Routes of administration: Difference between revisions

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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==

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===Oral===

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>

~~===Sublingual===~~

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

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~~====

===Oral mucosa===

~~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.~~

===Buccal===

====Buccal====

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

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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==

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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.]]

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]]

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

</gallery>

</center>

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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====

===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==

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| content=Avoid sharing drug paraphernalina for inhalation (vapes, joints, pipes, etc).

}}

===~~Inhalation~~===

===Inhalants===

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</center>

~~Inhaled administration is used for~~ [[~~inhalants|inhalants~~]] ~~gases such as~~ [[~~nitrous~~ oxide]], ~~volatile liquids such as [[ether]]~~, ~~and~~ volatile viscous compounds ~~such as~~ [[poppers]].

[[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>

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====

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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~~. Smoking a substance also bypasses the GI tract's tendency to break certain substances down, such as [[DMT]]~~.

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

</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]</ref>

====Vaporized====

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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~~. Vaporizing a substance also bypasses the GI tract's tendency to break certain substances down, such as [[DMT]]~~.

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.

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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" />

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====

=====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=====

======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====

=====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.

====~~Gravity bong~~====

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

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

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

~~<center>~~

[[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>

~~<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~~>

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

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

~~[[File:Chasing~~.~~jpg|thumb|Chasing~~ the ~~dragon~~, ~~aka foily~~.]]

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.

~~[[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>~~

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.

~~=====Risks=====~~

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.

~~This is likely~~ the ~~least clinically delivered route of administration~~. An overdose ~~caused by chasing~~ the ~~dragon~~ is ~~hard to predict because this technique doesn't deliver a standardized dosage. It's virtually impossible even for skilled users to know how much of the substance that has been evaporated, burned,~~ and inhaled.

~~These combined factors may create a false sense~~ of ~~security when a given dose seems safe~~ to ~~repeat~~, ~~but may cause~~ an overdose ~~when all the factors are randomly excluded~~.

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.

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

==Injection==

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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].

~~Injecting a substance also bypasses the GI tract's tendency to break certain substances down, such as [[DMT]].~~

===Intravenous===

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===Subcutaneous===

Subcutaneous administration (also known as 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.

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==

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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.

~~Boofing a substance also bypasses the GI tract's tendency to break certain substances down, such as [[DMT]].~~

===Risks===

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==Transdermal==

[[Image:Nicoderm.JPG|300px|thumb|right|A 21 mg dose patch applied to the left arm]]

[[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.

~~Transdermal is a route of administration where active ingredients are delivered across the skin for systemic distribution~~. ~~Examples include transdermal patches used for medicine delivery for~~ [[~~opioids~~]] ~~such as~~ [[~~fentanyl~~]] ~~<ref>{{Citation | title=Fentanyl Transdermal Patch~~: ~~MedlinePlus Drug Information | url=https://medlineplus.gov/druginfo/meds/a601202.html}}</ref> and 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==

Line 234:

Line 280:

==External links==

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

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

==References==

@@ Line 6: / Line 6: @@
 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==
@@ Line 12: / Line 24: @@
 ===Oral===
 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>
-===Sublingual===
+[[25I-NBOMe]] is widely rumored to be orally inactive; however, apparent overdoses have occurred via oral administration.
-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====
+===Oral mucosa===
-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.
-===Buccal===
+====Buccal====
 [[File:Dipping tobacco in mouth.jpg|thumb|right|[[Dipping tobacco]] is placed directly in the mouth.]]
@@ Line 35: / Line 41: @@
 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==
@@ Line 56: / Line 72: @@
 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.]]
+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]]
+File:Cocaine lines 2.jpg|Lines of [[cocaine]] prepared for snorting
 </gallery>
 </center>
@@ Line 69: / Line 85: @@
 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====
+===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==
@@ Line 77: / Line 99: @@
 | content=Avoid sharing drug paraphernalina for inhalation (vapes, joints, pipes, etc).
 }}
-===Inhalation===
+===Inhalants===
 <center>
 <gallery caption="" widths="300px" location="centre" perrow="4">
@@ Line 85: / Line 107: @@
 </center>
-Inhaled administration is used for [[inhalants|inhalants]] gases such as [[nitrous oxide]], volatile liquids such as [[ether]], and volatile viscous compounds such as [[poppers]].
+[[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>
+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====
@@ Line 115: / Line 139: @@
 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. Smoking a substance also bypasses the GI tract's tendency to break certain substances down, such as [[DMT]].
+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====
@@ Line 133: / Line 178: @@
 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. Vaporizing a substance also bypasses the GI tract's tendency to break certain substances down, such as [[DMT]].
+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.
@@ Line 142: / Line 187: @@
 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" />
+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====
+=====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=====
+======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====
+=====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.
-====Gravity bong====
+=====Chasing the dragon=====
-See [https://en.wikipedia.org/wiki/Gravity_bong Gravity bong (Wikipedia)]
+[[File:Chasing.jpg|thumb|Chasing the dragon, aka foily, can be considered unresponsible drug use due to its unpredictable nature.]]
-<center>
+[[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>
-<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>
-====Chasing the dragon====
+======Risks======
-[[File:Chasing.jpg|thumb|Chasing the dragon, aka foily.]]
+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.
-[[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>
+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.
-=====Risks=====
+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.
-This is likely the least clinically delivered route of administration. An overdose caused by chasing the dragon is hard to predict because this technique doesn't deliver a standardized dosage. It's virtually impossible even for skilled users to know how much of the substance that has been evaporated, burned, and inhaled.
-These combined factors may create a false sense of security when a given dose seems safe to repeat, but may cause an overdose when all the factors are randomly excluded.
+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.
+[[#The Machine]] is a much safer than "chasing the dragon".
 ==Injection==
@@ Line 185: / Line 224: @@
 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 -->
-Injecting a substance also bypasses the GI tract's tendency to break certain substances down, such as [[DMT]].
 ===Intravenous===
@@ Line 204: / Line 241: @@
 ===Subcutaneous===
 {{Main|Safer injection guide#SC injection}}
-Subcutaneous administration (also known as 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.
+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==
@@ Line 214: / Line 251: @@
 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.
-Boofing a substance also bypasses the GI tract's tendency to break certain substances down, such as [[DMT]].
 ===Risks===
@@ Line 221: / Line 256: @@
 ==Transdermal==
-[[Image:Nicoderm.JPG|300px|thumb|right|A 21 mg dose patch applied to the left arm]]
+[[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.
-Transdermal is a route of administration where active ingredients are delivered across the skin for systemic distribution. Examples include transdermal patches used for medicine delivery for [[opioids]] such as [[fentanyl]] <ref>{{Citation | title=Fentanyl Transdermal Patch: MedlinePlus Drug Information | url=https://medlineplus.gov/druginfo/meds/a601202.html}}</ref> and 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==
@@ Line 234: / Line 280: @@
 ==External links==
-*[[wikipedia:Route of administration|Route of administration (Wikipedia)]]
+*[[wikipedia:Route of administration |Route of administration (Wikipedia)]]
 ==References==