Safer injection guide: Difference between revisions

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*''' Reusing hypodermic needles ''' - Reusing needles (including '''stainless steel hypodermic needles''' that can be autoclaved) is not advised for a number of medical reasons. If upon injection the needle does not hit a vein or muscle tissue, only retry with that same needle one more time if needed. It is always best to use fresh needles for each injection because needles are designed to penetrate the surface of the skin only once. After the first use, the needle becomes dulled and each additional time increases the dullness. Reusing the same needle can lead to greater risk of bodily injury and abscessed infections. Fresh needles can be found at [[needle exchange programs]] in certain areas. Needles that have been re-used many times will get macro trauma to the needle tip, resulting in a hook shape. If the needle gets hooked when injected it will cause tissue damage (e.g. a collapsed vein when taken intravenously) when it is pulled out.

* '''Substances that are dangerous to inject:'''

** Some drugs '''cannot''' be taken intravenously. For example, [[hydroxyzine]] injection solutions for intravenous use is not available because they pose a risk of causing hemolysis.<ref>https://go.drugbank.com/drugs/DB00557</ref>

** Other drugs are conditionally intramusculary 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>

** Avoid to inject substances with notable low or high pH, without pH neutralize them first. Examples of caustic substances: [[4-FA]] or [[phenibut]] hydrochloride.

** Home made extracts from plants and fungi should never be injected.

*** Cannabis: [https://en.wikipedia.org/wiki/Intravenous_marijuana_syndrome Intravenous marijuana syndrome] is a distinct short-term clinical syndrome related to the intravenous injection of boiled cannabis broth, which had been filtered through a cotton cloth.

*** Magic mushroom tea: A man almost died from fungal infection after he administred magic mushroom tea intrevenously.<ref>{{cite web |last1=published |first1=Nicoletta Lanese |title='Magic mushrooms' grow in man's blood after injection with shroom tea |url=https://www.livescience.com/magic-mushroom-injection-case-report.html |website=livescience.com |language=en |date=13 January 2021}}</ref>

** Talc from crushed tablets

*** '''[https://en.wikipedia.org/wiki/Emphysema Emphysema]''' - Emphysema, or pulmonary emphysema, is a lower respiratory tract disease. The intravenous use of [[methylphenidate]], commonly marketed as Ritalin and widely used as a stimulant drug in the treatment of attention deficit hyperactivity disorder, can lead to emphysematous changes known as [https://en.wikipedia.org/wiki/Emphysema#Ritalin_lung Ritalin lung].

*** '''[https://en.wikipedia.org/wiki/Pulmonary_talcosis Pulmonary talcosis]''' - Pulmonary talcosis is a pulmonary disorder caused by talc. The injection of talc from crushed pills has been associated with pulmonary talcosis in intravenous drug users.<ref name="pmid6655726">{{Cite journal|last1=Davis|first1=LL.|date=Dec 1983|title=Pulmonary "mainline" granulomatosis: talcosis secondary to intravenous heroin abuse with characteristic x-ray findings of asbestosis.|journal=J Natl Med Assoc|volume=75|issue=12|pages=1225–8|pmc=2561715|pmid=6655726}}</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>

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*'''Injecting into the wrong tissue''' - Some substances need to be injected into certain types of tissue in order to be effective. For example, [[heroin]] is most potent when IV'd and can be extremely harmful when injected into the subcutaneous tissue. [[Ketamine]], however, is typically IM'd. It is vital to ensure that one's hypodermic needle is correctly inserted into the vein before proceeding with an I.V injection.

===Substances that are dangerous to inject===

* Some drugs '''cannot''' be taken intravenously. For example, [[hydroxyzine]] injection solutions for intravenous use is not available because they pose a risk of causing hemolysis.<ref>https://go.drugbank.com/drugs/DB00557</ref>

* Other drugs are conditionally intramusculary 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>

* Avoid heating up solutions of substances with poor water solubility (yohimbine, and [[caffeine]], for example), because they will go back to their solid state once you have injected them into the body. Dilute them with more water and use larger volume syringes if needed.

* Avoid to inject substances with notable low or high pH, without pH neutralize them first. Examples of caustic substances: [[4-FA]] or [[phenibut]] hydrochloride.

** Home made extracts from plants and fungi should never be injected.

*** Cannabis: [https://en.wikipedia.org/wiki/Intravenous_marijuana_syndrome Intravenous marijuana syndrome] is a distinct short-term clinical syndrome related to the intravenous injection of boiled cannabis broth, which had been filtered through a cotton cloth.

*** Magic mushroom tea: A man almost died from fungal infection after he administred magic mushroom tea intrevenously.<ref>{{cite web |last1=published |first1=Nicoletta Lanese |title='Magic mushrooms' grow in man's blood after injection with shroom tea |url=https://www.livescience.com/magic-mushroom-injection-case-report.html |website=livescience.com |language=en |date=13 January 2021}}</ref>

====Tablets====

'''It is extremely important to never inject pills''' as they contain pill binders that may congregate and cause blood clots and other serious bodily harm. This risk may be mitigated by the use of micron filters and extraction of the active pill ingredient, but it is not advised to inject pills of any kind. This issue is most often seen with pills that contain [[oxycodone]]. When crushed these pills may look safe to inject, but they may harbor pill binders and other materials that can clog up the veins and cause blockages in the bloodstream, resulting in circulation issues and kidney complications.<ref>{{Citation | title=What Are The Dangers of Snorting or Injecting OxyContin? | url=https://americanaddictioncenters.org/prescription-drugs/smoking-snorting-injecting}} </ref>

Talc from crushed tablets can cause:

* '''[https://en.wikipedia.org/wiki/Emphysema Emphysema]''' - Emphysema, or pulmonary emphysema, is a lower respiratory tract disease. The intravenous use of [[methylphenidate]], commonly marketed as Ritalin and widely used as a stimulant drug in the treatment of attention deficit hyperactivity disorder, can lead to emphysematous changes known as [https://en.wikipedia.org/wiki/Emphysema#Ritalin_lung Ritalin lung].

* '''[https://en.wikipedia.org/wiki/Pulmonary_talcosis Pulmonary talcosis]''' - Pulmonary talcosis is a pulmonary disorder caused by talc. The injection of talc from crushed pills has been associated with pulmonary talcosis in intravenous drug users.<ref name="pmid6655726">{{Cite journal|last1=Davis|first1=LL.|date=Dec 1983|title=Pulmonary "mainline" granulomatosis: talcosis secondary to intravenous heroin abuse with characteristic x-ray findings of asbestosis.|journal=J Natl Med Assoc|volume=75|issue=12|pages=1225–8|pmc=2561715|pmid=6655726}}</ref>

===Virus survival time outside the body===

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<span style="color:red"><b>It is extremely important to vary the administration sites of injections.</b></span> The overuse of one particular injection site can lead to degradation of the tissue of the site. With IV use, this can lead to collapsed veins.<ref>http://new.sfaf.org/tspsf/speedometer/shooters/vein_care.html</ref> Once a vein has collapsed, it cannot be used again. In regard to IM injection use, there have been animal studies that show there is risk of permanent scarring and damage the peripheral veins and muscle tissue if the site is overused.<ref>{{cite journal | vauthors=((Diness, V.)) | journal=Acta Pharmacologica Et Toxicologica | title=Local tissue damage after intramuscular injections in rabbits and pigs: quantitation by determination of creatine kinase activity at injection sites | volume=56 | issue=5 | pages=410–415 | date= May 1985 | issn=0001-6683 | doi=10.1111/j.1600-0773.1985.tb01311.x}}</ref>

'''It is extremely important to never inject pills''' as they contain pill binders that may congregate and cause blood clots and other serious bodily harm. This risk may be mitigated by the use of micron filters and extraction of the active pill ingredient, but it is not advised to inject pills of any kind. This issue is most often seen with pills that contain [[oxycodone]]. When crushed these pills may look safe to inject, but they may harbor pill binders and other materials that can clog up the veins and cause blockages in the bloodstream, resulting in circulation issues and kidney complications.<ref>{{Citation | title=What Are The Dangers of Snorting or Injecting OxyContin? | url=https://americanaddictioncenters.org/prescription-drugs/smoking-snorting-injecting}} </ref>

Avoid heating up solutions of substances with poor water solubility (yohimbine, and caffeine, for example), because they will go back to their solid state once you have injected them into the body. Dilute them with more water and use larger volume syringes if needed.

====Solution for injection====

@@ Line 17: / Line 17: @@
 *''' Reusing hypodermic needles ''' - Reusing needles (including '''stainless steel hypodermic needles''' that can be autoclaved) is not advised for a number of medical reasons. If upon injection the needle does not hit a vein or muscle tissue, only retry with that same needle one more time if needed. It is always best to use fresh needles for each injection because needles are designed to penetrate the surface of the skin only once. After the first use, the needle becomes dulled and each additional time increases the dullness. Reusing the same needle can lead to greater risk of bodily injury and abscessed infections. Fresh needles can be found at [[needle exchange programs]] in certain areas. Needles that have been re-used many times will get macro trauma to the needle tip, resulting in a hook shape. If the needle gets hooked when injected it will cause tissue damage (e.g. a collapsed vein when taken intravenously) when it is pulled out.
-* '''Substances that are dangerous to inject:'''
-** Some drugs '''cannot''' be taken intravenously. For example, [[hydroxyzine]] injection solutions for intravenous use is not available because they pose a risk of causing hemolysis.<ref>https://go.drugbank.com/drugs/DB00557</ref><!-- Added to: Routes of administration, Safer injection guide -->
-** Other drugs are conditionally intramusculary 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>
-** Avoid to inject substances with notable low or high pH, without pH neutralize them first. Examples of caustic substances: [[4-FA]] or [[phenibut]] hydrochloride.
-** Home made extracts from plants and fungi should never be injected.
-*** Cannabis: [https://en.wikipedia.org/wiki/Intravenous_marijuana_syndrome Intravenous marijuana syndrome] is a distinct short-term clinical syndrome related to the intravenous injection of boiled cannabis broth, which had been filtered through a cotton cloth.
-*** Magic mushroom tea: A man almost died from fungal infection after he administred magic mushroom tea intrevenously.<ref>{{cite web |last1=published |first1=Nicoletta Lanese |title='Magic mushrooms' grow in man's blood after injection with shroom tea |url=https://www.livescience.com/magic-mushroom-injection-case-report.html |website=livescience.com |language=en |date=13 January 2021}}</ref>
-** Talc from crushed tablets
-*** '''[https://en.wikipedia.org/wiki/Emphysema Emphysema]''' - Emphysema, or pulmonary emphysema, is a lower respiratory tract disease. The intravenous use of [[methylphenidate]], commonly marketed as Ritalin and widely used as a stimulant drug in the treatment of attention deficit hyperactivity disorder, can lead to emphysematous changes known as [https://en.wikipedia.org/wiki/Emphysema#Ritalin_lung Ritalin lung].
-*** '''[https://en.wikipedia.org/wiki/Pulmonary_talcosis Pulmonary talcosis]''' - Pulmonary talcosis is a pulmonary disorder caused by talc. The injection of talc from crushed pills has been associated with pulmonary talcosis in intravenous drug users.<ref name="pmid6655726">{{Cite journal|last1=Davis|first1=LL.|date=Dec 1983|title=Pulmonary "mainline" granulomatosis: talcosis secondary to intravenous heroin abuse with characteristic x-ray findings of asbestosis.|journal=J Natl Med Assoc|volume=75|issue=12|pages=1225–8|pmc=2561715|pmid=6655726}}</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>
@@ Line 54: / Line 43: @@
 *'''Injecting into the wrong tissue''' - Some substances need to be injected into certain types of tissue in order to be effective. For example, [[heroin]] is most potent when IV'd and can be extremely harmful when injected into the subcutaneous tissue. [[Ketamine]], however, is typically IM'd. It is vital to ensure that one's hypodermic needle is correctly inserted into the vein before proceeding with an I.V injection.
+===Substances that are dangerous to inject===
+* Some drugs '''cannot''' be taken intravenously. For example, [[hydroxyzine]] injection solutions for intravenous use is not available because they pose a risk of causing hemolysis.<ref>https://go.drugbank.com/drugs/DB00557</ref><!-- Added to: Routes of administration, Safer injection guide -->
+* Other drugs are conditionally intramusculary 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>
+* Avoid heating up solutions of substances with poor water solubility (yohimbine, and [[caffeine]], for example), because they will go back to their solid state once you have injected them into the body. Dilute them with more water and use larger volume syringes if needed.
+* Avoid to inject substances with notable low or high pH, without pH neutralize them first. Examples of caustic substances: [[4-FA]] or [[phenibut]] hydrochloride.
+** Home made extracts from plants and fungi should never be injected.
+*** Cannabis: [https://en.wikipedia.org/wiki/Intravenous_marijuana_syndrome Intravenous marijuana syndrome] is a distinct short-term clinical syndrome related to the intravenous injection of boiled cannabis broth, which had been filtered through a cotton cloth.
+*** Magic mushroom tea: A man almost died from fungal infection after he administred magic mushroom tea intrevenously.<ref>{{cite web |last1=published |first1=Nicoletta Lanese |title='Magic mushrooms' grow in man's blood after injection with shroom tea |url=https://www.livescience.com/magic-mushroom-injection-case-report.html |website=livescience.com |language=en |date=13 January 2021}}</ref>
+====Tablets====
+'''It is extremely important to never inject pills''' as they contain pill binders that may congregate and cause blood clots and other serious bodily harm. This risk may be mitigated by the use of micron filters and extraction of the active pill ingredient, but it is not advised to inject pills of any kind. This issue is most often seen with pills that contain [[oxycodone]]. When crushed these pills may look safe to inject, but they may harbor pill binders and other materials that can clog up the veins and cause blockages in the bloodstream, resulting in circulation issues and kidney complications.<ref>{{Citation | title=What Are The Dangers of Snorting or Injecting OxyContin? | url=https://americanaddictioncenters.org/prescription-drugs/smoking-snorting-injecting}} </ref>
+Talc from crushed tablets can cause:
+* '''[https://en.wikipedia.org/wiki/Emphysema Emphysema]''' - Emphysema, or pulmonary emphysema, is a lower respiratory tract disease. The intravenous use of [[methylphenidate]], commonly marketed as Ritalin and widely used as a stimulant drug in the treatment of attention deficit hyperactivity disorder, can lead to emphysematous changes known as [https://en.wikipedia.org/wiki/Emphysema#Ritalin_lung Ritalin lung].
+* '''[https://en.wikipedia.org/wiki/Pulmonary_talcosis Pulmonary talcosis]''' - Pulmonary talcosis is a pulmonary disorder caused by talc. The injection of talc from crushed pills has been associated with pulmonary talcosis in intravenous drug users.<ref name="pmid6655726">{{Cite journal|last1=Davis|first1=LL.|date=Dec 1983|title=Pulmonary "mainline" granulomatosis: talcosis secondary to intravenous heroin abuse with characteristic x-ray findings of asbestosis.|journal=J Natl Med Assoc|volume=75|issue=12|pages=1225–8|pmc=2561715|pmid=6655726}}</ref>
 ===Virus survival time outside the body===
@@ Line 146: / Line 151: @@
 <span style="color:red"><b>It is extremely important to vary the administration sites of injections.</b></span> The overuse of one particular injection site can lead to degradation of the tissue of the site. With IV use, this can lead to collapsed veins.<ref>http://new.sfaf.org/tspsf/speedometer/shooters/vein_care.html</ref> Once a vein has collapsed, it cannot be used again. In regard to IM injection use, there have been animal studies that show there is risk of permanent scarring and damage the peripheral veins and muscle tissue if the site is overused.<ref>{{cite journal | vauthors=((Diness, V.)) | journal=Acta Pharmacologica Et Toxicologica | title=Local tissue damage after intramuscular injections in rabbits and pigs: quantitation by determination of creatine kinase activity at injection sites | volume=56 | issue=5 | pages=410–415 | date= May 1985 | issn=0001-6683 | doi=10.1111/j.1600-0773.1985.tb01311.x}}</ref>
-'''It is extremely important to never inject pills''' as they contain pill binders that may congregate and cause blood clots and other serious bodily harm. This risk may be mitigated by the use of micron filters and extraction of the active pill ingredient, but it is not advised to inject pills of any kind. This issue is most often seen with pills that contain [[oxycodone]]. When crushed these pills may look safe to inject, but they may harbor pill binders and other materials that can clog up the veins and cause blockages in the bloodstream, resulting in circulation issues and kidney complications.<ref>{{Citation | title=What Are The Dangers of Snorting or Injecting OxyContin? | url=https://americanaddictioncenters.org/prescription-drugs/smoking-snorting-injecting}} </ref>
-Avoid heating up solutions of substances with poor water solubility (yohimbine, and caffeine, for example), because they will go back to their solid state once you have injected them into the body. Dilute them with more water and use larger volume syringes if needed.
 ====Solution for injection====