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Jun 272011
 
IV Safety Manual - How to Safely Shoot Up

Getting Off Right – How to Shoot Up

SAFETY/LEGAL NOTICE

This manual is for safety information only. “Addicts Helping Addicts (AHA)” in no ways promotes or encourages  the use of IV drugs or shooting up yet stands by the validity of the medical information to follow.  Please always consult a physician with questions related to this means of administration, and if experiencing any problems (abscesses, Hep C, etc.) from the use of IV drugs please see a doctor, or in the case of an emergency, please call 911 immediately. This manual is intended to help minimize the numerous dangers when injecting drugs and using needles and syringes.  While we always promote sobriety here at AHA, IV drug users still in the midst of an addiction can at least minimize the potential harm involved with needles, yet there are always several other dangers with the actual drug use, no matter the means of administration, including possible life threatening injuries, coma and death.   Please always exhibit extreme caution and care when preparing and using the needles.

Drug injection, or “shooting up” is a rather complex activity. There are many steps along the way where something can go wrong, but equally as many places where you can make the process safer. Before injecting, you should:

(1) assess the safety of your setting and evaluate your state of mind;
(2) make sure you have the best materials you can get, and enough of them; and
(3) prepare your drugs as cleanly as possible.

PREPARING YOUR SHOT TO “SHOOT UP”

Unfortunately, we don’t always have complete control over how we’re feeling when we want or need to get high, or the circumstances under which we use. While we may not always be aware of it, where we use, who we use with (if anyone), and our state of mind when we’re getting high, can all have an impact on injection safety.

WHERE YOU USE

Some places are safer for injecting than others, and you should always choose from among your options the safest one possible. The ideal location for injecting is one that is relatively clean, dry, warm, and well-lit, and where:

· your chances of getting caught by the police are minimal
· you feel comfortable that there will be no surprise interruptions or unwanted observers
· you can take as much time as you need
· you have adequate space for yourself and your equipment
· you have access to a sink or other source of clean water
· you are sheltered from the wind and weather.

All of these factors should be weighed against each other when choosing a place to shoot up.  It is clear, then, that using in your own home (if you’re fortunate enough to have one) or the home of a friend is safer than using in a public bathroom. However, a public bathroom – particularly if it’s a single room with a door that locks – is usually safer than injecting in a place such as a public park or the stairwell of an apartment building. In general, but not always, indoor locations are safer than outdoor ones, and definitely preferable in terms of wind and weather. If you’re injecting in a relatively public place, like a toilet stall in a public bathroom, try to make it look like you’re changing your clothes or freshening up. If you know you’ll have to be getting off in a location like this where there is no direct access to a sink, bring along a small bottle of water to mix your shot with (it’s probably a good idea in any case to make water a permanent part of the works you carry). Most importantly, always try to stay as calm as possible no matter where you’re injecting. While it can be nerve-wracking getting off in a public or semi-public place or somewhere else where you’re afraid of getting caught, it’s important to keep your wits about you so that you don’t end up knocking over your shot, spilling your drugs, being unable to get a hit because you’re so nervous, or getting blood all over. So, use common sense and planning when choosing a location to shoot up. If at all possible, wait to get off until you’ve found a place where you feel relatively comfortable and can minimize the risk of getting arrested. Make sure you have all the materials you need before you begin, and don’t assume you’ll always have access to water. Finally, be considerate of others – no one likes coming across a used needle and syringe in the apartment building or seeing bloody tissue in a public toilet, and there’s no reason they should have to. Drug injectors have a bad enough rap as it is. Let’s not give people the ammunition to keep us marginalized and oppressed!

WHO YOU USE WITH WHEN SHOOTING UP

Although it is not always (and for some people ever) desirable or possible to inject with someone else present, having another person around when you get high can be a safety net, particularly in terms of surviving overdose. For those who live alone, however, having someone else present every time you inject may be unrealistic; and some people simply prefer using by themselves. Another complication is that many of us use in secret for fear that we’ll be rejected or judged by those we come out to. It is important to try to put together a support system of people who know you use and who you can rely on for support or in case of an emergency. This may be easier said than done, however, and even though injecting drugs may have become a mundane activity for you, it is frequently shocking for non-users to learn that someone they know engages in this activity. Disclosing your use to the wrong person could add untold stress to your life, so make this decision carefully. Try to make yourself available to other users who may need support. If you’re worried that a friend has been using too much, for instance, have them check in with you by phone after they get high to make sure everything is okay. And finally, avoid using with people you don’t like or who could care less about what happens to you if you were to overdose.

ASSESSING YOUR MOOD

The quality of any drug experience and the ease of shooting up is determined not only by the drug itself (including factors like potency and purity), but also depends on how the drug is administered, the environment in which it is taken, and the mood or mindset of the individual at the time he or she takes the drug. It is therefore important for anyone who is going to take a drug to assess their mood and mindset before they get high. You should always be aware of how you’re feeling prior to altering your consciousness. Feeling relaxed, confident, and calm will help insure that you will take your time to inject hygienically and properly. If you’re in withdrawal, panicked about getting high in a public bathroom, or otherwise anxious and upset, the chances of something going wrong increase. Take a few deep breaths and try to gain some composure before you begin to prepare and inject your drugs in order to prevent accidents and make sure you get a hit without harming yourself in any way.

CHOOSING YOUR MATERIALS

There are a lot of materials needed to inject drugs– what those of us who use refer to as our “works.” Ideally, the type of equipment
someone uses to inject will be appropriately matched to the drug they’re using, where they plan to inject it, the condition of their veins (if they’re mainlining), and other factors. Unfortunately, drug injectors do not always have regular, legal access to the materials they need and are frequently forced to make to with what they can get.

This section of the manual discusses what materials are best for injecting drugs and how to use them safely; and offers suggestions for second-best options when the safest equipment is for some reason unavailable.

NEEDLES AND SYRINGES

The needle and syringe is arguably the most important piece of equipment needed to inject drugs. Due to legal restrictions on possession and over-the-counter sale, it can also be the most difficult piece of equipment to obtain.  Needles and syringes are not all the same. It’s important to find a needle and syringe that you feel comfortable with, so if you have the opportunity, experiment with different types, sizes, and brands of injection equipment until you’ve found the one that works for you. Or you may find that you’ll use different equipment at different times depending on what and where you’re injecting. Among the things you should consider when choosing a needle and syringe are:

NEEDLE GAUGE

Needle gauge: which refers to the size of the bore or hole in the needle. With needles it is important to remember that the higher the gauge, the thinner the needle (and the smallerthe hole). A 28 gauge needle (abbreviated 28G) is therefore thinner than a 25 gauge needle, which is in turn thinner than an 18 gauge needle. Most intravenous injectors use either a standard insulin set which typically has a 27G or 28G needle (and an orange cap), or a standard tuberculin set with a 25G needle (frequently called a bluetip because of its
color).  The smaller gauge needle you use, the smaller the puncture wound, and therefore the less opportunity for infection to occur. Using a smaller gauge needle is also likely to result in less bleeding. Intramuscular injections must be given with larger gauge needles
(frequently 21G or 23G), and certain substances such as injectable steroids and hormones can only be administered intramuscularly. Intravenous injectors typically use needles no larger than 25G, and whenever possible, needle gauge should be matched to the size or the vein into which you’re injecting. If you’re using a small, delicate vein like those in the hands, for instance, a thinner needle such as a 28G is the safest choice.  Drugs that are cut with a lot of impurities, like white powder or tar heroin, may clog the point of the syringe. The higher the gauge (therefor the thinner the needle and the smaller the hole), the more likely it is that the point may get clogged. This is particularly true with brown tar heroin.

NEEDLE LENGTH

Insulin needles are typically 1/2 inch in length and tuberculin needles are typically 5/8 of an inch in length – lengths
that most intravenous drug injectors find adequate if not ideal. A needle that is too short may miss your vein, and one that is too
long may go right through it or be difficult to properly position. Longer needles are often appropriate for intramuscular injections. As
inscribed on packaging, needle length appears after the gauge number: 28G 1/2 refers to a 28 gauge needle that is 1/2 inch long.
BRAND. Most drug injectors find that, if given the opportunity to try out different brands of needles and syringes, they will find one that they prefer over all others. Different manufacturers create needles and syringes of varying quality. Some brands of needles are
more comfortable to inject with than others, and the plungers on some brands of syringes are easier to manipulate than on others.

ONE-PIECE SETS VERSUS TWO-PIECE, DETACHABLE SETS

With some types of injection equipment, the needle detaches from the syringe resulting in two separate pieces. Standard insulin injection equipment is typically one piece, while tuberculin needles and syringes are often detachable. Detachable, two-piece equipment often has a larger reservoir above the needle in which a lot of blood can collect. If you’re using a two piece set, make absolutely sure that the needle is securely fastened to the syringe so that it does not detach while you’re injecting, causing you to lose your shot. Lastly, you might find that using a butterfly set often used for drawing blood from hospital patients is useful when getting off in the hands or feet. However, this type of set can be difficult to obtain. (Ask your local exchange if they have any).

SYRINGE SIZE

Standard insulin syringes are typically 1cc in size and are calibrated by .10cc’s along the barrel of the syringe. Most drug injectors find this size ideal and would rarely need use of a larger syringe, although some drug injectors like to use 1/2 cc syringes. Syringes other than 1cc in size may be difficult to obtain.

GUIDELINES FOR SAFER INJECTING.

As important as choosing an appropriate needle and syringe is how you use them. Below are some very important guidelines you should follow in order to make the process of injecting as safe as possible.

ONE SHOT = ONE NEW NEEDLE AND SYRINGE

In the same way that hospitals will use a needle and syringe only once and then dispose of it, this is the gold standard that anyone who injects drugs should also strive for. Needles become dull quickly, even after just a few uses. Using dull needles causes unnecessary trauma to the veins and surrounding tissue, results in a larger puncture wound and increased bleeding, and is simply not as comfortable as using a new, sharp needle every time. Attempting to sharpen a needle (on a matchbook, for instance) is dangerous because it can create a burr on the needle that can cause significant damage to the veins, or weaken the point and cause it to break off in your vein. Also, new needles and syringes are sterile as opposed to simply clean, which means they’re free of all biological matter that, if present, can cause infection. Using a new, sharp, sterile needle and syringe for every injection and then disposing of it is simply the safest possible way to go.
AVOID SHARING NEEDLES, SYRINGES, OR OTHER DRUG INJECTION EQUIPMENT.

Blood or other matter that remains in a needle and syringe after someone has used it can be passed on to anyone else who uses that same injection equipment. The same applies to cookers, cottons and spoons. In this way, life-threatening viruses such as Hepatitis and
HIV can be transmitted from one injector to another. The only definite way to avoid disease transmission of this sort is to never share needles, syringes, or other injection equipment.  It is therefore extremely important for every injector to have his or her own set of works, and an ample supply of needles and syringes, so that they never have to share or re-use their own – but especially other’s – injection equipment.

IF YOU ABSOLUTELY MUST SHARE NEEDLES, SYRINGES, OR OTHER DRUG INJECTION EQUIPMENT, BE SURE TO CLEAN IT THOROUGHLY BEFORE RE-USE.

If you find yourself in a situation where you must use someone else’s injection equipment or they must use yours, follow the cleaning
instructions listed below to reduce the likelihood of transmitting a blood-borne illness. Sharing injection equipment even after it has been cleaned is definitely a second-best choice because blood and other matter can remain in a needle or syringe even after cleaning. Cleaning needles and syringes is a complicated process that, even if done according to the best scientific advice currently available, is not a 100% fool-proof method of avoiding harmful bacteria, viruses, and other blood-borne pathogens.

FLUSH YOUR NEEDLE AND SYRINGE WITH WATER SEVERAL TIMES AFTER USE IF YOU PLAN TO RE-USE IT AT A LATER TIME.

While it is safest to use a new needle and syringe for every injection, if you know that you’ll have to re-use your injection equipment
at some later time, be sure to flush it several times with cold or room-temperature water so that it doesn’t become clogged with
blood or other matter (see cleaning instructions below).

HOW TO CLEAN A NEEDLE & SYRINGE.

As already mentioned, the only sure way for drug injectors to avoid contracting blood-borne infections and disease like hepatitis and HIV is to never use someone else’s works (including needles and syringes, cookers, cottons, or water) or let someone else use yours. Even though injection equipment might look clean to the naked eye, tiny amounts of blood can remain in the works which can result in infection.  If you find yourself in a situation where you absolutely must use someone else’s works or they must use yours, you can reduce the likelihood of disease transmission by carefully cleaning the equipment before you use it. Follow these instructions  carefully:
1. Rinse the needle and syringe with cold water several times (hot water will cause blood to clot, making at harder to remove). If
you’re using a detachable needle and syringe, you might want to take the equipment apart to clean it more thoroughly. Be sure to discard the water you use to rinse the equipment.

2. Flush the needle and syringe with undiluted household bleach. Be sure to fill the syringe all the way up. Keep the bleach in the syringe for a full two minutes while shaking it. Discard the bleach.

3. Thoroughly rinse the needle and syringe with clean, cold water to remove any remaining bleach. Discard the water.  If you do not have bleach, you can substitute hydrogen peroxide, a solution of dishwashing liquid and water; or rubbing alcohol. Use high-proof drinking alcohol, such as vodka or rum, if it’s all you’ve got.

IMPORTANT: In order for bleach to kill hepatitis B that might be in the syringe and/or cooker, you must leave the bleach in
the syringe and cooker for a full two minutes. It is unclear whether bleach kills hepatitis C, even after two minutes. This should also
kill any HIV that might be in the equipment.  (30 seconds is believed to do this).  Be sure to clean the cooker with bleach if it’s going to be shared. Split whatever cotton you have in two before you use it– it’s virtually impossible to clean such a filter.  And remember that sharing water is one of the most efficient ways to pass on or contract a virus or other infection-causing organism.  Rinse you equipment with cold water after you’ve used it in order to prevent any residual blood from clotting, especially if you plan to re-use it later.  If you purchase needles and syringes on the street, clean them before you use them; sometimes dirty equipment is re-packaged and sold as new. Do not clean equipment that is sterile; something that is sterile is as clean as you can get it, and “cleaning” it could
actually contaminate it.

COOKERS AND SPOONS.

Cookers and spoons are used to dissolve (cook up) powdered and solid drugs for injection.

· If using a spoon, try to find one that is rounder and deeper than an average teaspoon or tablespoon– closer to the shape of a ladle–
to decrease your chances of spilling your drugs. You might want to bend the handle to prevent the spoon from rocking or tipping
over.

· If using a bottle top or something similar, be sure you’ve removed any plastic or paper lining without scratching the cap’s finish.

· You may want to fashion a handle for your cooker with a bobby pin, paper clip, bag twist tie, or something similar so that you don’t
burn your finders when cooking your drugs. Be sure the handle is securely fastened to the cooker so it doesn’t fall off, causing you to
lose your shot.

· Always make sure that your spoon or cooker is as clean as possible; like needles and syringes, it should never be shared with anyone else because doing so can transmit viruses and infections from one person to another.

· Always place your spoon or cooker on a level surface and maneuver it carefully so that you don’t spill your shot.

COTTONS (FILTERS)

Most injectors draw their drug solution from a cooker or spoon into a syringe through some type of filter – most often a piece of cotton
or other absorbent material. The filter acts to keep out particulate matter and other foreign objects you don’t want in your shot, and enables you to get just about every drip of the drug solution into your syringe so that none of it is wasted.

· Clean, 100% cotton from a Q-Tip or cotton ball is the safest thing you can use to filter your drug solution. Filter paper or a small
piece of tampon are safe alternative.  (Editorial note: I don’t know about tampons. They are often loaded with chemicals which may not be safe to inject).

· Rayon and other synthetic fibers often don’t absorb liquid as well as cotton, and may prevent you from being able to adequately draw
up all of your drug solution.
· Cigarette filters are not safe to use since they are made with fiberglass, and contain tiny pieces of glass; and, if from a cigarette that has already been smoked, there are substances from the smoke that can be harmful if injected.

· Pocket lint may work, if it’s all you’ve got, but it isn’t sanitary.

· You might consider skipping the filter altogether if you have nothing safe to use.

· Use a fresh cotton every time you shoot up, and as with needles, syringes, and cookers, never use someone else’s cotton or let them
use yours. Infections, bacteria, and viruses can all be transmitted through sharing cottons.
· Make sure your fingers are as clean as possible before you tear off and roll up your cotton.

· Never stick the cotton in your mouth to help roll it up into a ball. Your mouth is filled with stuff that your stomach can handle, but
not your blood. Stick your finger in a little water, and use this instead. Discard the water.

· Finally, most of us cook up our old cottons to squeeze what we can out of them when we have no more money for drugs.   Unfortunately, fungi and bacteria can live and grow in these old cottons (which, because they are moist after use, provide ideal environments for microbes) and cause “cotton fever” when re-used at a later time. Cotton fever is an infection characterized by chills, sweating, fever, and other flu-like symptoms. It may go away on its own, or, if it persists or worsens, may require medical attention.

MIXING AND RINSE WATER

· You’ll need water in which to dissolve your drugs and to plush out your needle and syringe after you’ve gotten off. This is particularly
important for people with HIV, AIDS or other serious health conditions to use the cleanest water you can find. Remember, you’re putting the stuff straight into your bloodstream!

· Using sterile water to dissolve (cook) your drugs is your safest option. You can buy it at any drug store or pharmacy. DON’T buy sterile saline (salt water) because your drugs may not dissolve in it.

· After sterile water, your next best option is using water that you boiled for at least 10 mintues and stored in a sealed jar. (Don’t use
water that you boiled several days ago and which has been sitting in a pot or kettle.)

· If sterile or boiled water are not viable options for you, fresh, cold tap water or bottled water are the next best choices.

· If you’re getting off in a location without a sink or other fresh water source, try to find a toilet and use the water from the tank (never use water from the bowl).

· Using water from a stagnant (non-moving) source like a puddle or old tire can cause serious infections; instead, use water from a
fire hydrant, stream, or other moving body of water (even water flowing in a gutter is safer than a puddle) if this is all you can find.
THIS WATER CAN STILL GIVE YOU VERY SERIOUS INFECTIONS.

· Be sure the glass or whatever you have your water in is clean. Don’t contaminate your entire water source by sticking a used syringe
in it. Pour some water into another container if you want to rinse your syringe out, and always be sure to discard the water you use to
flush your injection equipment so no one else accidentally uses it.

· Finally, as mentioned above, you might want to get into the habit of carrying a little bottle of water as part of your works in case
you need to get off in a place where there’s not a sink or other clean water supply. Be sure to have cookers or other containers you
can pour the water into, so that you don’t have to stick your fingers or used needle into your bottle.

TOURNIQUETS (TIES)

Intravenous drug injectors usually need something to “tie off” with that will restrict blood flow and cause the veins to bulge out, making them more accesible for injection.

· Elastic tourniquets (like the kind that are used in hospitals) or stockings are kinder to your skin than belts or similar ties. They’re also better at securing rolling veins like the ones in your forearm. Neckties, lubricated condoms, rubber gloves and socks are other items that, because they’re softer and more pliable than leather, make better tourniquets than a belt.

· Use a slip-knot when typing up so that you can remove the tourniquet quickly, if necessary (see illustration). Never leave the tie on for too long to prevent your circulation from getting cut off. If you lose sensation in your limb or notice it turning blue, remove the tourniquet immediately! If
you’ve already tied up but need to re-cook your shot or transfer it to another syringe, take the tourniquet off and re-tie if just before you’re ready to inject.

LIGHTER OR MATCHES
If you’re using tar heroin or crack, you’ll need something to heat your drug solution with in order to make it dissolve.
· A gas stove works fine if you have access to one, although carrying your spoon or cooker to the stove after you’ve filled it may result in
a spilled shot, so prepare everything at the (hopefully reasonably clean) stove.
· Lighters produce a larger, hotter, easier-to-control flame than matches do, and can be ignited using only one hand. Also, a lighter won’t give off a sulfur smell like matches do, which could give you away if you’re getting off in a public bathroom.

OTHER HELPFUL MATERIALS
While the needle, syringe, cooker or spoon, water, cotton, tourniquet, and lighter or matches are all necessary for preparing and injecting drugs, there are a few other materials it’s helpful to have if you can get access to them:
· Alcohol pads are extremely helpful for cleaning an injection site prior to getting off to prevent bacteria and dirt on the skin from entering your bloodstream.
· To prevent blood from getting all over your shirtsleeves or clothes – a situation that will require a lot of explaining if you’re at work or visiting a friend who doesn’t know you use – carry tissues with you and maybe even Band-Aids to apply after you’ve gotten off.

1b. Preparing Your Shot
Preparing your shot as cleanly and hygienically as possible can help you avoid illnesses and infections, some of which can be quite serious and require hospitalization (see Chapter 3). Every time you inject, you’re creating the means by which bacteria and other infection-causing microbes can directly enter the body, and, if you mainline, the bloodstream itself. The skin is the body’s first immune system component, and we open ourselves up to potential infection every time we break it. That’s why it’s so important that the equipment and the process we use to shoot up is as clean and safe as possible.

FIRST STEPS
There are a few common sense things you should do before preparing and injecting your drugs.

· First, if at all possible, thoroughly wash your hands with soap and water. Any bacteria or germs you have or your hands can contaminate anything you touch when preparing your drugs. At the least, rinse your hands with water, wipe them with a moistened towelette, or otherwise try to get your hands as clean as possible.
· Inject your drugs in as clean a place as you can find and always try to use a level surface so you don’t tip anything over and lose you shot.
· If they’re not brand new, make sure all of your materials are thoroughly cleaned, and don’t unwrap or uncap your needle and syringe – especially if it’s sterile – until you’re going to use it.
· If you’re getting off with someone else, make sure each person’s equipment is clearly separate from yours so that accidental mix-ups and sharing don’t occur: needles, syringes, and water glasses all look the same!
· Finally, calm yourself down if you’re upset for some reason. Consider whether smoking or sniffing a little bit of your drug will help you relax if you’re in withdrawal or otherwise freaking out.

COOKING YOUR SHOT
Powdered drugs must be dissolved into a liquid form before they can be injected – a process known as “cooking.” Different drugs dissolve differently. If you’re using something like injectable morphine or hormones that are already in liquid form, cooking is completely unnecessary. Some drugs will dissolve in water without being heated; some people cook their cocaine, for instance, while many more do not, because it can clot when heated, mess up your shot, and clog your needle. Though brown heroin will dissolve without an acid, heating it along with an acid like powdered vitamin C will help dissolve it more easily. DON’T USE LEMON JUICE because it can cause fungal infections that can damage the eyeball. Finally, pills must be crushed up or pulverized as finely as possible before being dissolved for injection. Many drug manufacturers now formulate their pills so that they cannot be dissolved in water at all but just sort of clump up when you heat them. If you’re going to try to inject a pill, dissolve
a small corner of it first so that you don’t waste the entire thing. And inject pills only as a last resort; injecting the undissolved particles from a pill can cause all sorts of problems, particularly abscesses. For this reason, you should avoid muscle-popping or skin-popping pills altogether. (see pages 41 and 44)  Ideally, your drug solution will be clear and particle-free. If it’s not, you may want to try to re-cook it, although sometimes street drugs contain cuts that will not dissolve no matter what you do. In this case, use your cotton to filter out as much of the cut as you can. Lastly, don’t re-cook a shot with a lot of blood in it as the blood can coagulate and clog your needle.  After you’ve cooked up your drugs, draw the solution into your syringe through your cotton. Tap out all the air bubbles and push
the liquid to the tip of the needle.

DIVIDING DRUGS
If you’ve bought drugs with someone else, you need to ensure that everyone gets their fair share in a safe way. There are several ways this can be done:
· The safest way to divide drugs is to split the powder or tar and have each person cook up their own drugs with their own materials.
· If this first option is for some reason not acceptable, the drugs can be cooked up first (using sterile equipment!) and then divided (using sterile syringes!) after they’re in liquid form.
· Backloading (Piggybacking): A single, sterile syringe can be used to draw up equal amounts of the liquid which can then be carefully squirted into the back of each person’s sterile syringe after the plunger has been removed.
· Frontloading: The drug is carefully squirted into the front of each person’s syringe that still has the plunger in it but from which the detachable needle has been removed.
· Always be sure any equipment you use to cook up and divide drugs is new (preferably sterile) or, as a second-best option, properly cleaned.

The Basics of Safer Injection
As important as preparing your drugs as cleanly as possible is injecting them as safely and as carefully as possible. This section of the manual presents information on proper injection technique (intravenous, intramuscular, and subcutaneous injection). In addition to mastering proper injection technique, regular intravenous injectors must also be sure to practice good vein care, and
all injectors should be aware of the various things they can do -like rotating injection sites -that will help them avoid infection and maintain good health.

TAKING CONTROL
It is extremely important for regular injectors -particularly those who are physically dependent -to be able to prepare and safely inject drugs on their own. Having to rely on someone else to get you off can open the door to all kinds of abuse: don’t let anyone have this much power and control over you or your ability to function. Learn how to safely and properly inject yourself! Learning how to inject properly, like mastering any other complicated activity, takes practice. After a while, you will no doubt be able to hit veins you’ve never used before on the first try, causing minimal trauma to the injection site and leaving a tiny puncture wound that barely bleeds. You will develop ‘a feel’ for where your veins are and how you need to position and insert your needle in order to get a good hit.  Perhaps the safest way to learn how to inject is to have someone who knows what they’re doing teach you. An experienced injector can walk you through the process of injecting, or perhaps even demonstrate it, and prevent you from making any dangerous mistakes. If possible, find someone who you trust to mentor you through this process. And talk with other injectors about the various tips and wisdom about injecting they’ve picked up over the years.  Hopefully, there are things in this manual that will be new and helpful even to those of us who have been injecting for a long time.  However, reading about how to inject and actually doing it are two different things. If you are new to injecting, we can only caution you to read this manual thoroughly before you begin and to go slow and be aware of everything you’re doing. If the risk of injecting drugs seems too dangerous after you’ve read this booklet, deciding not to administer drugs via injection is a harm reduction response that we whole-heartedly support.

Mainlining (Intravenous Injection) Intravenous injection (mainlining), or injecting a substance directly into the bloodstream through a vein, is one of the fastest ways to deliver a drug into your system. It is also the riskiest method to use in terms of overdose (as opposed to sniffing,
smoking, or oral administration) because the entire dose enters the body all at once and very quickly. Injecting intravenously usually gives the user a “rush” that many people report to be extremely pleasurable, a sensation that does not occur with intramuscular or subcutaneous injection. While each injection method carries its own risks, mainlining is arguably the riskiest since it creates a direct opening between the bloodstream and the outside world. Heroin, cocaine, and amphetamine are three drugs that are commonly administered intravenously.

CHOOSING AN INJECTION SITE
People who inject drugs often have one or two
favorite places to inject -sites that feel the
most comfortable, are easy to access, and
where you almost always get a clean hit on
your first try. While it may seem awkward at
first, it is important to learn how to inject
in other places that may not seem as
comfortable or accessible on your first couple
of tries. If you keep injecting in your
favorite spots over and over without letting
the veins repair themselves, they will become
leaky, making your shot less satisfying and
harder to hit; could become seriously
infected; and will eventually collapse or scar
so badly that they become altogether unusable
and interfere with circulation. So, it is very
important to rotate the sites you use to
inject. Try to use a new site for each new
injection and go back to sites you’ve already
used only after they’ve had time to rest and
repair themselves.
In addition to learning to inject in new
places, it is also important to learn how to
inject with either hand so that if the veins
on one side of your body need a rest or are
otherwise unusable, you’re able to inject into
the veins on the other side of your body -even
if you need to use your non-dominant hand to
do it. The next time you’re in withdrawal and
really need to get off but can’t find a vein
in your usual spot, you’ll be thankful you
taught yourself how to inject into the other
arm!
CLEANING THE INJECTION SITE
Any time you inject intravenously, you risk
pushing bacteria, fungi, and any other
infection-causing microbes that are on your
skin directly into your bloodstream. It is
therefore extremely important to thoroughly
clean your injection site prior to getting
off. Alcohol pads work well for this purpose,
but be sure to wipe in only one direction and
not in a circular motion which will cause the
dirt and germs to stay on your skin. Plain old
soap and water also work fine, as do rubbing
alcohol, hydrogen peroxide, or any other type
of cleaning agent or disinfectant. Be sure not
to touch the injection site with your fingers
after you’ve cleaned it. Routinely cleaning
the skin prior to injection is one of the most
important things you can do to reduce your
risk of endocarditis, blood poisoning, and
similar infections (discussed in chapter 3).
TYING UP
Use gravity to bring blood to the limb you’re
going to use to inject before applying your
tourniquet (tie): swing or hang your arms,
make a fist, etc. Tie your tourniquet in such
a way that it can be easily removed if
necessary (see illustration p. 24). Try to
secure ‘rolling’ veins like those in your
forearms before you inject into them. Finally,
be sure not to leave the tourniquet on for too
long. If you feel your limb becoming numb or
notice it turning blue, undo your tourniquet
and don’t retie it until you’re ready to
inject.
INSERTING YOUR NEEDLE
Insert the needle into your vein with the
needle bevel opening facing up, at a 15 to 35
degree angle, and always in the direction of
the heart. The more perpendicular the needle
is to the injection site, the greater chance
you have of sticking the needle through the
vein instead of into it. REGISTERING
Once you think you’re in a vein, pull the
plunger back to see if blood comes into the
syringe. If so, and the blood is dark red and
slow moving, you know that you’ve hit a vein.
You can now untie your tourniquet and proceed
to inject your drugs. If no blood or only a
very tiny amount of blood comes into the
syringe when you pull back, you’re not in a
vein and will have to untie your tourniquet,
pull your needle out, and try again. If you
proceed to inject without being properly
positioned in a vein, you’ll be putting your
drugs into the tissue surrounding the vein,
under the skin, or some other place. It will
probably be painful and become swollen, and
the effects of your drugs will come on much
more slowly. You also risk abscess formation
and other possible problems.
If there’s too much blood in your shot to tell
if you’re properly registering, split the shot
into two and dilute each half with water.
Some people like to ‘boot’ their syringe after
they’ve injected their drugs -that is, pull
back the plunger, draw blood into the syringe,
and re-inject it. Some injectors like to do
this several times, ostensibly to rinse out
any drug solution that remains in the syringe.
Because of all the blood involved, you might
want to refrain from booting if you know
you’re going to be cleaning your needle and
syringe and allowing someone else to use it.
Be sure to thoroughly flush your needle and
syringe with water after booting if you plan
to re-use it at a later time, so that blood
doesn’t clog the needle.

PULLING OUT
After you’ve successfully injected your drugs,
carefully pull the needle out of the injection
site at the same angle at which it went in.
(To minimize bruising, you should have untied
your tourniquet before you injected your
shot.) Apply pressure to the injection site to
stop any bleeding. If you’re getting off in a
public place, it is a good idea to have some
tissue or Band-Aids around so you don’t get
blood all over your clothes. Don’t use alcohol
pads on a fresh injection wound: alcohol will
cause it to bleed more, not less.
MISSED SHOTS & AFTERCARE
Don’t apply creams, salves or oils you use to
treat your track marks or bruising until the
injection wound has begun to close (a couple
of hours after injecting, otherwise you might
cause an infection. Treat missed shots (those
that ended up somewhere other than in your
vein) immediately with a warm water soak or
compress to reduce the likelihood of
irritation and abscess formation. Warmth will
open the capillaries and bring
disease-fighting white blood cells to the
affected area.
MAINLINING COCAINE
Cocaine has a numbing effect on the veins and
causes them to constrict (shrink), so if
you’re shooting coke, you should be extra
careful to register properly and make sure
you’re in a vein before you inject your drugs.
Also, chances are that if you’re shooting
coke, you’ll be injecting many times in a
short period of time with perhaps only several
minutes elapsing between each injection. This
can be traumatic on the veins and the
surrounding tissues, and result in a lot of
bleeding.
* Try to use a sterile, sharp needle for each
injection;
* make sure you keep your injection equipment
separate from anyone else’s you’re getting off
with;
* and try to give the area a good rest for a
few days.
You may experience some pain and swelling
after such intense activity.
MAINLINING CRACK
Because crack comes in a solid form (rock), it
is necessary to dissolve it first. The safest
way to do this is with powdered citric or
ascorbic acid­ask your local needle exchange
or health food store where to find it. Avoid
lemon juice or vinegar, as these can lead to
serious infections.
To dissolve crack: put crack and citric or
ascorbic acid (about a pinch to a slab) in the
cooker; add plenty of water; mash and mix
well.
SHOOTING SPEED
Because speed is often cut with such dangerous
chemicals, it is very important not to miss
your shot. Skin-popping speed is extremely
painful, may cause an abscess, and will take a
long time for the body to absorb. If you get
the shakes after doing a few shots, it may be
helpful to have a friend inject you if you are
not using alone. Because the quality of speed
varies so dramatically, a tester shot is a
good idea.
HIRARCHY OF SAFETY for Choosing Intravenous
Injection Sites
The following is a breakdown of possible
intravenous injection sites, beginning with
the safest options and moving toward the least
safe ones.
ARMS: Arms, first upper then lower, are the
safest sites for injecting. You should be
careful to secure the ‘rolling’ veins in the
forearms before you inject into them. Arms are
also good if you’re concerned about hiding
your injection or track marks (although
wearing long sleeves in the summer can be a
drag!).

HANDS: Hands are somewhat less safe than arms
because the veins are significantly smaller
and more delicate and therefore more likely to
bruise or become damaged. Circulation is also
slower in the hands, causing healing to take
longer. If you’re getting off in your hands,
be sure to use the thinnest needle possible
(highest gauge) or, if you can find one, a
butterfly needle (see illustration on page 8).
Be vigilant about rotating the sites, and keep
in mind that it is difficult to conceal
injection marks and bruises on the hands.
LEGS: Circulation in the legs may be poor,
especially in people who don’t use theirs a
lot. Veins in the legs are more likely than
those in the arms to develop clots that can
obstruct circulation and eventually break off
and lodge in the lungs or heart. Also,
damaging the valves in the leg veins is more
serious that damaging those in the arms since
they play a greater role in getting blood back
to the heart.
FEET: As with the hands, the veins in the feet
are generally smaller than in other parts of
the body, and close to nerves, cartilage, and
tendons which you want to avoid hitting when
you inject. Because they are farther from the
heart than the veins in the hands, arms, and
legs, blood circulates more slowly in the foot
veins and they therefore require more time for
healing and repair. In addition, foot sweat and dirty socks can prevent wounds from
healing and increase the chance of infection
from bacteria.
GROIN: The femoral vein in the groin area is a
large and fairly easy vein to access, but its
location near the femoral nerve and the
femoral artery make it quite a risky place to
inject. Among the three, the femoral vein is
located closest to the groin, with the artery
and then the nerve located as you move
outward. If you’re going to inject into the
femoral vein, first locate your femoral
artery – where you do not want to inject – by
finding the pulse. Then move a short distance
toward the inside of your leg to find the
femoral vein. Because it lies fairly deep, you
will probably not be able to see it but will
have to inject into it “blind.”
NECK: The jugular vein in the neck is the
riskiest place to inject because it lies very
close to the carotid artery, a major blood
vessel that brings blood directly to the
brain. Accidentally hitting the carotid artery
could be fatal, and damaging the jugular vein
in any way can interfere with blood
circulation to the brain.
More Tips for Choosing an Appropriate
Injection Site
* Taking proper care of the veins in your arms
and other safer locations will prevent you
from having to shoot up in more dangerous
ones.
* You should avoid using veins that are
tender, hardened, or inflamed until (and if)
they heal. Warm compresses and the use of
appropriate creams can help speed the healing
process.
* The larger and more visible the vein, the
easier and safer it usually is to hit. Deep
veins are harder to hit, and trying to access
them increases your chance of hitting a nerve
or artery in the process. On the other hand,
it may be difficult to keep a needle properly
positioned in a very shallow vein, causing you
to accidentally skin-pop your hit.
* Areas that are farthest from the heart, like
the hands and feet, heal the slowest and have
the poorest circulation. Areas nearest to the
heart (like the groin and the neck) have veins
that are located near major arteries and
nerves which, if accidentally hit, can cause
serious, life-threatening damage.
* Injecting near a bone increases the chances
that swelling and pain will occur.
Veins vs. Arteries
You always want to inject into a vein and
never into an artery. Veins are blood vessels
that carry blood from the extremities of the
body back to the heart and lungs where it
becomes re-oxygenated. Veins have no pulse,
and the blood they carry is a deep, dark red
because it is low in oxygen. Arteries carry
blood rich in oxygen from the lungs and heart
to all the other parts of the body. Arteries
have a pulse, and the blood in them is bright
red and frothy. Arteries are located deeper in
the body than veins and so are not visible as
many of your veins are.
You’ll know you’ve hit an artery if:
* The plunger of your syringe is forced back
by the pressure of the blood.
* When you register, the blood in your syringe
is bright red, frothy, and ‘gushing.’ Blood in
veins is dark red, slow-moving, and “lazy.”
* You feel an electric “burn” along your limb.
You can avoid hitting an artery by:
* Never injecting where you feel a pulse.
* Injecting only into surface veins and not
trying to hit those that lie deeper.
What to do if you hit an artery:
* Untie your tourniquet and pull your needle
out immediately.
* Raise the limb above your head to stop the
bleeding, if possible.
* Apply firm pressure to the wound for at
least 10 minutes.
* If bleeding continues, apply a bandage or
cloth wrapped very tightly around the wound
and seek medical attention immediately. The
loss of blood from hitting an artery can be
life-threatening if it’s not stopped.
Veins vs. Nerves
Unlike some veins, nerves are not visible from
outside the body, although you will definitely
know if you’ve hit one while injecting because
you’ll experience extreme pain and no blood
will enter the syringe when you pull back to
register. Hitting a nerve can be very
dangerous and result in paralysis or the loss
of a limb. It’s a good idea to know where your
major nerves are so that you can avoid them
when getting off.
Exercises for Improving Vein Visibility
If you’re the athletic type, engaging in the
following activities can help make your veins
more visible from outside the body.
* Push-ups, pull-ups, and other exercises that
strengthen the arms
* Weight-lifting, particularly bicep exercises
* Squeezing tennis balls
* Wrist curls
Some tips for “Getting Veins Up”
If you’re having difficulty locating a vein to
inject into, you might want try one of the
following:
* Put a warm compress on your injection site
for five or ten minutes to help bring a vein
to the surface. When you’re cold, it can be
very difficult to access a vein. (If you’re
getting off in a bathroom or somewhere else
where there’s not a lot of heat, don’t unroll
your sleeve or uncover your injection site
until you’re ready to inject.)
* Lower your arms below your heart or swing
them in a circle.
* Lightly slap the injection site.
* Wrap your limb in Saran Wrap for a few
minutes. This traps the heat and causes veins
to rise to the surface.
* Remain calm. It can be extremely frustrating
to be unable to get a hit, particularly if
you’re in withdrawal. Chances are getting
upset will only increase your difficulty, so
take a few deep breaths and start over again
in a calmer state of mind.
Muscle Popping (Intramuscular Injection)
Some drugs, including injectable steroids and
hormones, must be injected into a muscle
instead of a vein, but heroin and other
opiates can also be administered using this
method. The physical and psychoactive effects
that result from an intramuscular injection of
a drug come on much more slowly than those of
an intravenous injection (half an hour to
forty-five minutes versus almost immediately),
although the overall, cumulative intensity of
the effects and the experience are virtually
identical. Also, the “rush” that is produced
when drugs like heroin are administered
intravenously is not experienced by
individuals who inject intramuscularly.
Most, if not all, of the infection control and
other safety precautions intravenous drug
injectors should follow also apply to
individuals who inject drugs intramuscularly.
Muscle-popping produces much less bleeding
than intravenous injection, if any at all, but
the risk of transmitting viruses and other
blood-borne bacteria as a result of
needle-sharing is as serious as it is with
intravenous injection. In addition,
muscle-poppers are at high risk for abscess
formation, especially if what they inject has
any particles in it whatsoever. When
muscle-popping, it is extremely important to
inject only a solution that is as
particle-free as possible.
Many of the substances that require
intramuscular injection come pre-prepared in
liquid form. To prevent contaminating your
entire supply (especially if you’re sharing it
with someone else), be sure to use only a
sterile needle and syringe when drawing the
liquid up from the bottle in which it’s
stored. Muscling speed or cocaine is very
painful and dangerous, and is likely to cause
an abscess.
CHOOSING AN INJECTION SITE
The buttocks, thighs, and upper arms are the
three best sites, respectively, for
intramuscular injection. The best is in the
deltoid, the muscle on your upper, outer arm
where your shoulder and your arm meet. If
injecting into the butt, mentally divide each
cheek into four equal sections and inject into
the top right or top left outer section of
each cheek (see illustration below). You can
also use the front surface of your thighs
about six inches above your knee to about six
inches below your hip, or the outer surfaces
of your upper arms between your shoulder and
your elbow. Always be careful to avoid nerves,
blood vessels, or bones, and rotate injection
sites to avoid bruising, abscess formation,
and the like. It is not uncommon for your
muscle to be sore for a few days after an
injection.
CLEANING THE INJECTION SITE
Be sure to carefully clean the injection site
prior to injecting (see ‘Mainlining’ section
above for more detail).
INSERTING THE NEEDLE
Try to relax the muscle prior to injection.
This will result in a less painful injection
and may prevent the soreness you usually feel
the following day or two. When injecting into
a muscle, insert the needle in one quick stab
straight into the injection site at a 90°
angle to the body. Nearly the entire needle
should enter the muscle. You definitely want
to draw your plunger back slightly to make
sure no blood comes into the syringe. If blood
does appear, you’ve hit a blood vessel and
need to pull out and try again. Inject your
substance slowly.
PULLING OUT
Pull your needle out in the same direction and
angle at which you inserted it. Because you
injected into a muscle, there should be little
if any bleeding. You might want to apply a
Band-Aid in any case to prevent infection.
Massaging the area lightly for a few minutes
will help the drug absorb and reduce the pain.
MUSCLING HORMONES
Hormones are to be injected only into the
thigh or buttock muscle. When injecting, be
careful of nerves, veins, and bones. The
buttock is the most common place people
inject. You can switch buttock cheeks to avoid
bruises and sores. After you inject into these
muscles, you might be sore for a day or two.
Do not inject more than the prescribed amount;
it will not speed up your treatment process.
You can cause serious liver damage and
increase the risk of blood clots. Blood clots
can appear in the veins of the legs and can
travel to the lungs; this is called Pulmonary
Embolism (see p. 64), which can be fatal.
People who smoke cigarettes and inject
hormones are more likely to develop Pulmonary
Embolism. (This section taken from Positive
Health Project’s “Safety Guidelines for
Injecting Hormones.”)
Skin-Popping (Subcutaneous Injection)
Skin-popping is the injection of drugs between
the body’s skin and fat layers. Like
muscle-popping, the effects of your drug will
come on much more slowly than if you’d
injected it intravenously, and you will not
experience a “rush.”
Skin-poppers should follow all of the
infection control and other safety precautions
that intravenous and intramuscular injectors
should follow. Although like with
muscle-popping, skin-popping results in little
or no bleeding at the site of the injection,
the risk for bacterial or viral infection is
real if injection equipment is shared or drugs
are not prepared and injected hygienically.
Also, skin-poppers are at greatly increased
risk for abscesses, especially if injecting
crushed pills or another solution with
particles in it. When skin-popping, it is
critical to use only a solution that is as
particle-free as possible
CHOOSING AN INJECTION SITE
The upper and lower arms and legs are probably
the best locations for skin-popping.
CLEANING THE INJECTION SITE
As always, thoroughly clean the injection site
with alcohol, soap and water, or other
detergent or disinfectant prior to injection.
INSERTING THE NEEDLE
Slide the needle under your skin at a shallow
angle, maybe 15° to 45° at the most. Inject no
more than 1/2 cc of liquid (half of the volume
of a 1 cc syringe) to form a little bubble
under the skin. If your hit is more than 1/2
cc, inject into two or more sites. The bump
from the solution you injected will slowly
decrease as the liquid is absorbed into the
body, and should disappear completely within a
few hours. Skin-popping can be uncomfortable,
and the bump you create may hurt a bit. If you
skin pop where the skin is loose, pinch the
skin between your thumb and forefinger and put
the needle into the skin you’ve pulled up.
PULLING OUT
Pull your needle out in the same direction as
it went in. There should not be much bleeding
at the injection site when skin-popping, but
you might want to apply a Band-Aid to prevent
infection.
Having to rely on someone else to get you off
can open the door to all kinds of abuse. Don’t
let anyone have this much power and control
over you.
Chapter 3: POTENTIAL HEALTH COMPLICATIONS OF
INJECTION DRUG USE
Many, if not all, of the things that can go
wrong during the process of preparing and
injecting drugs fall into one of three
categories: drug-related, technique-related,
and hygiene-related mishaps. Because we’re
forced to use blackmarket, unregulated drugs,
we’ll never have control over the quality or
purity of the substances we use. But while we
may not be able to do much about the actual
drugs we use, we can work to improve our
injection technique and hygiene which can have
far-ranging effects on our health.
There are numerous and potentially very
serious health complications associated with
injecting illicit drugs, from
injection-related injuries like tracking and
bruising, to bacterial and fungal infections,
from communicable diseases to drug overdoses
and other medical emergencies. This section of
the manual describes some of the medical and
health problems that can result from injecting
drugs and offers suggestions for how to
prevent them. Overdose prevention and survival
are addressed in chapter four.
DIRTY HITS
A “dirty hit” is a general term for a shot
that makes someone sick or causes an abscess
as a result of being contaminated with
infection-causing microbes or toxic
substances. Dirty hits can be caused by any
number of things, such as:
* contaminants in the water you used to
dissolve your drugs;
* bacteria, fungi, or other microbes from old
cottons;
* chemicals in a cigarette filter that was
used to filter a shot;
* adulterants or contaminants in the drugs
themselves; or
* not properly cleaning the skin prior to
injection.
A dirty hit can result in a fairly quick and
intense reaction or might take days or weeks
to produce an effect. Symptoms often include
sweating, headache, fever, and trembling.
While the effects of a dirty hit may pass by
themselves, you should seek medical attention
if they are particularly strong or persistent.
BLOOD POISONING (Septicemia)
Blood poisoning (septicemia) is a bacterial
infection of the bloodstream that can be
caused by injecting with contaminated water,
re-using old cottons, or failing to clean the
skin prior to injection.
Early symptoms include chills, fever, and
extreme fatigue. If you experience these
symptoms, seek medical attention. Septicemia
can be fatal!
ENDOCARDITIS
Endocarditis is an infection of the heart
lining that is caused by bacteria, fungi, and
other infection-causing microbes that enter
the bloodstream during injection and build up
around the valves of the heart, weakening them
as well as other parts of the heart muscle.
Endocarditis can eventually cause a heart
murmur, as well as fever, chest pains,
fainting spells, shortness of breath, and
heart palpitations. It can be treated with
antibiotics if detected early, but can be
fatal if it goes untreated.
You can help prevent endocarditis, septicemia,
and “dirty hits” by always using clean water
(and a clean water glass) when preparing your
shot; using new, clean cottons for every
injection; making sure your spoon or cooker is
clean; and thoroughly washing your hands and
cleaning your skin prior to injection.
TETANUS
Tetanus is a bacterial infection that occurs
when tetanus spores enter a wound and release
tetanus bacteria, usually after a scab has
already formed. The bacteria then enter the
bloodstream and cause an infection, which is
characterized by muscle spasms or rigidity,
especially in the neck and jaw (tetanus is
commonly called “lockjaw”). Tetanus is fatal
if not treated.
Tetanus spores live in the soil and on rust,
which is why a tetanus shot is recommended if
you step on an old nail or other rusty object.
If your needle, syringe, or other injection
equipment is contaminated with tetanus spores
due to dirt or rust, you could infect
yourself. Skin-poppers and muscle-poppers are
particularly susceptible to tetanus infection
and should always use new, sterile equipment.
NECROTIZING FASCIITIS (Flesh-Eating Disease)
Necrotizing fasciitis is a bacterial infection
commonly known as “flesh-eating disease” that
enters the body through broken skin and then
affects the surrounding tissue and nearby
muscle. It can be transmitted by the exchange
of blood during needle sharing, and has
recently been traced to “black tar” heroin on
the West Coast.
Symptoms of necrotizing fasciitis include
increasing redness and swelling and extreme
pain at the wound or injection site
accompanied by a fever. The flesh around the
site of infection begins to decay and looks as
if it had been “eaten” away. Since this
infection is fatal, early treatment with
antibiotics is crucial to survival, although
even appropriate therapy does not prevent
death in all cases. Wounds must be kept
impeccably clean.
Always using new, sterile injection equipment;
never sharing injection equipment; thoroughly
washing your hands and cleaning the skin prior
to injection; and preparing your drugs on a
clean surface will all help prevent
necrotizing fasciitis infections.
WOUND BOTULISM
Wound botulism is caused by a bacteria that
produces a toxin on the skin where a puncture
would is made and that eventually stops your
breathing by paralyzing your muscles. Recent
cases have been associated with the
subcutaneous injection of “black tar” heroin
on the West Coast. The source of the botulism
could be the drug itself, a cut in the drug,
dirty injection equipment, or contamination
during the preparation process. Wound botulism
can be prevented in the same ways as
necrotizing fasciitis­by following excellent
sterile technique when preparing and injecting
your drugs. Symptoms of wound botulism include
droopy eyelids, blurred or double vision, and
a dry, sore throat which may progress into
difficulty speaking and swallowing, a weakness
of the neck, arms, and legs, and difficulty
breathing. If untreated, wound botulism will
cause death by paralyzing the muscles used for
breathing. Early treatment for wound botulism
is essential. If you experience any of the
symptoms listed above, seek medical attention
immediately. Treatment usually involves an
antibiotic regimen and the draining of any
abscesses or infected wounds.
HEPATITIS
Hepatitis is an inflammation of the liver that
can be caused by certain toxic drugs, alcohol,
or street drugs (iatrogenic or
chemically-induced hepatitis); or that is the
result of infection with a hepatitis virus
(viral hepatitis). While there are numerous
types of hepatitis viruses, hepatitis-B and
hepatitis-C are the two that most frequently
affect injection drug users, with hepatitis-A
coming in third.
General symptoms of hepatitis include fatigue,
loss of appetite, nausea, mild fever, and
muscle aches, and if you smoke cigarettes,
you’ll notice that they taste unpleasant. More
severe symptoms of hepatitis include dark
(tea-colored) urine, light-colored stools, and
jaundice (a yellowing of the skin and the
whites of the eyes).
Hepatitis-A (also called “infectious”
hepatitis) is excreted in feces (shit) and
spread by fecal-oral contact
(feces-to-hand-to-mouth contact). Hepatitis-A
can be spread from contaminated food, water,
hands, and eating utensils, for example, by a
restaurant worker who didn’t wash his hands
after using the bathroom and who then prepared
food. Unlike hepatitis-B and -C, hepatitis-A
is not transmitted by blood-to-blood contact
that occurs when needles or other drug
injection equipment is shared, and is not
generally spread through sexual contact unless
rimming (oral-anal contact) is involved.
Hepatitis-A illness resembles the flu and can
last from four to six weeks. It causes an
acute (short-term) infection only and never
develops into a chronic condition like
hepatitis-B or -C. You develop antibodies to
hepatitis-A after you’ve been infected with
it, so your chances of ever getting it again
are slight. A hepatitis-A vaccine
(gamma-globulin) should be administered within
72 hours after exposure to the virus. Gamma
globulin is often used as treatment after an
exposure, but can also be used as a
preventative vaccine. The most complete
prevention is a two-shot regimen, with the
second injection taken 6 to 12 months after
the first.
Hepatitis-B (also called “serum” hepatitis or
“HBV”) is spread through blood-to-blood
contact of the kind that occurs when drug
injection equipment is shared; contact with
infected body fluids like semen, blood, urine,
saliva, and mucous; sex that involves contact
with semen; and from a mother to her infant at
birth. Hepatitis-B infection can be acute
(short-term and intense) and/or chronic
(long-term); chronic HBV can cause serious
liver damage, including cirrhosis (scarring),
liver cancer, and death from liver failure,
and results in premature death in about 15 to
25 percent of individuals affected.
Hepatitis-B is much more infectious than HIV,
which means it is spread much easier. It is
one of the most important reasons drug
injectors should never share injection
equipment of any kind.
A vaccine that will protect you against
hepatitis-B if you’re exposed to it is
available, and all drug injectors should think
about getting it.The vaccine involves a series
of three intramuscular injections, with the
second shot being administered 30 days after
the first, and the third shot being
administered 4 to 6 months after the second.
The vaccine is safe and effective. If you’ve
had hepatitis-B in the past, you’ve developed
antibodies to it and will not catch
hepatitis-B again in the future and do not
need the vaccine. You can get your blood
tested to see if you’ve ever been exposed to
the hepatitis-B virus, and get the vaccine at
your local Department of Public Health or your
doctor.
Hepatitis-C (formerly known as “non-A, non-B”
hepatitis and also referred to as “HCV”) is
spread mainly through blood-to-blood contact
and is very infectious, which means you can
acquire it quite easily if exposed to it.
There is a blood test (ELISA) available that
detects whether or not you have antibodies to
the hepatitis-C virus in your blood, which, if
positive, should be confirmed with a second
test called the RIBA; the only way to test
whether or not you have the actual virus in
your blood is by getting a polymerase chain
reaction (PCR) RNA test, but these tests are
not terribly sensitive and interpretation of
the results may differ depending on who’s
reading them. There is as yet no vaccine for
hepatitis-C, and antibodies are not
protective–that is, they don’t make you
immune to re-infection as with HBV. Scientists
estimate the arrival of a vaccine in 1 to 2
years. Currently, there is only prevention
with use of sterile injection equipment, by
not sharing injection equipment, and through
safer sex.
Hepatitis-C can either be chronic but
asymptomatic (without symptoms, which means
you barely even notice you have it), or
chronic-active, which means disease will
develop over a long period of time­several
years or perhaps even decades. Unlike acute
HBV infection, HCV is never completely cleared
from the body. People with active hepatitis-C
may have elevated liver function tests (LFTs),
fatigue, and jaundice, and active disease can
result in cirrhosis, liver cancer, and
ultimately liver failure, all of which can be
fatal. Hepatitis-C is an extremely serious
health risk for injection drug users, many of
whom – it is now being discovered – have been
exposed to the virus at some point in their
lives.
Interferon alfa-2B is the only therapy
currently approved for the treatment of
chronic hepatitis-B and -C in the United
States. However, many people use a variety of
alternative therapies for hepatitis treatment
including western and Chinese herbal therapies
or acupuncture. The Hepatitis C Handbook by
Matthew Dolan is a very comprehensive book
covering a variety of hepatitis therapies from
Western to Chinese medicine and other
alternative therapies. It is available through
Catalyst Press, P.O. Box 13036, London, NW1 3
WG, or you can call (802) 655-3415 to order
it.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Human Immunodeficiency Virus (HIV) is the
virus believed to cause AIDS (Acquired Immune
Deficiency Syndrome), an immune system
disorder that causes the body to lose its
ability to ward off infection and fight
disease. HIV can be spread through the
exchange of infected semen or vaginal fluids
during unprotected sex; the exchange of blood
via the sharing of drug injection equipment or
accidental needlesticks; and from mother to
infant during pregnancy, childbirth, or
breastfeeding.
Blood-to-blood contact is one of the most
efficient means of transmitting HIV from one
individual to another, and the sharing or
re-use of drug injection equipment is
extremely risky in terms of HIV transmission.
It is important to point out that injection
drug use itself does not cause HIV; rather,
HIV is transmitted (like hepatitis and other
viruses) when infected blood from one
individual is left in a needle, syringe,
cooker, cotton, or water and injected into the
bloodstream or body of a second individual who
uses those same works. HIV from injection drug
use is therefore 100% preventable as long as
you always use your own sterile works and
never share them with anyone.
Anonymous or confidential HIV-antibody tests
are available from virtually all municipal,
county, and/or state health departments, local
health and family planning clinics, AIDS
service organizations, needle exchange
programs, and many other types of providers.
General symptoms of HIV infection may include
a low-grade fever and fatigue. The longer a
person is HIV-infected, the more likely they
are to develop one of the many bacterial,
fungal, or viral infections, cancers,
neurological disorders, or other conditions
that afflict people with HIV and AIDS.
Traditional Western and alternative therapies
are available for fighting replication of the
HIV virus in the body and for preventing and
treating some of the numerous opportunistic
infections that people with HIV and AIDS
commonly get. There is no cure for HIV or AIDS
at this time.
INJECTION-RELATED INJURIES
TRACKING AND BRUISING
Track marks are the scars that appear along
the veins of someone who injects frequently
and repeatedly uses the same injection sites.
Bruising occurs when blood leaks out from the
vein under the skin in the process of
injecting.
Damage to the veins, including tracking and
bruising, can be minimized or prevented
altogether by practicing the following safer
injection guidelines. (These are especially
important for those individuals who are
worried about family, friends, an employer, or
someone else finding out about their drug use.
Track marks are one of the most visible signs
that you use.)
* Use a sharp, sterile needle for every
injection. Using dull needles will cause
trauma to the veins and surrounding tissue,
cause a much larger puncture wound, and
increase bleeding at the site.
Sharpening a used needle can cause it to
develop a burr, which will tear the vein and
surrounding tissue and result in unnecessary
trauma to the injection site. If you keep
resharpening your point, it becomes less
flexible and can break off into your vein. If
this happens, seek medical attention
immediately!
* Use the highest gauge (thinnest) needle you
can find to make the smallest puncture wound
possible.
* Alternate and rotate your injection sites.
Always try to inject at least one inch from
your previous injection site. Give your veins
a chance to rest in between injections. Stay
away from veins that are red or tender until
they heal.
* Always inject in the direction of the body’s
blood flow (toward the heart).
* Use a soft, flexible, easy-to-open
tourniquet and remove it after you’ve
registered but before you inject to help
prevent bruising.
* Use emollient-rich or antibiotic creams on
injection sites once they’ve closed or scabbed
over. Aloe vera gel and vitamin E oil are two
commonly-available preparations that can help
reduce the appearance of track marks.
VEIN COLLAPSE
Vein collapse occurs when veins close up due
to repeated injections into the same site,
repeated local infections, or trauma to the
veins and surrounding tissues. Using barbed or
dull needles can precipitate vein collapse.
You know you have a collapsed vein when you
can’t draw blood from it or when the vein
“disappears.” Thrombosis is the formation of
an obstruction of a blood vessel by a blood
clot. Don’t use veins that do not bend when
pushed as they may have blood clots that can
break off and lodge in the lungs or other
parts of the body and cause serious damage.
You can avoid vein collapse by always rotating
and alternating your injection sites and by
injecting in the direction of the body’s blood
flow (toward the heart). Using the same
injection site over and over without letting
the vein heal is one of the surest ways to
cause vein collapse. Also, insert your needle
at a 15 to 45 degree angle with the bevel of
the needle facing upwards. Taking oral vitamin
C may help your veins repair themselves and
reduce bleeding and bruising. NEVER inject
viatamin C, only swallow it.
ABSCESSES
Abscesses begin with redness, swelling, and
tenderness at an injection site and develop
into an infection with a hard, pus-filled
core. Abscesses result from missed hits
(injecting into the tissue surrounding the
vein), injecting a solution with a lot of
particles in it, failing to clean the
injection site prior to injecting, using dirty
injection equipment, or skin-popping drugs
like coke or speed that cause damage to muscle
tissue and skin.
If you notice a hard, warm lump developing at
an injection site, apply warm compresses at
least three times a day to either make the
abscess that is forming go away or come to a
head (soften and fill with pus). If it comes
to a head, you can get the abscess opened and
drained at a hospital or clinic. If you
experience fever, chills, extreme fatigue, or
pain associated with an abscess, seek medical
attention immediately because you could have a
blood infection. Pain in the groin or armpits
also means you most likely have an infection
for which you should seek medical treatment.
If you’re unable or unwilling to seek medical
care for an abscess, take the following steps:
1. Clean the area with soap and water, and be
sure to keep it as clean as possible at all
times.
2. If the abscess is draining, let it continue
to do so.
3. Keep the area covered with sterile gauze
you can buy in a pharmacy, and change the
dressing twice a day until the pus stops
draining and at least once a day until the
abscess is completely healed. Dressings that
directly touch the wound should be dampened
with sterile saline (which you can also
purchase at a drug store) and then covered
with dry gauze and tape. Properly dressing an
abscess will help keep it free from further
infection and speed healing.
4. When removing the dressing, dampen the
gauze that’s touching the wound so you don’t
pull off newly formed tissue.
5. Warm compresses and salt soaks will
encourage the abscess to drain and promote
healing. Do not soak or use a compress once
the wound is open or draining. After the
abscess has drained and scabbed over,
antibiotic creams and preparations like aloe
vera gel can be helpful.
6. Let the area heal completely. If the
abscess refuses to drain completely or pain
and swelling persist, seek medical attention.
Only use the emergency room as a last resource
for getting your abscess drained. Chances are
the trauma or surgery doctor you see will not
be too sympathetic to your plight,
under-medicate you for pain, make a large
incision, and provide no follow-up or
aftercare. Instead, try to go to a community
clinic where the care might be more humane
(although there are certainly no guarantees
when it comes to people’s views about
injection drug use!). Try to find a wound
clinic where you can get your dressing changed
on a regular basis and make sure the abscess
is healing properly. This will help insure
that minimal scarring occurs.
EMBOLI
An embolism is something such as air, fat,
impurities, dirt, or other particles that can
obstruct a blood vessel which results in the
blockage of blood flow. Particles from
injected pills that were not completely
pulverized and clumps of bacteria are two
examples of things that can cause emboli.
Emboli can be extremely serious, particularly
if they travel through the blood vessels to
the heart or lungs or lodge in the small
capillaries of the fingers, eyes, or toes
where severe circulation damage can occur.
Emboli can be avoided by filtering out any
particles in your shot and refraining from
injecting pills, no matter how pulverized they
appear to be.
TAKING CARE OF YOUR HEALTH
Because they’re involved in the daily struggle
to procure their drugs, many users often
aren’t able to fully care for their health,
and the added stress to the body of injecting
daily results in chronic poor health. Each new
injection of drugs potentially showers your
bloodstream with all sorts of infectious
agents and contaminants which can weaken your
immune system. Not getting proper nutrition or
adequate fluids, enough sleep, and regular
medical care can compound this situation. To
the extent possible, follow basic, common
sense steps to take care of your health.
Chapter 4: Overdose and Other Medical
Emergencies One of the most serious health
consequences associated with using illicit
drugs is the risk of overdose. While overdose
is indeed serious, it doesn’t have to be
fatal. Anyone who uses illicit drugs should
take the time to talk with friends and develop
an overdose plan in the event that something
happens. Whether or not an individual survives
an overdose depends mostly on what those
present do or don’t do to help. All users
should learn how to perform cardio-pulmonary
resuscitation (CPR), for example, and be aware
of the necessary steps they should take if
someone they’re with overdoses. Most overdoses
occur in the presence of another person, so
often we have the opportunity to help our
friends and loved ones survive if we know what
to do. Read the following section carefully
and do what you need to do to feel confident
that you could help someone who has overdosed
survive. We owe it to ourselves and to each
other.
WHAT IS AN OVERDOSE?
Drugs that people take to get high work by
affecting the brain. Because the brain
controls other parts and functions of the body
(like the lungs which enable oxygen to get to
the blood, the kidneys and liver which remove
toxins from the body, and the heart which
pumps blood to all parts of the body), using
drugs can affect one or more of these crucial
activities in addition to making you high. For
example, cocaine speeds up your heart rate and
heroin slows down your breathing. A person’s
body can usually adjust to these changes, but
if you take too much of a particular drug,
such changes may overwhelm the body’s ability
to adjust to them and very dangerous side
effects can occur. Some side effects that
occur from taking a lot of drugs are often
serious but not immediately life-threatening,
such as the damage that can result to the
liver and kidneys from making them work hard
to remove drugs from the body over a period of
years. But if too much of a drug gets to the
brain or other organs too fast, dangerous side
effects such as unconsciousness, stopped
breathing, heart failure, or seizures may
occur — any of which can be deadly. This is
what is known as a drug overdose (o.d.).
Overdoses are very serious but do not have to
be fatal. Often, the difference between life
and death depends on who is around and what
actions they take to care for a person who has
overdosed.
This chapter will help you or someone you love
avoid overdosing in the first place and give
you some basic information about what to do in
case you’re with someone who overdoses. There
is no reason you should die just because you
get high!
HOW DO O.D.’s HAPPEN?
Anyone who uses drugs can overdose, from the
first-time user to the person with many years’
experience. There are numerous reasons a
person can overdose:
* One of the effects of drugs being illegal is
that there is no quality control; in other
words, you don’t know what you’re getting.
Drugs you buy on the street — especially
drugs like heroin that, unlike pills, are not
made by drug companies — can be a different
strength from day to day. Sometimes a drug may
be cut a lot, and sometimes it’s hardly cut at
all and therefore much stronger. If you’re
using drugs of unknown strength (and you are
every time you purchase from a different
dealer or new batch), do a tester shot first
to see how strong they are. You can always do
more later. Many people overdose when they do
a full hit of a strong drug.
Warn people you’re using with, or have gotten
drugs for, if you come across something that’s
unusually potent.
* Sometimes dope, speed, and coke are cut with
other, cheaper drugs which can be dangerous
and unpredictable and increase your chances of
overdosing. If possible, try to purchase your
drugs from a regular source that, to the
extent possible given the situation, you can
trust. Establish a relationship with a dealer
who you feel you can talk to about his or her
product.
* Some people overdose because they simply do
too many drugs which build up in their system.
Let your drugs work first before you do more,
and perhaps plan to use only a certain amount
(maybe even purchasing just the amount you’re
going to use at a given time). Take your time
to prepare your drugs right, even if you’re in
withdrawal or in a hurry. Minimize uncertainty
by thinking through each step of your
drug-taking. Deep breathing may help focus
you, and sniffing or smoking a little bit of
the drug may help calm you before preparing
your injection.
* Take control of your own drug preparation
and intake. Different users have different
tolerances to drugs, so a dose that’s fine for
one person could be lethal to someone else.
Make sure you know what you’re putting into
your own body.
* A person can overdose if they haven’t used
for a while, even for a short time. After
detoxing or spending some time in a
rehabilitation center, your body is no longer
used to the same amount of drugs. One of the
consequences of jailtime is that your
tolerance decreases and you’re a lot more
sensitive to dope, so be careful if you’re
getting high after release. Take a smaller
dose if you’re using after a break until you
figure out how much you need. Someone who’s
using a drug for the first time should also be
extremely careful, since they will have no
tolerance to it at all. You might try using
the drug in a way that makes it come on more
slowly (sniffing heroin or cocaine rather than
injecting it, for example). And make sure you
use with someone who knows what they’re doing
and has experience with the drug.
* Mixing drugs like heroin, pills, and alcohol
can be very dangerous. One of the most common
reasons for death from an o.d. is mixing
drugs, since drugs that are taken together can
be much stronger than if they’re taken alone.
You may get a stronger high when you mix, but
you’re also putting yourself at much greater
risk of having an overdose. Mixing drugs also
increases the risk of passing out and
vomiting, and vomit can block your airways and
cause you to suffocate. Finally, some
pharmaceuticals may interact with “street”
drugs in dangerous ways. If you feel
comfortable doing so, you might want to talk
to your doctor about this issue.
* Changes in your health may cause you to be
at higher risk for an o.d. If you have lost a
lot of weight, a smaller amount of a drug will
get you high; and if your liver or kidneys
aren’t working well, you can overdose easier.
Your body is less able to protect itself after
you’ve been sick, so help it out by using less
and giving it a chance to recover. Eat and
sleep well, always drink a lot of fluids, and
get that annual physical.
* Using drugs alone increases the chance that
if you overdose, it will be fatal because you
can’t take care of yourself or call for help.
If you find yourself alone in an overdose
situation and have called 911, remember to
unlock your door so that the paramedics can
get inside. If possible, use with people who
care about you and who you trust, and sit down
and talk with them about an overdose plan. Try
to put together a support system for yourself
of people who know you use and will be there
for you if something happens.
HOW CAN YOU TELL IF A PERSON HAS OVERDOSED?
Depressant drugs like opiates (e.g., heroin
and Dilaudid) and sedatives (e.g., Valium and
alcohol) slow down the body’s functions. A
person who overdoses on a depressant will
experience respiratory arrest–that is, their
breathing will become life-threateningly slow
or stop altogether, leading to heart failure.
Stimulant drugs, such as cocaine and speed,
can cause a person who has overdosed to have a
heart attack or experience cardiac arrest,
collapse from exhaustion, have a seizure, or
become so disoriented that they accidentally
hurt themselves.
One of the clearest signs that someone is
overdosing is that their face or lips will
turn blue. They may also look very pale; be
very limp; be able to breathe and look at you,
but not be able to talk; be breathing, but
very slowly and shallowly; stop breathing
altogether; have a slow pulse (heartbeat) or
no pulse at all; foam at the mouth; vomit; be
shaking or have a seizure; complain of chest
pain, pressure, tightness, or shortness of
breath; or suddenly collapse and become
unconscious. You have about 4 minutes from the
time your lips turn blue to coma. A person who
is overdosing isn’t usually aware of what is
happening because of the effects of the drug
they’re on. They are helpless and need someone
to act quickly. If a person stops breathing,
it can take only a few minutes for them to
die. Just waiting for them to “get over it” is
the worst thing you can do if someone is
overdosing. Immediate action must be taken to
help them survive.
WHAT TO DO IF SOMEONE OVERDOSES
Anyone who uses drugs should develop an
overdose plan in the event that something
happens. If someone is overdosing, follow
these steps:
1. Check to see if the person is able to open
their eyes or speak to you. Shake them and
call their name.
2. Check the person’s pulse and breathing.
Does a mirror held under their mouth fog up?
Can you feel their breath on your hand? Is
their chest moving up and down? Can you detect
a heartbeat when you put your ear to their
chest?
3. If the person doesn’t respond or seems to
have stopped breathing, try to bring them
around by pinching their earlobes or rubbing
their breastbone with your knuckles. Try to
get them up and walking around, even if you
have to hold them up. Talk to them. It is
important to keep someone who has overdosed as
alert as possible.
4. If the person has stopped breathing, they
need attention immediately or they will die
within minutes if they don’t get air. Keep
them alive by giving them mouth-to-mouth
resuscitation.Helping with breathing is
relatively harmless­ it’s the pumping the
chest that can be harmful and that should only
be done by someone who knows how. Call 911 and
tell them that the person has stopped
breathing. Put them in the “recovery position”
on the floor.
5. If you can’t get them in the “recovery
position,” tilt the body forward instead of
leaning back so that their airway will be
clear and fluid will come out of their mouth.
REMEMBER, vomit carries virtually no
communicable diseases as it’s acidic and kills
bacteria. So, clean out their mouth with your
hand (don’t use water because they may choke),
and GET TO IT. It may be gross, but it could
save someone’s life.
6. If the person is unconscious, (that is, you
can’t wake them up no matter what you do),
call 911 immediately! If they are going to
have a seizure or stop breathing, you want
them to be in an ambulance or at a hospital
when it happens. Don’t wait for them to just
“come out of it.”
7. If the person is conscious but experiencing
nausea, chest tightness, shortness of breath,
or other such symptoms, convince them to call
911 or call 911 for them.
8. When you call 911, you don’t have to tell
the operator that the person has overdosed.
This will prevent a lot of police from
arriving with the ambulance. While you’re
waiting for the ambulance, check to see if the
person’s airways are clear, but do not stick
anything into their mouth unless you can see
something blocking their throat, like vomit or
food.
9. Never leave someone alone who has
overdosed. If you need to remove drugs or
smoking or injection equipment before the
ambulance arrives, don’t let the person out of
your sight. If you absolutely must leave the
person alone for some reason, put them in the
recovery position, call 911 before you leave
or from another nearby location, and make sure
the ambulance technicians will be able to gain
access to where the person is.
10. When the ambulance arrives, tell the
emergency medical technicians (EMTs) that the
person sometimes uses ‘x’ drug. They can best
help the person if they know what has
happened. The EMTs will need to know how to
treat the person, but you don’t have to tell
them you used drugs with your friend. The
ambulance service will generally not call the
police unless they are physically threatened.
Be respectful of the EMTs and they will
usually just do their job.
What you should NOT do if someone overdoses
There are also some things you should NOT do
if someone you’re with has overdosed:
* Do NOT inject a person who has overdosed
with salt water. This is an old junky myth and
will do nothing to help revive the person.
* Do NOT inject a person who has overdosed on
heroin with cocaine or speed, or vice versa.
It will just waste valuable time and probably
make them worse.
* Do NOT give CPR (this is the heart
compression part–the pumping the chest)
unless you know how. You may do more harm than
good. Mouth to mouth resuscitation is okay.
If you want to learn CPR, call your local Red
Cross or see if your needle exchange offers
classes. Learning CPR is one of the most
important things you can do to help someone
survive an overdose. Every user should learn
CPR!
* Do NOT put the person in a cold water bath
because it may cause them to go into shock or
to drown. You can put them in a cool shower to
wake them up, but you must stay there with
them. Do NOT put ice on their genitals (down
their pants).
* Again, do NOT leave someone alone who has
overdosed, even after you’ve called an
ambulance. Your friend will need you to see
them through this very scary experience.
NARCAN
Narcan (naloxone) is an opioid antagonist
that, when injected into a person who is
overdosing on heroin, methadone, or other
synthetic opiates, immediately counters the
effects of these drugs and brings the person
‘to.’ Narcan can be given intravenously or by
intramuscular injection. Ambulances and other
emergency response vehicles often carry Narcan
to use in the event of an opiate overdose, and
some detox programs still use Narcan to
initiate withdrawal when a patient is
admitted. Narcan is restricted for use by
medical and health professionals only, and
will only help someone who has overdosed on
heroin or another opiate.
Giving someone who has overdosed an injection
of Narcan can get pretty hectic because the
person’s body is thrown into severe withdrawal
almost immediately, causing them extreme
dislocation and discomfort. The person who is
overdosing may become quite upset, begin to
thrash around and scream, become physically
aggressive, and even refuse to go to the
hospital. Encourage medical personnel to
administer Narcan slowly to make the
transition to withdrawal less painful and more
gradual. Because Narcan is short-acting and
wears off relatively quickly, the person can
revert back to a state of euphoria and, if
they still have enough drugs in their system,
begin to overdose again. It is therefore
important to have an adequate supply of the
drug on hand and experience in properly
administering it.
Some clinicians prefer not to administer
Narcan in the event of an overdose because of
its disturbing and harsh effects. The major
problem for people overdosing on opiates is
that they stop breathing; as long as emergency
measures are taken to keep an overdose victim
breathing, most people will wake up and “come
to” within a few minutes without the profound
shock caused by Narcan administration.
ACCIDENTAL NEEDLESTICK INJURIES
There is a remote chance of being infected
with HIV if you are pricked or scratched with
a used needle. The risk of infection from
hepatitis and tetanus are far greater if the
needle was contaminated with either of these
pathogens, both of which are much more
infectious than HIV. If you are accidentally
stuck with a needle that was used by someone
else, try not to panic and take the following
precautions:
1. Encourage the wound to bleed by squeezing
the puncture site. This will help keep any
pathogens from entering your body.
2. Wash the wound with soap and water as soon
as possible.
3. Apply an antiseptic and a sterile bandage.
4. Seek medical attention from an emergency
room or clinic. If the person whose needle you
were stuck with is HIV+, you may be encouraged
to take a short regimen of anti-viral drugs to
prevent infection with the virus. You may also
be offered a tetanus shot. If not, you may
want to request one if your vaccination is not
current.
5. If you’re around needles and syringes
regularly, you may want to get a tetanus
booster every five years and be vaccinated
against hepatitis-B.
There is no reason that accidental
needlesticks should happen.
* If at all possible, never handle injection
equipment that was used by someone else,
especially if it is uncapped.
* NEVER try to re-cap a needle that was used
by someone else.
* ALWAYS re-cap your own needle immediately
after use.
* Do NOT break the needle off with your
fingers.
* Always store your used needles and syringes
safely (see chapter 5).
Chapter 5: Tools of the trade: Where to Get
New equipment, and what to do with the old
For your safety and the safety of others, it
is extremely important to store and dispose of
used injection equipment properly. There is no
excuse for being lazy or sloppy about how you
get rid of your potentially contaminated
needles and syringes.
Throwing your equipment in an empty lot, park,
public bathroom, playground, or anywhere else
where someone might get stuck endangers the
health of others, gives all of us a bad name,
and fuels discrimination against drug users.
Be considerate of the people who take away
your garbage, and think about where those
needles and syringes that you flush down your
toilet end up! Take the time to dispose of
your equipment right.
SAFE STORAGE AND HANDLING OF INJECTION
EQUIPMENT
Particularly if you have small children,
always store your injection equipment–dirty
or clean–in a location where others are not
likely to come across it. Keep your new
equipment in its package until you’re ready to
use it so that it remains sterile, and store
your needles and syringes in a cool, dry
place.
Always carefully store your used needles and
syringes in a coffee can, spaghetti sauce jar,
sharps container, polyurethane soda bottle, or
similar container to prevent accidental
needlesticks. If you live with another
injector, be sure to keep your equipment
separate to prevent accidental sharing. You
might also want to mark your syringes so you
can tell them apart.
PROPER DISPOSAL OF USED EQUIPMENT
It’s best to take your used equipment to a
needle exchange program or some other place
where it will be properly disposed of. If you
don’t have access to such a program, throw it
in the garbage but only after you’ve securely
packaged it in a puncture-proof container.
Don’t flush your used equipment down the
toilet because it may end up on a beach or in
the ocean somewhere or stick the plumber who
has to unclog the pipes.
Fortunately, many communities now have needle
exchange programs where you can get new,
sterile equipment for free and dispose of your
used works. Definitely check out your local
needle exchange if there is one, and get
involved! It’s a great way to help out
yourself and other users.
You may live in a place where you can buy
injection equipment over the counter. Try to
find a cooperative pharmacist and let him or
her know you appreciate their assistance. Let
other users know what drug stores will sell
equipment to them.
If there are no other options, you can usually
find injection equipment on the black market.
If you purchase needles and syringes on the
street, however, clean them before you use
them; sometimes dirty equipment is re-packaged
and sold as new.

 

 

  8 Responses to “How to Shoot Up: A Safety Manual For Injection Drug Users”

  1.  

    I am impressed by the quality of information on this website. There are a lot of good resources here. I am sure I will visit this place again soon.

  2.  

    Thank you we post everything we humanly are able to, being that it is only two of us as well as one new guest blogger we just recently acquired! Yet, we have so many more ideas and so much more content so please keep checking back with us as there will always be new content on a very regular basis. Actually, as long as AHA is around, there will be new content being added! So thank you and please come back soon!

  3.  

    Would like the ebook on shooting up. Thank you dawn

  4.  

    thanks helped alot!!!!! :)

  5.  

    wish i woulda went here sooner… my girlfriend has cotton fever :(

  6.  

    I believe I sent it to you but if not we changed the section around, so if you check again all you have to do is tweet the post and the download will become available!

  7.  

    It’s very simple to find out any topic on net as compared to textbooks, as I found this paragraph at this web page.

  8.  

    WOW..I knew doing dope this way was bad…but I had no idea it was this bad!! No wonder ppl freak out and look at you like your crazy:-(

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