel to the lungs or the heart causing complications or death.
11. Rolling veins: A vein may roll if a tie is too thin. To stop a vein from rolling, you can put your arm against a flat surface and apply pressure.
12. Angle of injection: you want to inject at a 45 degree angle with the hole in the needle (the bevel) pointing up. This causes less tearing to the vein and lowers the chances of going through the vein. It also makes it easier for the point to enter the injection site.
13. Tying off: will raise the vein and slow the flow of blood. Use something at least 1” wide and have it about 4” above the injection site. Loosen the tie after getting register and before injecting.
14. Don’t slam the shot: don’t push the plunger down quickly because the drug may be more pure than you think or cut with something like rat poison. Slamming increases chances of an O.D. (once it’s in, you can’t take it out). Instead, slowly push the plunger in or do a test shot (part of a bag) to see what you’ve got; you can always do more later.