The best way to avoid harm from injecting is not to start. This section has been written for current IV users only. The hi team have tried to make our injecting information easy to understand, but also to provide stimulating ways to work through the process with clients. Injecting carries many risks; the more information individuals have about the process the fewer the risks.
The Injecting Process
Injecting illicit drugs will always carry risks, this section
aims to help reduce those risks for those who already inject drugs.
These pages are intended to be used by harm reduction workers to
provide safer injecting advice for clients.
Avoiding injection is the best way to avoid harm.
Six golden rules for self-injecting
- Use your own injecting equipment
- Don’t lend or borrow used injecting equipment
- Use your own spoon, water and filter
- Use the smallest needle for the injection site
- Don’t inject alone. Try to do it with other people
around, and try to make sure you all know what to do in an
- Use your own works once only
Pates, R. McBride, A. Arnold, K. (2005) “Injecting
illicit Drugs” Blackwell Publishing
Safer Injecting Points
Preparation and the Injection Process:
Hygiene: Wash your hands before start as this will help reduce
the spread of infection and other health problems.
Surface: Use a clean surface to prepare injection this helps to
stop the spread of infection and blood- borne virus. Lay the
new equipment out on paper to prevent cross infection. Putting the
equipment on paper will mean that you have a cleaner surface to
prepare the drugs on and you know who the equipment belongs
Syringes: Select the smallest size needle for the injection
site; using a smaller needle will cause less damage to the
Cookers and Filters: Most injecting drug users now use a cooker
or a spoon in which they heat the substance with powdered Citric
Acid or Vitamin C and sterile water that breaks the substance down
to liquid. The cookers usually have a fixed filter, which enables
them to pass the substance through. If a spoon is used or there is
no filter available, a clean hand-rolling filter can be used.
Cigarette filters are less effective than hand roll filters, but
syringe filters are most effective. Don’t share this equipment and
dispose of it after use.
Citric: Using less citric will reduce the risk of burns to the
skin and veins. The “how much citric” video on this
site will describe some of the benefits of getting the amount of
citric right. Remember, less is more!
Swabs: Use an alcohol swab before injecting, but make sure you
let the area dry before injecting. Do not use alcohol swabs
after injection as it encourages bleeding.
Water: A freshly opened ampule of sterile water is best for
injecting. Throw away unused water, because as soon as the
lid is off bacteria can start and grow. Next best thing is recently
boiled water, as the boiling process will kill any bacteria. The
water is added to the substance.
When the solution has been mixed on the spoon or steri-cup, heat
with a freestanding heat source. Do not overheat as boiling
evaporates some of the drug.
Once heated stir gently with needle sheath
Using a new filter draw up the solution making sure that the
needle aperture is pointed down as more of the drug gets into the
syringe this way.
Do not rub the needle on the bottom of the spoon or cup; this will
make the needle blunt.
When it is all drawn up, gently push the plunger up until a drop
of the drug appears at the needle end. Do not lick the needle
as the bacteria from the mouth are then transferred on to the
needle and into the blood stream.
Clear up all paraphernalia while waiting for the solution to
Put all used equipment in a sharps bin. Remember, your
sharps, your responsibility
Raise a vein
- If using a tourniquet don’t have it on so tight, this reduces
the blood flow and the size of the vein. If you feel any tingling
in your fingers or discomfort in the limb, the tourniquet is on too
tight. Stop the process and loosen it before you continue.
- Ensure you have the smallest size needle for the injection
- Ensure that aperture is facing up. If it is down it may rest on
the bottom of the vein and cause trauma
- Point the needle towards the heart in direction of the blood
flow. Pushing against the blood flow will put pressure on the
Different injection methods need different injection
- IVI Syringe at 15 to 45 degrees for intravenous injection (this
prevents the needle touching the wall of the vein
- IMI Syringe at 90 degrees for intramuscular injection
- SC Syringe at 15 to 30 degrees for subcutaneous
Insert needle slowly, feel for resistance, and stop pushing if
you feel resistance.
Reduction in resistance means that the needle has entered more
pushing will pass the needle through the vein into the tissue and
Draw back gently
For IV injecting: blood is present
If dark red, continue
If bright red -stop. This means that an artery has been
For IMI and SC if you see blood it’s not good.
Release the tourniquet (if IVI)
Continue to push plunger slowly; if there is any pain, unusual
sensation or anything different, stop. The needle may have
gone through the vein or the drugs may be much stronger and may
cause an overdose.
When finished, remove needle and syringe slowly.
Use clean cotton or tissue to stem any blood flow.
Dispose of any sharps in the sharps bin. Remember, your sharps
Wash hands after injecting to stop the risk of spreading
Further advice on injecting
Ensure that you are
- Sitting or lying down
- Vein prominent
- Skin cleaned with swab
- Allow the alcohol form the swab time to evaporate
- Stretch skin below vein if another person is
- In the direction of venous blood flow
- Aperture facing up (down if drawing up)
- 15 to 45 degree angle
- Up and along the vein
- Only part way in
Raising veins in hand and arms
Choose fullest looking vein
Raise less prominent veins, improving access by:
- Being in a warm environment
- Applying tourniquet, not too tight (putting it on too tight
will result in reducing the size of veins; if the person feels
tingling/pins and needles when applying the tourniquet, it is on
- Gently tap the area close to the injection site
- Lower the limb
- Clench fist
- Apply warmth to the site, not too warm as burning can occur and
this will reduce the chance of finding a vein
- Massage the arm from wrist to elbow, with care and very
- Squeezing biceps
- Explore other sites, use fingers to feel for veins, it may be
possible to feel veins that can not be seen.
What to avoid when injecting intravenously
- Avoid injecting standing and unsupported
- Damaged or thrombosed/ collapsed veins
- Swollen skin or tissues
- Rolling veins, ones that move easily
- Arteries (bright red frothy blood)
- Inserting needle too deep or too shallow (both leading to
missing vein and then drug getting into tissue)
- Pulling too hard on the plunger
- Pushing too hard on the plunger (the increased pressure can
- Keep in good health
- Inject less frequently
- Learn which veins to access
- Learn where to avoid
- Learn to feel the veins
- Rotate sites, so as not to overuse sites
- Use sharp needles (even after one use the tip of the needle
bends, this causes damage to veins)
Smoking or Chasing Heroin
Smoking offers lower risks than injecting, both in terms of
viral transmission and risk of overdose. The effect does not offer
the same intensity as injecting, but is a gentler and less risky
form of use. Compared with injecting, smoking the drug offers no
risk of viral transmission, a lower risk of overdose and lower
health risks. It is also an alternative for those who are having
difficulty finding veins or need to rest sites.
Taking drugs into the body via the anus is a method that is
occasionally practiced using a syringe without a needle. Due to the
large number of blood vessels available in this area to absorb the
drug, some of the rush is retained and the risks of sharing
equipment are lowered.
Sniffing drugs is normally safer than injecting due to the
lesser risk of transmitting blood-borne viruses. There still is
some risk if straws etc. are used by more than one person.
Continued sniffing of drugs can lead to damage of the mucous
membranes of the nose.
Swallowing drugs is common for amphetamine users, either
dissolving in a drink or by ‘bombing’. For those who crush tablets
such as benzodiazepines for injecting, swallowing is a much safer
option and the effect, although slower to start, will be the
same. For any injector contemplating injecting risky
substances e.g. the leftovers, swallowing may represent the safest