Routes of administration: Difference between revisions

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~~=General=~~

~~The~~ method in which a ~~drug has been ingested~~ can greatly ~~effect the~~ potency, duration, and ~~overall experience of a drug~~. ~~Many~~ substances are more effective when consumed using ~~certain ROA's over others~~, ~~and~~ some ~~drugs~~ are completely inactive ~~using~~ certain routes ~~of administration~~. Determining a route of administration is highly dependent on the substance consumed, desired duration of the substance,and ~~personal comfort~~.

A '''route of administration''' is the method in which a [[psychoactive substance]] is delivered into the body.

The route through which a substance is administered can greatly impact its potency, duration, and [[subjective effects]]. For example, many substances are more effective when consumed using particular routes of administration, while some substances are completely inactive with certain routes.

Determining an optimal route of administration is highly dependent on the substance consumed, its desired duration and potency and side effects, and one's personal comfort level.

Intravenous injection is the fastest route of administration, causing blood concentrations to rise the most quickly, followed by smoking, suppository (anal or vaginal insertion), insufflation (snorting), and ingestion (swallowing).<ref>{{cite journal |url=https://www.researchgate.net/publication/312678025 |doi=10.1016/j.drugalcdep.2016.08.210|title=Intravenous and smoked methamphetamine produce different subjective and physiological effects in women |year=2017 |last1=Goeders |first1=Nicholas E. |journal=Drug and Alcohol Dependence |volume=171 |pages=e73 }}</ref> A rapid rise in concentration can trigger an intense surge of effects for many substances. A rapid rise in concentration can trigger a quick [https://en.wikipedia.org/wiki/Rush_(psychology) rush] of effects for many substances.

==Multi-route hazard substances==

===Orally inactive tryptamines===

* Substances: [[5-MeO-DMT]], [[DMT]].

* Routes of administration:

** Oral: When these substances are taken orally, they are inactive because stomach enzymes called MAO enzymes break it down. To experience effects orally, they are frequently combined with [[MAO inhibitor]]s (MAOIs), which prevent this breakdown. This combination is known as [[pharmahuasca]] for [[DMT]] (or [[5-MeO-DMT]]). When the MAOIs and DMT are derived from plant extracts, it is referred to as [[ayahuasca]]. However, it is important to note that MAOIs require careful consideration, as they can be dangerous when combined with certain drug classes, potentially leading to life-threatening consequences if not used properly.

* Orally ingested as unintended second route: Any amount swallowed undergoes rapid enzymatic degradation in the stomach, rendering it inactive. This can introduce variability in effect intensity among users. Inconclusive experiences due to the swallowed substance may lead to a false sense of security, potentially causing users to increase the dose in subsequent administrations. However, due to the unpredictable nature of salivation or intranasal dripping, this could result in an unexpectedly potent dose due to less substance being metabolized in the stomach.

** In the mouth (buccal (sublabial), sublingual): Holding the substances in the mouth can increase salivation, causing it to be swallowed and deactivated by stomach enzymes. Additionally, many alkaloids, have a bitter taste that makes them difficult to keep in the mouth, triggering a swallowing reflex. To improve tolerability with this route, using a safe taste-masking agent is recommended.

** Insufflation (snorting): When these substances are delivered intranasally (through the nose), they can deposit along the nasal passage and drip down into the gastrointestinal tract.

==Oral cavity==

''It is worth noting that most substances are reported to be strongly bitter and unpleasant to administer via sublingual or buccal routes.''

===Oral===

~~Arguably~~ the most common route of ~~adminstration~~ for most classes ~~of drugs, oral adminstration~~ allows a substance to be absorbed through blood vessels ~~contained in~~ the stomach, ~~where Enterochromaffin cells contain approximately 90%~~ of the ~~bodys serotonin~~. [1] ~~Due to this~~, absorption ~~of serotonin releasing drugs~~ such as [[~~MDMA~~]], [[~~BK-MDMA~~]], and [[~~MDAI~~]] ~~have been shown~~ to ~~have~~ a ~~higher overall effectivity when compared~~ to insufflation.

Oral administration is the most common route of administration for most substance classes. This route allows a substance to be absorbed through blood vessels lining the stomach and intestines. The onset is generally slower than other methods of ingestion as it must undergo first-pass metabolism through the liver (may vary greatly between individual substances).<ref name="Ohlsson1980">{{cite journal | vauthors=((Ohlsson, A.)), ((Lindgren, J.-E.)), ((Wahlen, A.)), ((Agurell, S.)), ((Hollister, L. E.)), ((Gillespie, H. K.)) | journal=Clinical Pharmacology and Therapeutics | title=Plasma delta-9-tetrahydrocannabinol concentrations and clinical effects after oral and intravenous administration and smoking | volume=28 | issue=3 | pages=409–416 | date= September 1980 | url=http://doi.wiley.com/10.1038/clpt.1980.181 | issn=0009-9236 | doi=10.1038/clpt.1980.181}}</ref> Additionally, the absorption and overall duration are generally longer as well.

====Risks====

This method can also have a greater propensity for [[nausea]] and gastrointestinal discomfort.<ref>{{cite journal | vauthors=((Niv, D.)), ((Davidovich, S.)), ((Geller, E.)), ((Urca, G.)) | journal=Anesthesia and Analgesia | title=Analgesic and hyperalgesic effects of midazolam: dependence on route of administration | volume=67 | issue=12 | pages=1169–1173 | date= December 1988 | issn=0003-2999}}</ref><ref>{{Citation | vauthors=((Porter, W. R.)) | title=Intraoral methods of using benzodiazepines | url=https://patents.google.com/patent/US4229447/en}}</ref>

[[25I-NBOMe]] is widely rumored to be orally inactive; however, apparent overdoses have occurred via oral administration.

===Oral mucosa===

====Buccal====

[[File:Dipping tobacco in mouth.jpg|thumb|right|[[Dipping tobacco]] is placed directly in the mouth.]]

Buccal administration refers to absorption through the cheek and gum.

This route is commonly employed when ingesting potent psychedelics such as [[25I-NBOMe|25I-NBOMe]], [[DOM]], [[LSD]], and other substances distributed on blotter paper. Potent clandestine manufactured [[benzodiazepines]] like [[alprazolam]] and [[etizolam]] are also sometimes distributed on blotters.

Like sublingual absorption, the substance is largely absorbed through the lingual artery, but is also absorbed through the gum lining. This method is used when chewing plant leaves such as [[khat]], [[kratom]], [[salvia divinorum]], and sometimes [[tobacco]] (snus).

====Sublingual====

Sublingual administration refers to absorption under the tongue.<ref name="DeBoer1984">{{cite journal | vauthors=((De Boer, A. G.)), ((De Leede, L. G. J.)), ((Breimer, D. D.)) | journal=British Journal of Anaesthesia | title=DRUG ABSORPTION BY SUBLINGUAL AND RECTAL ROUTES | volume=56 | issue=1 | pages=69–82 | date= January 1984 | url=https://linkinghub.elsevier.com/retrieve/pii/S000709121742397X | issn=00070912 | doi=10.1093/bja/56.1.69}}</ref> It is a common route of administration for [[lysergamides]] like [[LSD]].

This route causes the substance to be absorbed through the large lingual artery present underneath the tongue, generally resulting in a faster absorption than oral administration.

It also circumvents first-pass metabolism of certain substances which can be absorbed via sublingual and buccal administration but not oral administration (e.g. [[25x-NBOMe]], [[25x-NBOH]]).

=====Risks=====

Caustic compounds, such as the freebase form of amine-containing substance, should not be used sublingually because they can severely burn the inside of one's mouth.

==Nasal cavity==

{{GenericPanel/warning

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===Nasal spray===

[[File:Action photo of nasal spray on a black background.jpg|thumb|150px|Actuation of a nasal spray bottle, used to deliver medication via the nostrils]]

~~===Sublingual===~~

"The administration of nasal powder formulations has been associated with greater sensory irritation than liquid sprays and the amount of powder.".<ref>https://pubmed.ncbi.nlm.nih.gov/35386013/</ref>

~~===Buccal===~~

To learn how to make nasal spray, see the [[nasal spray guide]].

===Insufflation===

===Smoked/Vaporized===

File:Two snuff bullets for snorting drugs in powder form.jpg|Two snuff bullets for snorting drugs in powder form

File:Kuripe.jpg|A kuripe is a simple device which is used to self-applicate a powder (drug). One end is inserted into the nostril, whilst the other is

File:Stopper, snuff bottle (AM 687402-2).jpg|100px|Chinese snuff bottle stopper with a [https://en.wikipedia.org/wiki/Snuff_spoon snuff spoon] (also known as a cocaine spoon)

Image:SpiRaL.jpg|[[Ketamine]] prepared in a spiral for "snorting". A common technique for self-administration of some recreational drugs.

File:Cocaine lines 2.jpg|Lines of [[cocaine]] prepared for snorting

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Insufflation (also called "inhalation" and "snorting") refers to the introduction of a substance into the sinus via the nostrils, circumventing first pass metabolism.

It is a very common method of use for substances in powder form, specifically so-called "street drugs" like [[cocaine]], [[heroin]], and [[methamphetamine]]. Some users find this route to be painful and uncomfortable, although certain substances are easier to insufflate than others.

This method is capable of rapid absorption through mucous membranes and blood vessels in the sinus. Absorption and onset is generally much more rapid than oral and, as a result, a substance feels much more intense and is often shorter acting than if taken orally.

Insufflation is common with substances such as [[cocaine]] and [[ketamine]]. It is also utilized in [[yopo]] rituals, the self-applicator pipe is known as ‘Kuripe’, and the blow pipe is known as a ‘Tepi’ in the Brazilian tradition. Insufflating [[tobacco]] in snuff form was a common practice until the early 20th century.{{citation needed}}

===Risks===

Short-term side effects of insufflation includes nasal congestion, which may last for 24 hours.

Frequent insufflation of some substances can damage one's mucous membranes, induce bleeding, damage the nostril's cartilage and lining, burn the throat, and cause other trauma to the nasal passage and sinus area.<ref>{{Citation | title=Ask Erowid : ID 41 : Is snorting MDMA worse for you than taking it orally? | url=https://www.erowid.org/ask/ask.php?ID=41}}</ref> A [https://en.wikipedia.org/wiki/Nasal_septum_perforation nasal septum perforation] is a medical condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole or fissure.

Also, sharing snorting equipment (nasal spray bottles, straws, banknotes, bullets, etc) has been linked to the transmission of hepatitis C. (Bonkovsky and Mehta) In one study, the University of Tennessee Medical Center researches warned that other blood-borne diseases such as HIV, the AIDS-causing virus, could be transmitted as well.<ref>{{Citation | year=2016 | title=Sharing Drug “Snorting Straws” Spreads Hepatitis C | url=https://consumer.healthday.com/infectious-disease-information-21/hepatitis-news-373/sharing-drug-snorting-straws-spreads-hepatitis-c-713114.html}}</ref> Drinking makes it harder to resist pressure and clouds your ability to make safe choices. Not only might you miss signs of danger, like blood stains on shared equipment, but alcohol weakens your immune system, making it easier to catch and spread viruses.

==Respiratory tract==

{{GenericPanel/warning

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===Inhalants===

File:NOS Cracker With Balloon And Charger.jpg|Food grade nitrous oxide charger (bottom right), cracker (top right) and balloon

File:HOpoppers.jpg|A selection of poppers

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[[Inhalants]] can be delivered through the respiratory system in two main ways:

* Mouth inhalation: This method involves breathing in a gas or vapor through the mouth. [[Nitrous oxide]] is a common example.

* Nasal inhalation: This method involves breathing in a gas, vapor, or volatile liquid through the nose. Volatile viscous compounds like [[poppers]] are typically inhaled this way.

Inhalants do not require an external heat source to produce psychoactive vapors that can then be inhaled through various methods depending on the substance used. Inhaled substances are absorbed very rapidly and lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.<ref>http://www.ct.gov/dds/lib/dds/edsupp/medadmin_recert_part_ii.pdf</ref>

====Risks====

It is substantially easier to overdose on [https://en.wikipedia.org/wiki/Alcohol_inhalation alcohol inhalation] than drinking alcohol.

Many substances can be inhaled to achieve an altered state of consciousness, however, some substances used for this purpose produce highly negative physical and neurotoxic effects including solvents like toluene (see [https://en.wikipedia.org/wiki/Toluene_toxicity toluene toxicity]) often found in glue, acetone often found in nail polish, and gasoline.<ref>{{cite journal | vauthors=((Burbacher, T. M.)) | journal=Environmental Health Perspectives | title=Neurotoxic effects of gasoline and gasoline constituents. | volume=101 | issue=Suppl 6 | pages=133–141 | date= December 1993 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1520019/ | issn=0091-6765}}</ref>, and number of gases intended for household or industrial use including [https://en.wikipedia.org/wiki/Butane butane] gas sold as lighter gas refill.

Inhaling liquified gas directly from cans or canisters can freeze the throat.

===Heating===

[[File:502px-Crack Ingredients.JPG|thumb|200px|right|In order for cocaine (in plastic bag at bottom) to be converted to crack, several supplies are needed. Pictured here are baking soda (a commonly used base in making crack) a metal spoon, a tea light, and a cigarette lighter. The spoon is held over the heat source in order to "cook" the cocaine into crack.]]

Substances that come in HCl form can be converted to freebase by mean of pH regulation. For example, [[cocaine]] decomposes when heated strongly so the freebase and hydrogen carbonate salts of cocaine, which have much lower boiling points compared to the hydrochloride salt, are typically used when the substance is to be vaporized and are known as cocaine base and "crack" respectively.

Other substances decomposes to easily even from low heat so they cannot even be vaporized for this reason. Examples of substances include [[amphetamine]], [[caffeine]], [[LSD]], and [[psilocybin]]. Also, there's not a single trip report in [[PiHKAL]] (''“Phenethylamines I Have Known and Loved”'') in which the subject is smoking or vaporizing the phenethylamine compound. Notable compunds in PiHKAL include [[MDMA]], and the “''Magical half-dozen''” ([[mescaline]], [[DOM]], [[2C-B]], [[2C-E]], [[2C-T-2]], [[2C-T-7]]). However, a [[substituted phenethylamine]] that was synthesized after PiHKAL was released albeit very toxic, [[25I-NBOMe]], has been smoked.<ref name="erowid effects">{{Cite web |url=https://www.erowid.org/chemicals/2ci_nbome/2ci_nbome_effects.shtml |title=2C-I-NBOMe (25I) Effects |publisher=Erowid}}</ref>

====Smoked====

File:Unrolled joint.jpg|''A joint/spliff prior to rolling with a paper handmade filter on the left.''

File:Bong.jpg|A bong

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Smoking substances is a common method of consumption with the most common examples including [[cannabis]] and [[tobacco]]. Smoking yeilds low bioavailability, especially if the substance is smoked slowly.

To smoke a substance a direct heat source, most often a flame, is applied directly to the substance with no barrier between the heat source and the substance. The smoking of substances can lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.<ref name="Ohlsson1980" />

When a substance is smoked, the substance is absorbed through blood vessels found in the bronchi tubes contained within the lungs. Like insufflation, the duration is decreased while its intensity is increased in proportion to oral absorption.

Cannabis is commonly consumed via the respiratory tract. The average THC transfer rate for joints, bongs, and vaporizers, is 20-26%,<ref name="ukcia">https://www.ukcia.org/research/FactorsThatInfluenceBioavailability.pdf</ref> 40%,<ref name="ukcia" /> and 55-83%,<ref>{{cite journal | vauthors=((Lanz, C.)), ((Mattsson, J.)), ((Soydaner, U.)), ((Brenneisen, R.)) | journal=PLoS ONE | title=Medicinal Cannabis: In Vitro Validation of Vaporizers for the Smoke-Free Inhalation of Cannabis | volume=11 | issue=1 | pages=e0147286 | date=19 January 2016 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718604/ | issn=1932-6203 | doi=10.1371/journal.pone.0147286}}</ref> respectively. For a proper gas or smoke deposition, one are advised to take a deep initial breath, and then hold it for 10 seconds to allow for the gas or smoke to get fully absorbed in the lungs. Subjects are frequently instructed to follow the "10 seconds rule" in studies.<ref>{{cite journal | vauthors=((Wallace, M. S.)), ((Marcotte, T. D.)), ((Umlauf, A.)), ((Gouaux, B.)), ((Atkinson, J. H.)) | journal=The journal of pain : official journal of the American Pain Society | title=Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy | volume=16 | issue=7 | pages=616–627 | date= July 2015 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152762/ | issn=1526-5900 | doi=10.1016/j.jpain.2015.03.008}}</ref><ref>{{cite journal | vauthors=((Wilsey, B.)), ((Marcotte, T.)), ((Tsodikov, A.)), ((Millman, J.)), ((Bentley, H.)), ((Gouaux, B.)), ((Fishman, S.)) | journal=The journal of pain : official journal of the American Pain Society | title=A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain | volume=9 | issue=6 | pages=506–521 | date= June 2008 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968043/ | issn=1526-5900 | doi=10.1016/j.jpain.2007.12.010}}</ref> Prolonged breath holding does not substantially enhance the effects of inhaled marijuana smoke.<ref>{{cite journal | vauthors=((Zacny, J. P.)), ((Chait, L. D.)) | journal=Psychopharmacology | title=Response to marijuana as a function of potency and breathhold duration | volume=103 | issue=2 | pages=223–226 | date= 1991 | issn=0033-3158 | doi=10.1007/BF02244207}}</ref><ref>{{cite journal | vauthors=((Zacny, J. P.)), ((Chait, L. D.)) | journal=Pharmacology, Biochemistry, and Behavior | title=Breathhold duration and response to marijuana smoke | volume=33 | issue=2 | pages=481–484 | date= June 1989 | issn=0091-3057 | doi=10.1016/0091-3057(89)90534-0}}</ref>

Bongs that are cleaned regularly eliminates yeast, fungi, bacteria and pathogens that can cause several symptoms that vary from allergy to lung infection.<ref>{{Citation | title=Can You Get Sick From Dirty Bong Water? | url=https://herb.co/learn/sick-dirty-bong-water/}}</ref><ref>https://www.maryjanetokes.com/dirty-bong-the-dangers-of-using-one/</ref><ref>{{Citation | year=2018 | title=The Dangers of a Dirty Bong | url=https://www.leafscience.com/2018/07/16/dangers-dirty-bong/}}</ref>

=====Gravity bong=====

[[File:Buckie.JPG|thumb|A gravity bong made from a large PET bottle and a bucket.]]

See [https://en.wikipedia.org/wiki/Gravity_bong Gravity bong (Wikipedia)]

File:Bucket bong diagram.jpg|Diagram of bucket bong in operation

File:Waterfall bong diagram.svg|Diagram of waterfall bong in operation

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=====Spots=====

[[File:Spots.jpg|thumb|Spotting knives heating]]

[https://en.wikipedia.org/wiki/Spots_(cannabis) Spots] (also known as spotting, knifers, knife hits, knife tokes, dots, hot knives, kitchen tracking blades, or bladers) refers to a method of smoking cannabis.<ref>Handbook of Pharmacy Education, Harmen R.J., 2001, Pg 169</ref> Small pieces of cannabis are rolled (or simply torn from a larger bud) to form the spot.

======Risk======

Users spotting cannabis are susceptible to greater health risks than other methods of smoking cannabis. Spotting cannabis oil or resin is thought to be particularly harmful to the lungs, as the smoke comes off the oil at such a high temperature.<ref>

[https://web.archive.org/web/20071027140016/http://www.healthaction.org.nz/Dope_Tips_II.htm Dope Tips II dope tips, reducing cannabis related harms, tips for safer use of cannabis use in nz, using marijuana]</ref>

====Vaporized====

File:Volcano Vaporizer.jpg|''A forced-air vaporizer. The detachable balloon (top) fills with vapors that are then inhaled.''

File:VripTechVHWInAction.jpg|A vaporization heat wand and vaporization chamber bowl used to deliver vapor through a water pipe

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Vaporizing substances is a common method of consumption with the most common examples including [[cannabis]] and [[nicotine]], but also [[heroin]] and [[cocaine|crack-cocaine]]. Vaporizing a substance, especially with a digital temperature controlled device, allows for more temperature control because the flame or heat source does not come into direct contact with the substance.

Even though many drugs, like [[heroin]] and [[oxycodone]] pills are colloquially referred to as "smoked" the process used to consume them is vaporization. Vaporizing substances can lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.<ref name="Ohlsson1980" />

When a substance is vaporized, the substance is absorbed through blood vessels found in the bronchi tubes contained within the lungs. Like insufflation, the duration is decreased while its intensity is increased in proportion to oral absorption.

Vaporization is commonly associated with the vaporizer pens that have become popular within the past decade, but it is not limited to ingesting the vapors from an electronic heat source.

=====Risks=====

Smoking a substance that should be vaporized leads to a blast of heat that may burn off the active ingredient or ignite the substance itself, both of which are wasteful and incorrect, which may cause judgement impairment of the dosage.

Ethnobotanist Daniel Siebert cautions that inhaling hot air can be irritating and potentially damaging to the lungs. Vapor produced by a heat gun needs to be cooled by running it through a water pipe or cooling chamber before inhalation.<ref>{{Citation | title=Ask Erowid : ID 3139 : Do vaporizers work with Salvia divinorum? | url=https://www.erowid.org/ask/ask.php?ID=3139}}</ref>

Re-used uncleaned vapes, and vape sharing, may cause bacterial pneumonia,<ref name="pmid32042584">{{cite journal |last1=Kooragayalu |first1=S |last2=El-Zarif |first2=S |last3=Jariwala |first3=S |doi=10.1016/j.rmcr.2020.100997 |pmid=32042584 |pmc=6997893}}</ref><ref>{{cite web |title=Vaping changes oral microbiome and raises infection risk |url=https://www.medicalnewstoday.com/articles/vaping-changes-oral-microbiome-and-raises-infection-risk |website=www.medicalnewstoday.com |language=en |date=14 March 2020}}</ref> fungal pneumonia,<ref>{{cite web |last1=Mughal |first1=Mohsin Sheraz |last2=Dalmacion |first2=Denise Lauren V. |last3=Mirza |first3=Hasan Mahmood |last4=Kaur |first4=Ikwinder Preet |last5=Dela Cruz |first5=Maria Amanda |last6=Kramer |first6=Violet E. |title=E-cigarette or vaping product use associated lung injury, (EVALI) - A diagnosis of exclusion |url=https://www.sciencedirect.com/science/article/pii/S2213007120303889 |website=Respiratory Medicine Case Reports |pages=101174 |language=en |doi=10.1016/j.rmcr.2020.101174 |date=1 January 2020}}</ref> and viral pneumonia.<ref name="pmid32042584" />

=====E-cigarette=====

[[File:Electronic Cigarette and USB Charger (14939561277) (retouched).jpg|thumb|upright=1.25|A first-generation e-cigarette that resembles a tobacco cigarette, with a battery portion that can be disconnected and recharged using the USB power charger|alt=Photo of device]]

An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such, using an e-cigarette is often called "vaping". The atomizer is a heating element that vaporizes a liquid solution called e-liquid. The most common e-liquid carrying agents includes glycerin (often called vegetable glycerin, or VG), and propylene glycol (often referred to as PG).

======Risks======

[https://en.wikipedia.org/wiki/Vaping-associated_pulmonary_injury Vaping-associated pulmonary injury] (VAPI) is an umbrella term used to describe lung diseases associated with the use of vaping products that can be severe and life-threatening.

Glycerin was long thought to be a safe option. However, the carcinogen formaldehyde is known as a product of propylene glycol and glycerol vapor degradation.<ref>{{cite journal |last1=Lestari |first1=Kusuma S. |last2=Humairo |first2=Mika Vernicia |last3=Agustina |first3=Ukik |title=Formaldehyde Vapor Concentration in Electronic Cigarettes and Health Complaints of Electronic Cigarettes Smokers in Indonesia |journal=Journal of Environmental and Public Health |date=July 11, 2018 |volume=2018 |pages=1–6 |doi=10.1155/2018/9013430 |pmid=30105059 |pmc=6076960 |issn=1687-9805|doi-access=free }}</ref>

=====The Machine=====

[https://wiki.dmt-nexus.me/The_Machine The Machine], utilizing a glass bottle with a hole, and foil in the neck. The Machine was invented to make it more convenient to smoke [[DMT]], but it can be used for any substance.

=====Chasing the dragon=====

[[File:Chasing.jpg|thumb|Chasing the dragon, aka foily, can be considered unresponsible drug use due to its unpredictable nature.]]

[[Heroin]] is colloquially referred to as "smoked" but is really vaporized, often using tinfoil as a barrier between the substance and the flame source. The heat source can be held at different distances as temperature control. An alternative version is to use a "stainless steel one-quarter teaspoon and vaporized it over a cigarette lighter collecting the smoke in an upside-down funnel."<ref>{{cite web |title=Erowid Online Books : "TIHKAL" - #38 5-MEO-DMT |url=http://www.erowid.org/library/books_online/tihkal/tihkal38.shtml |website=www.erowid.org}}</ref>

======Risks======

Overdosing from inhaling vaporized drugs through the "chasing the dragon" method is extremely difficult to anticipate. This technique does not allow for a controlled, standardized dose. Even experienced users cannot accurately gauge how much of the substance has been vaporized, burned, and ultimately inhaled into the body.

The inconsistent and unregulated nature of this consumption method creates a false sense of safety. A dose that seemed harmless one time may potentially prove fatal the next, as various random factors influence how much of the drug is actually ingested.

Moreover, using specialized smoking devices like bongs designed for more efficient inhalation dramatically increases the amount consumed compared to rudimentary foil methods. An amount that may have been tolerable when smoked off foil could easily become an overdose when the same quantity is fully vaporized and inhaled through an optimized apparatus.

The lack of dosage control and potential to underestimate potency make chasing the dragon an inherently risky and unpredictable way to use drugs, with an ever-present danger of accidental overdose.

[[#The Machine]] is a much safer than "chasing the dragon".

==Injection==

[[File:Angles for injections.png|400px|thumb|right|A diagram showing the different angles needed for different types of injections]]

[[Safer_injection_guide#Substances_that_are_dangerous_to_inject|Some drugs '''should not''' be taken by injection]]: For example, injectable [[codeine]] is available for subcutaneous or intramuscular injection only; intravenous injection is contraindicated as this can result in non-immune mast-cell degranulation and resulting anaphylactoid reaction.

About 0.1 mL of the solution is lost in conventional syringes through the [https://en.wikipedia.org/wiki/Luer_taper Luer taper] tip and the Luer taper adapter of the hypodermic needle. That can be compensated by either adding extra 10% or 5% substance in 1 mL or 2 mL syringes respectively, or by using [https://en.wikipedia.org/wiki/Low_dead_space_syringe low dead space syringes].

===Intravenous===

Intravenous administration refers to a drug being directly introduced into the bloodstream using a hypodermic needle. This method has the benefit of a very short onset and eliminates absorption by directly entering the bloodstream.<ref name="Ohlsson1980" /> However, much greater care must be taken when compared to other methods of administration.

Sterilized, unused needles and a high purity substance with little to no adulterant are required to avoid damage to the circulatory system.<ref>{{cite journal | vauthors=((Evans, S. M.)), ((Cone, E. J.)), ((Henningfield, J. E.)) | journal=Journal of Pharmacology and Experimental Therapeutics | title=Arterial and venous cocaine plasma concentrations in humans: relationship to route of administration, cardiovascular effects and subjective effects. | volume=279 | issue=3 | pages=1345–1356 | date=1 December 1996 | url=https://jpet.aspetjournals.org/content/279/3/1345 | issn=0022-3565}}</ref>

Make sure no air bubbles are present in the reservoir before the plunger is released. Hold the syringe vertically and flick it with your fingers to release bubbles to the needle adapter, and gently push the plunger. Don't worry about [https://en.wikipedia.org/wiki/Air_embolism air embolism], it is estimated that a large volume of 50-500 mL or greater infused at a rapid rate is potentially fatal.<ref>{{cite web |url=http://www.ajol.info/index.php/sajr/article/viewFile/34461/6388}}</ref><ref>{{cite journal | vauthors = Gordy S, Rowell S | title = Vascular air embolism | journal = International Journal of Critical Illness and Injury Science | volume = 3 | issue = 1 | pages = 73–76 | date = January 2013 | pmid = 23724390 | pmc = 3665124 | doi = 10.4103/2229-5151.109428 }}</ref>

This route is strongly associated with substances that have bad oral bioavailability, such as [[heroin]] and [[cocaine]], but can be employed with almost any pure substance.

===Intramuscular===

Intramuscular administration refers to a drug being injected into the muscle tissue using a hypodermic needle. This method is very similar to the intravenous route, but is often more painful with a decreased onset and absorption. Some drugs (such as [[ketamine]] that has low oral bioavailability, and is dangerous to take intravenously rapidly) are commonly administered via this route.<ref>{{cite journal | vauthors=((Craven, R.)) | journal=Anaesthesia | title=Ketamine | volume=62 | issue=s1 | pages=48–53 | date= December 2007 | url=https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2007.05298.x | issn=0003-2409 | doi=10.1111/j.1365-2044.2007.05298.x}}</ref> Like intravenous administration, intramuscular injection must be taken with precaution, using sterilized unused needles.

===Subcutaneous===

Subcutaneous administration (also known as [https://en.wikipedia.org/wiki/Skin_popping skin popping]) refers to a drug being injected into the subcutis, the layer of skin directly below the dermis and epidermis. Subcutaneous administration is relatively uncommon among psychonautics, as many people are not trained how to do it or would rather use a different route of administration which they are more familiar with.

==Rectal==

[[Image:Rectal bulb syringe.jpg|thumb|A rectal "bulb" syringe for introducing a small amount of fluid into the rectum.]]

Rectal administration, also commonly referred to as boofing or plugging, is one of the most effective methods of administration for many substances.<ref>{{cite journal | vauthors=((Aungst, B. J.)), ((Rogers, N. J.)), ((Shefter, E.)) | journal=Journal of Pharmacology and Experimental Therapeutics | title=Comparison of nasal, rectal, buccal, sublingual and intramuscular insulin efficacy and the effects of a bile salt absorption promoter. | volume=244 | issue=1 | pages=23–27 | date=1 January 1988 | url=https://jpet.aspetjournals.org/content/244/1/23 | issn=0022-3565}}</ref><ref name="DeBoer1984" /> The absorption rate is very high compared to other methods and the onset is usually very short, generally with a higher intensity and shorter duration.

This is due to a large amount of arteries located in the rectum; thus rectal administration is often superior to other methods despite social stigma.

Rectal administration can involve either the insertion of a low-volume solution into the rectum, using a syringe or pipette, or by placing a pill or gelatin capsule containing the active substance. The latter form is known as a suppository, and is common in medicine when the gastrointestinal tract cannot support oral medicine.

===Risks===

Caustic substances such as [[4-FA]] or [[phenibut]] hydrochloride should not be plugged because they can burn the interior rectum resulting in a considerable amount of gastrointestinal distress.

==Transdermal==

[[Image:Nicoderm.JPG|300px|thumb|right|A 21 mg dose [https://en.wikipedia.org/wiki/Nicotine_patch nicotine patch] applied to the left arm]]

Transdermal administration delivers active ingredients through the skin for systemic effects throughout the body. This method is used in various medications, including:

* '''Transdermal patches:''' These deliver controlled doses of some stimulant like [https://en.wikipedia.org/wiki/Nicotine_patch nicotine patches], and [https://en.wikipedia.org/wiki/Caffeine_patch caffeine patches]. Patches for [[opioids]] such as [[fentanyl]] also exist.<ref>{{Citation | title=Fentanyl Transdermal Patch: MedlinePlus Drug Information | url=https://medlineplus.gov/druginfo/meds/a601202.html}}</ref>

* '''Transdermal implants:''' Used for medical or anesthetic purposes.

This route is typically not observed in non-medical or recreational contexts due to the manufacturing requirements.

==Ocular==

*'''Transconjunctival:''' Most commonly observed medically (ex. eyedrops) but infrequently occurs with recreational drug abuse, such as with [[LSD]] and [[Heroin]]

*'''Intraocular:''' This route is rarely observed in non-ophthalmological-medical or recreational environments due to the fragile and complex structure of the eye

===Risks===

Transconjunctival drug administration has been associated with corneal and conjunctival abrasions and hemorrhaging<ref>Lo D, Cobbs L, Chua M, Young J, Haberman ID, Modi Y. "Eye Dropping"-A Case Report of Transconjunctival Lysergic Acid Diethylamide Drug Abuse. Cornea. 2018 Oct;37(10):1324-1325. PMID: 30004961. doi: 10.1097/ICO.0000000000001692.</ref>

==See also==

*[[Responsible use]]

*[[Psychoactive substance index]]

*[[Duration]]

*[[Dosage]]

==External links==

*[[wikipedia:Route of administration |Route of administration (Wikipedia)]]

==References==

[[Category:Pharmacology]]

=~~==Rectal/Plugging===~~

@@ Line 1: / Line 1: @@
-=General=
+{{see also|Dosage form}}
-The method in which a drug has been ingested can greatly effect the potency, duration, and overall experience of a drug. Many substances are more effective when consumed using certain ROA's over others, and some drugs are completely inactive using certain routes of administration. Determining a route of administration is highly dependent on the substance consumed, desired duration of the substance,and personal comfort.
+A '''route of administration''' is the method in which a [[psychoactive substance]] is delivered into the body.
+The route through which a substance is administered can greatly impact its potency, duration, and [[subjective effects]]. For example, many substances are more effective when consumed using particular routes of administration, while some substances are completely inactive with certain routes.
+Determining an optimal route of administration is highly dependent on the substance consumed, its desired duration and potency and side effects, and one's personal comfort level.
+Intravenous injection is the fastest route of administration, causing blood concentrations to rise the most quickly, followed by smoking, suppository (anal or vaginal insertion), insufflation (snorting), and ingestion (swallowing).<ref>{{cite journal |url=https://www.researchgate.net/publication/312678025 |doi=10.1016/j.drugalcdep.2016.08.210|title=Intravenous and smoked methamphetamine produce different subjective and physiological effects in women |year=2017 |last1=Goeders |first1=Nicholas E. |journal=Drug and Alcohol Dependence |volume=171 |pages=e73 }}</ref> A rapid rise in concentration can trigger an intense surge of effects for many substances. A rapid rise in concentration can trigger a quick [https://en.wikipedia.org/wiki/Rush_(psychology) rush] of effects for many substances.
+==Multi-route hazard substances==
+===Orally inactive tryptamines===
+* Substances: [[5-MeO-DMT]], [[DMT]].
+* Routes of administration:
+** Oral: When these substances are taken orally, they are inactive because stomach enzymes called MAO enzymes break it down. To experience effects orally, they are frequently combined with [[MAO inhibitor]]s (MAOIs), which prevent this breakdown. This combination is known as [[pharmahuasca]] for [[DMT]] (or [[5-MeO-DMT]]). When the MAOIs and DMT are derived from plant extracts, it is referred to as [[ayahuasca]]. However, it is important to note that MAOIs require careful consideration, as they can be dangerous when combined with certain drug classes, potentially leading to life-threatening consequences if not used properly.
+* Orally ingested as unintended second route: Any amount swallowed undergoes rapid enzymatic degradation in the stomach, rendering it inactive. This can introduce variability in effect intensity among users. Inconclusive experiences due to the swallowed substance may lead to a false sense of security, potentially causing users to increase the dose in subsequent administrations. However, due to the unpredictable nature of salivation or intranasal dripping, this could result in an unexpectedly potent dose due to less substance being metabolized in the stomach.
+** In the mouth (buccal (sublabial), sublingual): Holding the substances in the mouth can increase salivation, causing it to be swallowed and deactivated by stomach enzymes. Additionally, many alkaloids, have a bitter taste that makes them difficult to keep in the mouth, triggering a swallowing reflex. To improve tolerability with this route, using a safe taste-masking agent is recommended.
+** Insufflation (snorting): When these substances are delivered intranasally (through the nose), they can deposit along the nasal passage and drip down into the gastrointestinal tract.
+==Oral cavity==
+''It is worth noting that most substances are reported to be strongly bitter and unpleasant to administer via sublingual or buccal routes.''
 ===Oral===
-Arguably the most common route of adminstration for most classes of drugs, oral adminstration allows a substance to be absorbed through blood vessels contained in the stomach, where Enterochromaffin cells contain approximately 90% of the bodys serotonin. [1] Due to this, absorption of serotonin releasing drugs such as [[MDMA]], [[BK-MDMA]], and [[MDAI]] have been shown to have a higher overall effectivity when compared to insufflation.
+Oral administration is the most common route of administration for most substance classes. This route allows a substance to be absorbed through blood vessels lining the stomach and intestines. The onset is generally slower than other methods of ingestion as it must undergo first-pass metabolism through the liver (may vary greatly between individual substances).<ref name="Ohlsson1980">{{cite journal | vauthors=((Ohlsson, A.)), ((Lindgren, J.-E.)), ((Wahlen, A.)), ((Agurell, S.)), ((Hollister, L. E.)), ((Gillespie, H. K.)) | journal=Clinical Pharmacology and Therapeutics | title=Plasma delta-9-tetrahydrocannabinol concentrations and clinical effects after oral and intravenous administration and smoking | volume=28 | issue=3 | pages=409–416 | date= September 1980 | url=http://doi.wiley.com/10.1038/clpt.1980.181 | issn=0009-9236 | doi=10.1038/clpt.1980.181}}</ref> Additionally, the absorption and overall duration are generally longer as well.
+====Risks====
+This method can also have a greater propensity for [[nausea]] and gastrointestinal discomfort.<ref>{{cite journal | vauthors=((Niv, D.)), ((Davidovich, S.)), ((Geller, E.)), ((Urca, G.)) | journal=Anesthesia and Analgesia | title=Analgesic and hyperalgesic effects of midazolam: dependence on route of administration | volume=67 | issue=12 | pages=1169–1173 | date= December 1988 | issn=0003-2999}}</ref><ref>{{Citation | vauthors=((Porter, W. R.)) | title=Intraoral methods of using benzodiazepines | url=https://patents.google.com/patent/US4229447/en}}</ref>
+[[25I-NBOMe]] is widely rumored to be orally inactive; however, apparent overdoses have occurred via oral administration.
+===Oral mucosa===
+====Buccal====
+[[File:Dipping tobacco in mouth.jpg|thumb|right|[[Dipping tobacco]] is placed directly in the mouth.]]
+Buccal administration refers to absorption through the cheek and gum.
+This route is commonly employed when ingesting potent psychedelics such as [[25I-NBOMe|25I-NBOMe]], [[DOM]], [[LSD]], and other substances distributed on blotter paper. Potent clandestine manufactured [[benzodiazepines]] like [[alprazolam]] and [[etizolam]] are also sometimes distributed on blotters.
+Like sublingual absorption, the substance is largely absorbed through the lingual artery, but is also absorbed through the gum lining. This method is used when chewing plant leaves such as [[khat]], [[kratom]], [[salvia divinorum]], and sometimes [[tobacco]] (snus).
+====Sublingual====
+Sublingual administration refers to absorption under the tongue.<ref name="DeBoer1984">{{cite journal | vauthors=((De Boer, A. G.)), ((De Leede, L. G. J.)), ((Breimer, D. D.)) | journal=British Journal of Anaesthesia | title=DRUG ABSORPTION BY SUBLINGUAL AND RECTAL ROUTES | volume=56 | issue=1 | pages=69–82 | date= January 1984 | url=https://linkinghub.elsevier.com/retrieve/pii/S000709121742397X | issn=00070912 | doi=10.1093/bja/56.1.69}}</ref> It is a common route of administration for [[lysergamides]] like [[LSD]].
+This route causes the substance to be absorbed through the large lingual artery present underneath the tongue, generally resulting in a faster absorption than oral administration.
+It also circumvents first-pass metabolism of certain substances which can be absorbed via sublingual and buccal administration but not oral administration (e.g. [[25x-NBOMe]], [[25x-NBOH]]).
+=====Risks=====
+Caustic compounds, such as the freebase form of amine-containing substance, should not be used sublingually because they can severely burn the inside of one's mouth.
+==Nasal cavity==
+{{GenericPanel/warning
+| title=[https://auto.psy.is/cov19-safety/ SARS-CoV-2: drug use safety considerations]
+| content=Avoid sharing drug paraphernalina for insufflation (straws, bank notes, ‘Kuripe’, etc).
+}}
+===Nasal spray===
+[[File:Action photo of nasal spray on a black background.jpg|thumb|150px|Actuation of a nasal spray bottle, used to deliver medication via the nostrils]]
-===Sublingual===
+"The administration of nasal powder formulations has been associated with greater sensory irritation than liquid sprays and the amount of powder.".<ref>https://pubmed.ncbi.nlm.nih.gov/35386013/</ref>
-===Buccal===
+To learn how to make nasal spray, see the [[nasal spray guide]].
 ===Insufflation===
-===Smoked/Vaporized===
+<center>
+<gallery caption="" widths="300px" location="centre" perrow="4">
+File:Two snuff bullets for snorting drugs in powder form.jpg|Two snuff bullets for snorting drugs in powder form
+File:Kuripe.jpg|A kuripe is a simple device which is used to self-applicate a powder (drug). One end is inserted into the nostril, whilst the other is
+File:Stopper, snuff bottle (AM 687402-2).jpg|100px|Chinese snuff bottle stopper with a [https://en.wikipedia.org/wiki/Snuff_spoon snuff spoon] (also known as a cocaine spoon)
+Image:SpiRaL.jpg|[[Ketamine]] prepared in a spiral for "snorting". A common technique for self-administration of some recreational drugs.
+File:Cocaine lines 2.jpg|Lines of [[cocaine]] prepared for snorting
+</gallery>
+</center>
+Insufflation (also called "inhalation" and "snorting") refers to the introduction of a substance into the sinus via the nostrils, circumventing first pass metabolism.
+It is a very common method of use for substances in powder form, specifically so-called "street drugs" like [[cocaine]], [[heroin]], and [[methamphetamine]]. Some users find this route to be painful and uncomfortable, although certain substances are easier to insufflate than others.
+This method is capable of rapid absorption through mucous membranes and blood vessels in the sinus. Absorption and onset is generally much more rapid than oral and, as a result, a substance feels much more intense and is often shorter acting than if taken orally.
+Insufflation is common with substances such as [[cocaine]] and [[ketamine]]. It is also utilized in [[yopo]] rituals, the self-applicator pipe is known as ‘Kuripe’, and the blow pipe is known as a ‘Tepi’ in the Brazilian tradition. Insufflating [[tobacco]] in snuff form was a common practice until the early 20th century.{{citation needed}}
+===Risks===
+{{Template:Warning/Nasal administration}}
+Short-term side effects of insufflation includes nasal congestion, which may last for 24 hours.
+Frequent insufflation of some substances can damage one's mucous membranes, induce bleeding, damage the nostril's cartilage and lining, burn the throat, and cause other trauma to the nasal passage and sinus area.<ref>{{Citation | title=Ask Erowid : ID 41 : Is snorting MDMA worse for you than taking it orally? | url=https://www.erowid.org/ask/ask.php?ID=41}}</ref> A [https://en.wikipedia.org/wiki/Nasal_septum_perforation nasal septum perforation] is a medical condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole or fissure.
+Also, sharing snorting equipment (nasal spray bottles, straws, banknotes, bullets, etc) has been linked to the transmission of hepatitis C. (Bonkovsky and Mehta) In one study, the University of Tennessee Medical Center researches warned that other blood-borne diseases such as HIV, the AIDS-causing virus, could be transmitted as well.<ref>{{Citation | year=2016 | title=Sharing Drug “Snorting Straws” Spreads Hepatitis C | url=https://consumer.healthday.com/infectious-disease-information-21/hepatitis-news-373/sharing-drug-snorting-straws-spreads-hepatitis-c-713114.html}}</ref> Drinking makes it harder to resist pressure and clouds your ability to make safe choices. Not only might you miss signs of danger, like blood stains on shared equipment, but alcohol weakens your immune system, making it easier to catch and spread viruses.
+==Respiratory tract==
+{{GenericPanel/warning
+| title=[https://auto.psy.is/cov19-safety/ SARS-CoV-2: drug use safety considerations]
+| content=Avoid sharing drug paraphernalina for inhalation (vapes, joints, pipes, etc).
+}}
+===Inhalants===
+<center>
+<gallery caption="" widths="300px" location="centre" perrow="4">
+File:NOS Cracker With Balloon And Charger.jpg|Food grade nitrous oxide charger (bottom right), cracker (top right) and balloon
+File:HOpoppers.jpg|A selection of poppers
+</gallery>
+</center>
+[[Inhalants]] can be delivered through the respiratory system in two main ways:
+* Mouth inhalation: This method involves breathing in a gas or vapor through the mouth. [[Nitrous oxide]] is a common example.
+* Nasal inhalation: This method involves breathing in a gas, vapor, or volatile liquid through the nose. Volatile viscous compounds like [[poppers]] are typically inhaled this way.
+Inhalants do not require an external heat source to produce psychoactive vapors that can then be inhaled through various methods depending on the substance used. Inhaled substances are absorbed very rapidly and lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.<ref>http://www.ct.gov/dds/lib/dds/edsupp/medadmin_recert_part_ii.pdf</ref>
+====Risks====
+It is substantially easier to overdose on [https://en.wikipedia.org/wiki/Alcohol_inhalation alcohol inhalation] than drinking alcohol.
+Many substances can be inhaled to achieve an altered state of consciousness, however, some substances used for this purpose produce highly negative physical and neurotoxic effects including solvents like toluene (see [https://en.wikipedia.org/wiki/Toluene_toxicity toluene toxicity]) often found in glue, acetone often found in nail polish, and gasoline.<ref>{{cite journal | vauthors=((Burbacher, T. M.)) | journal=Environmental Health Perspectives | title=Neurotoxic effects of gasoline and gasoline constituents. | volume=101 | issue=Suppl 6 | pages=133–141 | date= December 1993 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1520019/ | issn=0091-6765}}</ref>, and number of gases intended for household or industrial use including [https://en.wikipedia.org/wiki/Butane butane] gas sold as lighter gas refill.
+Inhaling liquified gas directly from cans or canisters can freeze the throat.
+===Heating===
+[[File:502px-Crack Ingredients.JPG|thumb|200px|right|In order for cocaine (in plastic bag at bottom) to be converted to crack, several supplies are needed. Pictured here are baking soda (a commonly used base in making crack) a metal spoon, a tea light, and a cigarette lighter. The spoon is held over the heat source in order to "cook" the cocaine into crack.]]
+Substances that come in HCl form can be converted to freebase by mean of pH regulation. For example, [[cocaine]] decomposes when heated strongly so the freebase and hydrogen carbonate salts of cocaine, which have much lower boiling points compared to the hydrochloride salt, are typically used when the substance is to be vaporized and are known as cocaine base and "crack" respectively.
+Other substances decomposes to easily even from low heat so they cannot even be vaporized for this reason. Examples of substances include [[amphetamine]], [[caffeine]], [[LSD]], and [[psilocybin]]. Also, there's not a single trip report in [[PiHKAL]] (''&ldquo;Phenethylamines I Have Known and Loved&rdquo;'') in which the subject is smoking or vaporizing the phenethylamine compound. Notable compunds in PiHKAL include [[MDMA]], and the &ldquo;''Magical half-dozen''&rdquo; ([[mescaline]], [[DOM]], [[2C-B]], [[2C-E]], [[2C-T-2]], [[2C-T-7]]). However, a [[substituted phenethylamine]] that was synthesized after PiHKAL was released albeit very toxic, [[25I-NBOMe]], has been smoked.<ref name="erowid effects">{{Cite web |url=https://www.erowid.org/chemicals/2ci_nbome/2ci_nbome_effects.shtml |title=2C-I-NBOMe (25I) Effects |publisher=Erowid}}</ref><!-- Added to: PiHKAL, Substituted phenethylamines, Routes of administration -->
+====Smoked====
+<center>
+<gallery caption="" widths="250px" location="centre" perrow="4">
+File:Unrolled joint.jpg|''A joint/spliff prior to rolling with a paper handmade filter on the left.''
+File:Bong.jpg|A bong
+</gallery>
+</center>
+Smoking substances is a common method of consumption with the most common examples including [[cannabis]] and [[tobacco]]. Smoking yeilds low bioavailability, especially if the substance is smoked slowly.
+To smoke a substance a direct heat source, most often a flame, is applied directly to the substance with no barrier between the heat source and the substance. The smoking of substances can lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.<ref name="Ohlsson1980" />
+When a substance is smoked, the substance is absorbed through blood vessels found in the bronchi tubes contained within the lungs. Like insufflation, the duration is decreased while its intensity is increased in proportion to oral absorption.
+Cannabis is commonly consumed via the respiratory tract. The average THC transfer rate for joints, bongs, and vaporizers, is 20-26%,<ref name="ukcia">https://www.ukcia.org/research/FactorsThatInfluenceBioavailability.pdf</ref> 40%,<ref name="ukcia" /> and 55-83%,<ref>{{cite journal | vauthors=((Lanz, C.)), ((Mattsson, J.)), ((Soydaner, U.)), ((Brenneisen, R.)) | journal=PLoS ONE | title=Medicinal Cannabis: In Vitro Validation of Vaporizers for the Smoke-Free Inhalation of Cannabis | volume=11 | issue=1 | pages=e0147286 | date=19 January 2016 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718604/ | issn=1932-6203 | doi=10.1371/journal.pone.0147286}}</ref> respectively. For a proper gas or smoke deposition, one are advised to take a deep initial breath, and then hold it for 10 seconds to allow for the gas or smoke to get fully absorbed in the lungs. Subjects are frequently instructed to follow the "10 seconds rule" in studies.<ref>{{cite journal | vauthors=((Wallace, M. S.)), ((Marcotte, T. D.)), ((Umlauf, A.)), ((Gouaux, B.)), ((Atkinson, J. H.)) | journal=The journal of pain : official journal of the American Pain Society | title=Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy | volume=16 | issue=7 | pages=616–627 | date= July 2015 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152762/ | issn=1526-5900 | doi=10.1016/j.jpain.2015.03.008}}</ref><ref>{{cite journal | vauthors=((Wilsey, B.)), ((Marcotte, T.)), ((Tsodikov, A.)), ((Millman, J.)), ((Bentley, H.)), ((Gouaux, B.)), ((Fishman, S.)) | journal=The journal of pain : official journal of the American Pain Society | title=A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain | volume=9 | issue=6 | pages=506–521 | date= June 2008 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968043/ | issn=1526-5900 | doi=10.1016/j.jpain.2007.12.010}}</ref> Prolonged breath holding does not substantially enhance the effects of inhaled marijuana smoke.<ref>{{cite journal | vauthors=((Zacny, J. P.)), ((Chait, L. D.)) | journal=Psychopharmacology | title=Response to marijuana as a function of potency and breathhold duration | volume=103 | issue=2 | pages=223–226 | date= 1991 | issn=0033-3158 | doi=10.1007/BF02244207}}</ref><ref>{{cite journal | vauthors=((Zacny, J. P.)), ((Chait, L. D.)) | journal=Pharmacology, Biochemistry, and Behavior | title=Breathhold duration and response to marijuana smoke | volume=33 | issue=2 | pages=481–484 | date= June 1989 | issn=0091-3057 | doi=10.1016/0091-3057(89)90534-0}}</ref>
+Bongs that are cleaned regularly eliminates yeast, fungi, bacteria and pathogens that can cause several symptoms that vary from allergy to lung infection.<ref>{{Citation | title=Can You Get Sick From Dirty Bong Water? | url=https://herb.co/learn/sick-dirty-bong-water/}}</ref><ref>https://www.maryjanetokes.com/dirty-bong-the-dangers-of-using-one/</ref><ref>{{Citation | year=2018 | title=The Dangers of a Dirty Bong | url=https://www.leafscience.com/2018/07/16/dangers-dirty-bong/}}</ref>
+=====Gravity bong=====
+[[File:Buckie.JPG|thumb|A gravity bong made from a large PET bottle and a bucket.]]
+See [https://en.wikipedia.org/wiki/Gravity_bong Gravity bong (Wikipedia)]
+<center>
+<gallery caption="" widths="300px" location="centre" perrow="4">
+File:Bucket bong diagram.jpg|Diagram of bucket bong in operation
+File:Waterfall bong diagram.svg|Diagram of waterfall bong in operation
+</gallery>
+</center>
+=====Spots=====
+[[File:Spots.jpg|thumb|Spotting knives heating]]
+[https://en.wikipedia.org/wiki/Spots_(cannabis) Spots] (also known as spotting, knifers, knife hits, knife tokes, dots, hot knives, kitchen tracking blades, or bladers) refers to a method of smoking cannabis.<ref>Handbook of Pharmacy Education, Harmen R.J., 2001, Pg 169</ref> Small pieces of cannabis are rolled (or simply torn from a larger bud) to form the spot.
+======Risk======
+Users spotting cannabis are susceptible to greater health risks than other methods of smoking cannabis. Spotting cannabis oil or resin is thought to be particularly harmful to the lungs, as the smoke comes off the oil at such a high temperature.<ref>
+[https://web.archive.org/web/20071027140016/http://www.healthaction.org.nz/Dope_Tips_II.htm Dope Tips II dope tips, reducing cannabis related harms, tips for safer use of cannabis use in nz, using marijuana<!-- Bot generated title -->]</ref>
+====Vaporized====
+<center>
+<gallery caption="" widths="250px" location="centre" perrow="4">
+File:Volcano Vaporizer.jpg|''A forced-air vaporizer. The detachable balloon (top) fills with vapors that are then inhaled.''
+File:VripTechVHWInAction.jpg|A vaporization heat wand and vaporization chamber bowl used to deliver vapor through a water pipe
+</gallery>
+</center>
+Vaporizing substances is a common method of consumption with the most common examples including [[cannabis]] and [[nicotine]], but also [[heroin]] and [[cocaine|crack-cocaine]]. Vaporizing a substance, especially with a digital temperature controlled device, allows for more temperature control because the flame or heat source does not come into direct contact with the substance.
+Even though many drugs, like [[heroin]] and [[oxycodone]] pills are colloquially referred to as "smoked" the process used to consume them is vaporization. Vaporizing substances can lead to an almost instantaneous absorption of the substance and passage through the blood brain barrier.<ref name="Ohlsson1980" />
+When a substance is vaporized, the substance is absorbed through blood vessels found in the bronchi tubes contained within the lungs. Like insufflation, the duration is decreased while its intensity is increased in proportion to oral absorption.
+Vaporization is commonly associated with the vaporizer pens that have become popular within the past decade, but it is not limited to ingesting the vapors from an electronic heat source.
+=====Risks=====
+Smoking a substance that should be vaporized leads to a blast of heat that may burn off the active ingredient or ignite the substance itself, both of which are wasteful and incorrect, which may cause judgement impairment of the dosage.
+Ethnobotanist Daniel Siebert cautions that inhaling hot air can be irritating and potentially damaging to the lungs. Vapor produced by a heat gun needs to be cooled by running it through a water pipe or cooling chamber before inhalation.<ref>{{Citation | title=Ask Erowid : ID 3139 : Do vaporizers work with Salvia divinorum? | url=https://www.erowid.org/ask/ask.php?ID=3139}}</ref>
+Re-used uncleaned vapes, and vape sharing, may cause bacterial pneumonia,<ref name="pmid32042584">{{cite journal |last1=Kooragayalu |first1=S |last2=El-Zarif |first2=S |last3=Jariwala |first3=S |doi=10.1016/j.rmcr.2020.100997 |pmid=32042584 |pmc=6997893}}</ref><ref>{{cite web |title=Vaping changes oral microbiome and raises infection risk |url=https://www.medicalnewstoday.com/articles/vaping-changes-oral-microbiome-and-raises-infection-risk |website=www.medicalnewstoday.com |language=en |date=14 March 2020}}</ref> fungal pneumonia,<ref>{{cite web |last1=Mughal |first1=Mohsin Sheraz |last2=Dalmacion |first2=Denise Lauren V. |last3=Mirza |first3=Hasan Mahmood |last4=Kaur |first4=Ikwinder Preet |last5=Dela Cruz |first5=Maria Amanda |last6=Kramer |first6=Violet E. |title=E-cigarette or vaping product use associated lung injury, (EVALI) - A diagnosis of exclusion |url=https://www.sciencedirect.com/science/article/pii/S2213007120303889 |website=Respiratory Medicine Case Reports |pages=101174 |language=en |doi=10.1016/j.rmcr.2020.101174 |date=1 January 2020}}</ref> and viral pneumonia.<ref name="pmid32042584" />
+=====E-cigarette=====
+[[File:Electronic Cigarette and USB Charger (14939561277) (retouched).jpg|thumb|upright=1.25|A first-generation e-cigarette that resembles a tobacco cigarette, with a battery portion that can be disconnected and recharged using the USB power charger|alt=Photo of device]]
+An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such, using an e-cigarette is often called "vaping". The atomizer is a heating element that vaporizes a liquid solution called e-liquid. The most common e-liquid carrying agents includes glycerin (often called vegetable glycerin, or VG), and propylene glycol (often referred to as PG).
+======Risks======
+[https://en.wikipedia.org/wiki/Vaping-associated_pulmonary_injury Vaping-associated pulmonary injury] (VAPI) is an umbrella term used to describe lung diseases associated with the use of vaping products that can be severe and life-threatening.
+Glycerin was long thought to be a safe option. However, the carcinogen formaldehyde is known as a product of propylene glycol and glycerol vapor degradation.<ref>{{cite journal |last1=Lestari |first1=Kusuma S. |last2=Humairo |first2=Mika Vernicia |last3=Agustina |first3=Ukik |title=Formaldehyde Vapor Concentration in Electronic Cigarettes and Health Complaints of Electronic Cigarettes Smokers in Indonesia |journal=Journal of Environmental and Public Health |date=July 11, 2018 |volume=2018 |pages=1–6 |doi=10.1155/2018/9013430 |pmid=30105059 |pmc=6076960 |issn=1687-9805|doi-access=free }}</ref>
+=====The Machine=====
+[https://wiki.dmt-nexus.me/The_Machine The Machine], utilizing a glass bottle with a hole, and foil in the neck. The Machine was invented to make it more convenient to smoke [[DMT]], but it can be used for any substance.
+=====Chasing the dragon=====
+[[File:Chasing.jpg|thumb|Chasing the dragon, aka foily, can be considered unresponsible drug use due to its unpredictable nature.]]
+[[Heroin]] is colloquially referred to as "smoked" but is really vaporized, often using tinfoil as a barrier between the substance and the flame source. The heat source can be held at different distances as temperature control. An alternative version is to use a "stainless steel one-quarter teaspoon and vaporized it over a cigarette lighter collecting the smoke in an upside-down funnel."<ref>{{cite web |title=Erowid Online Books : "TIHKAL" - #38 5-MEO-DMT |url=http://www.erowid.org/library/books_online/tihkal/tihkal38.shtml |website=www.erowid.org}}</ref>
+======Risks======
+Overdosing from inhaling vaporized drugs through the "chasing the dragon" method is extremely difficult to anticipate. This technique does not allow for a controlled, standardized dose. Even experienced users cannot accurately gauge how much of the substance has been vaporized, burned, and ultimately inhaled into the body.
+The inconsistent and unregulated nature of this consumption method creates a false sense of safety. A dose that seemed harmless one time may potentially prove fatal the next, as various random factors influence how much of the drug is actually ingested.
+Moreover, using specialized smoking devices like bongs designed for more efficient inhalation dramatically increases the amount consumed compared to rudimentary foil methods. An amount that may have been tolerable when smoked off foil could easily become an overdose when the same quantity is fully vaporized and inhaled through an optimized apparatus.
+The lack of dosage control and potential to underestimate potency make chasing the dragon an inherently risky and unpredictable way to use drugs, with an ever-present danger of accidental overdose.
+[[#The Machine]] is a much safer than "chasing the dragon".
+==Injection==
+[[File:Angles for injections.png|400px|thumb|right|A diagram showing the different angles needed for different types of injections]]
+[[Safer_injection_guide#Substances_that_are_dangerous_to_inject|Some drugs '''should not''' be taken by injection]]: For example, injectable [[codeine]] is available for subcutaneous or intramuscular injection only; intravenous injection is contraindicated as this can result in non-immune mast-cell degranulation and resulting anaphylactoid reaction.
+About 0.1 mL of the solution is lost in conventional syringes through the [https://en.wikipedia.org/wiki/Luer_taper Luer taper] tip and the Luer taper adapter of the hypodermic needle. That can be compensated by either adding extra 10% or 5% substance in 1 mL or 2 mL syringes respectively, or by using [https://en.wikipedia.org/wiki/Low_dead_space_syringe low dead space syringes].<!-- Added to: Routes of administration, Safer injection guide -->
 ===Intravenous===
+{{Main|Safer injection guide#IV injection}}
+Intravenous administration refers to a drug being directly introduced into the bloodstream using a hypodermic needle. This method has the benefit of a very short onset and eliminates absorption by directly entering the bloodstream.<ref name="Ohlsson1980" /> However, much greater care must be taken when compared to other methods of administration.
+Sterilized, unused needles and a high purity substance with little to no adulterant are required to avoid damage to the circulatory system.<ref>{{cite journal | vauthors=((Evans, S. M.)), ((Cone, E. J.)), ((Henningfield, J. E.)) | journal=Journal of Pharmacology and Experimental Therapeutics | title=Arterial and venous cocaine plasma concentrations in humans: relationship to route of administration, cardiovascular effects and subjective effects. | volume=279 | issue=3 | pages=1345–1356 | date=1 December 1996 | url=https://jpet.aspetjournals.org/content/279/3/1345 | issn=0022-3565}}</ref>
+Make sure no air bubbles are present in the reservoir before the plunger is released. Hold the syringe vertically and flick it with your fingers to release bubbles to the needle adapter, and gently push the plunger. Don't worry about [https://en.wikipedia.org/wiki/Air_embolism air embolism], it is estimated that a large volume of 50-500 mL or greater infused at a rapid rate is potentially fatal.<ref>{{cite web |url=http://www.ajol.info/index.php/sajr/article/viewFile/34461/6388}}</ref><ref>{{cite journal | vauthors = Gordy S, Rowell S | title = Vascular air embolism | journal = International Journal of Critical Illness and Injury Science | volume = 3 | issue = 1 | pages = 73–76 | date = January 2013 | pmid = 23724390 | pmc = 3665124 | doi = 10.4103/2229-5151.109428 }}</ref><!-- Added to: Template:Safer_injection_guide-basic_procedure, Routes_of_administration -->
+This route is strongly associated with substances that have bad oral bioavailability, such as [[heroin]] and [[cocaine]], but can be employed with almost any pure substance.
 ===Intramuscular===
+{{Main|Safer injection guide#IM injection}}
+Intramuscular administration refers to a drug being injected into the muscle tissue using a hypodermic needle. This method is very similar to the intravenous route, but is often more painful with a decreased onset and absorption. Some drugs (such as [[ketamine]] that has low oral bioavailability, and is dangerous to take intravenously rapidly) are commonly administered via this route.<ref>{{cite journal | vauthors=((Craven, R.)) | journal=Anaesthesia | title=Ketamine | volume=62 | issue=s1 | pages=48–53 | date= December 2007 | url=https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2007.05298.x | issn=0003-2409 | doi=10.1111/j.1365-2044.2007.05298.x}}</ref> Like intravenous administration, intramuscular injection must be taken with precaution, using sterilized unused needles.
+===Subcutaneous===
+{{Main|Safer injection guide#SC injection}}
+Subcutaneous administration (also known as [https://en.wikipedia.org/wiki/Skin_popping skin popping]) refers to a drug being injected into the subcutis, the layer of skin directly below the dermis and epidermis. Subcutaneous administration is relatively uncommon among psychonautics, as many people are not trained how to do it or would rather use a different route of administration which they are more familiar with.
+==Rectal==
+[[Image:Rectal bulb syringe.jpg|thumb|A rectal "bulb" syringe for introducing a small amount of fluid into the rectum.]]
+Rectal administration, also commonly referred to as boofing or plugging, is one of the most effective methods of administration for many substances.<ref>{{cite journal | vauthors=((Aungst, B. J.)), ((Rogers, N. J.)), ((Shefter, E.)) | journal=Journal of Pharmacology and Experimental Therapeutics | title=Comparison of nasal, rectal, buccal, sublingual and intramuscular insulin efficacy and the effects of a bile salt absorption promoter. | volume=244 | issue=1 | pages=23–27 | date=1 January 1988 | url=https://jpet.aspetjournals.org/content/244/1/23 | issn=0022-3565}}</ref><ref name="DeBoer1984" /> The absorption rate is very high compared to other methods and the onset is usually very short, generally with a higher intensity and shorter duration.
+This is due to a large amount of arteries located in the rectum; thus rectal administration is often superior to other methods despite social stigma.
+Rectal administration can involve either the insertion of a low-volume solution into the rectum, using a syringe or pipette, or by placing a pill or gelatin capsule containing the active substance. The latter form is known as a suppository, and is common in medicine when the gastrointestinal tract cannot support oral medicine.
+===Risks===
+Caustic substances such as [[4-FA]] or [[phenibut]] hydrochloride should not be plugged because they can burn the interior rectum resulting in a considerable amount of gastrointestinal distress.
+==Transdermal==
+[[Image:Nicoderm.JPG|300px|thumb|right|A 21 mg dose [https://en.wikipedia.org/wiki/Nicotine_patch nicotine patch] applied to the left arm]]
+Transdermal administration delivers active ingredients through the skin for systemic effects throughout the body. This method is used in various medications, including:
+* '''Transdermal patches:''' These deliver controlled doses of some stimulant like [https://en.wikipedia.org/wiki/Nicotine_patch nicotine patches], and [https://en.wikipedia.org/wiki/Caffeine_patch caffeine patches]. Patches for [[opioids]] such as [[fentanyl]] also exist.<ref>{{Citation | title=Fentanyl Transdermal Patch: MedlinePlus Drug Information | url=https://medlineplus.gov/druginfo/meds/a601202.html}}</ref>
+* '''Transdermal implants:''' Used for medical or anesthetic purposes.
+This route is typically not observed in non-medical or recreational contexts due to the manufacturing requirements.
+==Ocular==
+*'''Transconjunctival:''' Most commonly  observed medically (ex. eyedrops) but infrequently occurs with recreational drug abuse, such as with [[LSD]] and [[Heroin]]
+*'''Intraocular:''' This route is rarely observed in non-ophthalmological-medical or recreational environments due to the fragile and complex structure of the eye
+===Risks===
+Transconjunctival drug administration has been associated with corneal and conjunctival abrasions and hemorrhaging<ref>Lo D, Cobbs L, Chua M, Young J, Haberman ID, Modi Y. "Eye Dropping"-A Case Report of Transconjunctival Lysergic Acid Diethylamide Drug Abuse. Cornea. 2018 Oct;37(10):1324-1325. PMID: 30004961. doi: 10.1097/ICO.0000000000001692.</ref>
+==See also==
+*[[Responsible use]]
+*[[Psychoactive substance index]]
+*[[Duration]]
+*[[Dosage]]
+==External links==
+*[[wikipedia:Route of administration |Route of administration (Wikipedia)]]
+==References==
+<references />
+[[Category:Pharmacology]]
-===Rectal/Plugging===
+{{#set:Featured=true}}