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Safer injecting

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

  1. Use your own injecting equipment
  2. Don’t lend or borrow used injecting equipment
  3. Use your own spoon, water and filter
  4. Use the smallest needle for the injection site
  5. 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 emergency
  6. 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:

  1. Hygiene: Wash your hands before start as this will help reduce the spread of infection and other health problems.

  2. 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 to. 

    Syringes: Select the smallest size needle for the injection site; using a smaller needle will cause less damage to the veins.  

    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.

  3. 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 cool. 

    Put all used equipment in a sharps bin.  Remember, your sharps, your responsibility

Injecting

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 vein
Different injection methods need different injection positions:
  • 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 injection

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 cause pain. 

Draw back gently
For IV injecting: blood is present
If dark red, continue
If bright red -stop. This means that an artery has been hit

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 your responsibility!

Wash hands after injecting to stop the risk of spreading infection.

Further advice on injecting

Ensure that you are

  • Hydrated
  • Relaxed
  • Sitting or lying down

Site preparation:

  • Vein prominent
  • Skin cleaned with swab
  • Allow the alcohol form the swab time to evaporate
  • Stretch skin below vein if another person is injecting.

Insert needle:

  • 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 too tight)
  • 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 gently
  • 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 burst veins)

Remember:

  • 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)

Injecting Alternatives

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.

Rectal

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

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

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 option.

Supporting Documents