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Safer injection guide: Difference between revisions
>David Hedlund Added a new section: ====Drugs that require special consideration to inject==== * Some psychoactive substances such as benzodiazepines (valium, oxazepam, clonazepam) are water soluble to a small degree (about 3.5ml/mg). |
>David Hedlund |
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{{Danger/Injection}} | {{Danger/Injection}} | ||
{{#ev:youtube|https://www.youtube.com/watch?v=MppHWdZ-S_I|340x240|right|[[#Sterile single-use spoon|Sterile single-use spoons]] for preparation of drugs for injection complement [[#Sterile syringe and sterile hypodermic needle|sterile syringes and sterile hypodermic needles]] in preventing transmission of blood-borne diseases, which often goes unnoticed through communal pools: ''Boiling, burning, or using common cleaning fluids, alcohol, or peroxide can reduce the amount of the hepatitis C virus (HCV), but this may not prevent you from getting infected.''<ref>https://www.cdc.gov/hepatitis/hcv/pdfs/factsheet-pwid.pdf</ref> The [[Sharing_injection_materials#Hepatitis_C|hepatitis C]] virus can survive outside the body for <span style="color:red">'''6 weeks'''</span>.<ref name="pmid24273176" /> The international prevalence of {{nowrap|hepatitis C}} is between <span style="color:red">'''60% and 80%'''</span> among people who use injection drugs.<ref name=Lancet2011>{{cite journal | vauthors = Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, Degenhardt L | title = Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews | journal = Lancet | volume = 378 | issue = 9791 | pages = 571–83 | date = August 2011 | pmid = 21802134 | pmc = 3285467 | doi = 10.1016/S0140-6736(11)61097-0 }}</ref><ref name=China2008>{{cite journal | vauthors = Xia X, Luo J, Bai J, Yu R | title = Epidemiology of hepatitis C virus infection among injection drug users in China: systematic review and meta-analysis | journal = Public Health | volume = 122 | issue = 10 | pages = 990–1003 | date = October 2008 | pmid = 18486955 | doi = 10.1016/j.puhe.2008.01.014 }}</ref>|frame}} | {{#ev:youtube|https://www.youtube.com/watch?v=MppHWdZ-S_I|340x240|right|[[#Sterile single-use spoon|Sterile single-use spoons]] for preparation of drugs for injection complement [[#Sterile syringe and sterile hypodermic needle|sterile syringes and sterile hypodermic needles]] in preventing transmission of blood-borne diseases, which often goes unnoticed through communal pools: ''Boiling, burning, or using common cleaning fluids, alcohol, or peroxide can reduce the amount of the hepatitis C virus (HCV), but this may not prevent you from getting infected.''<ref>https://www.cdc.gov/hepatitis/hcv/pdfs/factsheet-pwid.pdf</ref> The [[Sharing_injection_materials#Hepatitis_C|hepatitis C]] virus can survive outside the body for <span style="color:red">'''6 weeks'''</span>.<ref name="pmid24273176" /> The international prevalence of {{nowrap|hepatitis C}} is between <span style="color:red">'''60% and 80%'''</span> among people who use injection drugs.<ref name=Lancet2011>{{cite journal | vauthors = Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, Degenhardt L | title = Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews | journal = Lancet | volume = 378 | issue = 9791 | pages = 571–83 | date = August 2011 | pmid = 21802134 | pmc = 3285467 | doi = 10.1016/S0140-6736(11)61097-0 }}</ref><ref name=China2008>{{cite journal | vauthors = Xia X, Luo J, Bai J, Yu R | title = Epidemiology of hepatitis C virus infection among injection drug users in China: systematic review and meta-analysis | journal = Public Health | volume = 122 | issue = 10 | pages = 990–1003 | date = October 2008 | pmid = 18486955 | doi = 10.1016/j.puhe.2008.01.014 }}</ref> Hepatitis C cannot be prevented once the virus has already been introduced into the body, and currently, there is no vaccine.|frame}} | ||
'''Injection''' is the act of delivering a [[psychoactive substance]] into the body using a hypodermic needle. Injected substances are mixed with a liquid (such as [[#Sterilie water for injection|sterilie water for injection]]) to form a solution, which is usually either injected directly into the bloodstream via the veins (i.e. intravenous or [[#IV_injection|IV injection]]) or into the muscle tissue (i.e. intramuscular or [[#IM_injection|IM injection]]). | '''Injection''' is the act of delivering a [[psychoactive substance]] into the body using a hypodermic needle. Injected substances are mixed with a liquid (such as [[#Sterilie water for injection|sterilie water for injection]]) to form a solution, which is usually either injected directly into the bloodstream via the veins (i.e. intravenous or [[#IV_injection|IV injection]]) or into the muscle tissue (i.e. intramuscular or [[#IM_injection|IM injection]]). | ||
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While most psychoactive substances are capable of being injected, the practice is most commonly associated with [[opiates]] like [[heroin]], [[stimulants]] like [[methamphetamine]] and [[cocaine]], and [[dissociatives]]. | While most psychoactive substances are capable of being injected, the practice is most commonly associated with [[opiates]] like [[heroin]], [[stimulants]] like [[methamphetamine]] and [[cocaine]], and [[dissociatives]]. | ||
When using opiates it is highly recommended to have [[naloxone]] nasal spray, available for free at some pharmacies, in order to reverse the effects of the opiate, and then call or get someone to call emergency services, as multiple doses of the naloxone are needed in order to continue effects, which first responders and the hospital will have. This can save a life. | |||
==Risks and hazards== | ==Risks and hazards== | ||
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===Substances that are dangerous to inject=== | ===Substances that are dangerous to inject=== | ||
* '''Substances''' | * '''Substances''': See [[List of psychoactive substances to avoid#Contraindicated substances for injection]] | ||
*'''Increased risk of [[Drug overdose|overdose]]''' - This risk is especially present with [[opiates]] such as [[heroin]]. If one is injecting opiates, it is important to have [[naloxone]] available, if possible, as this can reverse the effects of an opiate [[drug overdose]] if administered quickly.<ref>Overdose Prevention For Injection Drug Users (drugpolicy.org) | http://www.drugpolicy.org/resource/overdose-prevention-injection-drug-users</ref> The risk of fatal overdoses rise sharply after a period of cessation and relapse, largely because of reduced tolerance.<ref>Why Heroin Relapse Often Ends In Death - Lauren F Friedman (Business Insider) | http://www.businessinsider.com.au/philip-seymour-hoffman-overdose-2014-2</ref> To account for this lack of tolerance, it is safer to only dose a small fraction of one's usual [[dosage]] if relapsing after an extended break. It has also been found that the environment one is in can play a role fatal overdosing. In one scientific study, rats were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment.<ref>{{cite journal | vauthors=((Siegel, S.)), ((Hinson, R. E.)), ((Krank, M. D.)), ((McCully, J.)) | journal=Science | title=Heroin “Overdose” Death: Contribution of Drug-Associated Environmental Cues | volume=216 | issue=4544 | pages=436–437 | date=23 April 1982 | url=https://www.science.org/doi/10.1126/science.7200260 | issn=0036-8075 | doi=10.1126/science.7200260}}</ref> Other drugs are conditionally intramuscularly self-injected to prevent intravenous complications that can be prevented in a hospital setting. For example, [[ketamine]] taken intravenously quicker than 1.5 minute can cause breathing depression for short time (up to a minute).<ref>Ketamine: Dreams and Realities, p276</ref> | *'''Increased risk of [[Drug overdose|overdose]]''' - This risk is especially present with [[opiates]] such as [[heroin]]. If one is injecting opiates, it is important to have [[naloxone]] available, if possible, as this can reverse the effects of an opiate [[drug overdose]] if administered quickly.<ref>Overdose Prevention For Injection Drug Users (drugpolicy.org) | http://www.drugpolicy.org/resource/overdose-prevention-injection-drug-users</ref> The risk of fatal overdoses rise sharply after a period of cessation and relapse, largely because of reduced tolerance.<ref>Why Heroin Relapse Often Ends In Death - Lauren F Friedman (Business Insider) | http://www.businessinsider.com.au/philip-seymour-hoffman-overdose-2014-2</ref> To account for this lack of tolerance, it is safer to only dose a small fraction of one's usual [[dosage]] if relapsing after an extended break. It has also been found that the environment one is in can play a role fatal overdosing. In one scientific study, rats were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment.<ref>{{cite journal | vauthors=((Siegel, S.)), ((Hinson, R. E.)), ((Krank, M. D.)), ((McCully, J.)) | journal=Science | title=Heroin “Overdose” Death: Contribution of Drug-Associated Environmental Cues | volume=216 | issue=4544 | pages=436–437 | date=23 April 1982 | url=https://www.science.org/doi/10.1126/science.7200260 | issn=0036-8075 | doi=10.1126/science.7200260}}</ref> Other drugs are conditionally intramuscularly self-injected to prevent intravenous complications that can be prevented in a hospital setting. For example, [[ketamine]] taken intravenously quicker than 1.5 minute can cause breathing depression for short time (up to a minute).<ref>Ketamine: Dreams and Realities, p276</ref> | ||
====Dosage forms not intended for injection==== | ====Dosage forms not intended for injection==== | ||
See [[List of psychoactive substances to avoid#Dosage forms]] | |||
===Virus survival time outside the body=== | ===Virus survival time outside the body=== | ||
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"Do not put your needle into a common pool with others. This practice may be responsible for the spread of hepatitis C in people who say that they don't share needles."<ref>[Ketamine: Dreams and Realities, p269]</ref> | "Do not put your needle into a common pool with others. This practice may be responsible for the spread of hepatitis C in people who say that they don't share needles."<ref>[Ketamine: Dreams and Realities, p269]</ref> | ||
Typically, a small aluminum single-use spoon specifically designed for the purpose of dissolving and sterilizing the substance for injection. | Typically, a small disposable aluminum single-use spoon, ideally color-coded, specifically designed for the purpose of dissolving and sterilizing the substance for injection. | ||
====Risk of shared, non-sterile reservoirs==== | |||
In situations where people inject drugs, there's a chance of unknowingly sharing equipment like spoons, shot glasses, or even the concave bottom of a soda can. | |||
This can happen for several reasons: | |||
* '''Incomplete sterilization:''' Washing with dish soap doesn't guarantee sterility. Used equipment might be put back for reuse by others, creating a risk of bloodborne disease transmission. | |||
* '''Memory lapses:''' People may forget that the equipment was previously used and unintentionally share it, putting themselves and others at risk. | |||
===Sterile syringe and sterile hypodermic needle=== | ===Sterile syringe and sterile hypodermic needle=== | ||
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**'''United States''': At a federal level in the USA, naloxone is a prescription drug. Many states have programs that make naloxone over the counter and available at request at most pharmacies. In the United States, most jurisdictions have programs to deploy naloxone to law enforcement and fire and rescue services. The states that have a [[naloxone]] access laws (in varying degrees) as of January 2016 are: Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Michigan, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington State, West Virginia, and Wisconsin.<ref>State Naloxone Laws in the USA http://www.drugpolicy.org/sites/default/files/Fact%20Sheet_State%20based%20Overdose%20Prevention%20Legislation%20%28January%202016%29.pdf</ref> | **'''United States''': At a federal level in the USA, naloxone is a prescription drug. Many states have programs that make naloxone over the counter and available at request at most pharmacies. In the United States, most jurisdictions have programs to deploy naloxone to law enforcement and fire and rescue services. The states that have a [[naloxone]] access laws (in varying degrees) as of January 2016 are: Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Michigan, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington State, West Virginia, and Wisconsin.<ref>State Naloxone Laws in the USA http://www.drugpolicy.org/sites/default/files/Fact%20Sheet_State%20based%20Overdose%20Prevention%20Legislation%20%28January%202016%29.pdf</ref> | ||
**'''United Kingdom''': In the United Kingdom, naloxone is considered a Prescription Only Medicine. It is also given out at drug intervention programs and needle distribution centers, provided one has undertaken a quick 10 minute training protocol. | **'''United Kingdom''': In the United Kingdom, naloxone is considered a Prescription Only Medicine. It is also given out at drug intervention programs and needle distribution centers, provided one has undertaken a quick 10 minute training protocol. | ||
==Substance notes== | |||
===Drugs that are useless to inject=== | |||
* [[Lisdexamfetamine dimesylate]] (Vyvanse) - is formulated with a low potential for abuse as it is a prodrug necessitating conversion to dextroamphetamine in the gastrointestinal tract or liver. | |||
===Drugs that require special consideration to inject=== | |||
* Some psychoactive substances such as [[benzodiazepines]] (valium, oxazepam, clonazepam) are water soluble to a small degree (about 3.5ml/mg). | |||
==See also== | ==See also== | ||
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[[Category:Responsible drug use]] | [[Category:Responsible drug use]] | ||
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