Safer injection guide

Disclaimer: This guide is provided for informational and educational purposes only. We do not encourage you to break the law and cannot claim any responsibility for your actions.

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Injecting is the process of dissolving a compound in a liquid and drawing the resulting solution into a needle-tipped syringe for the purposes of self-administration.

Substances are typically either injected directly into the bloodstream via their veins (a practice known as intravenous or I.V. injection) or into the muscle tissue (known as intramuscular or I.M. injection). More rarely, substances are injected in the flesh right under one's outer layer of skin (known as subcutaneous or S.C. injection), which is referred to as "skin popping" in street drug circles.

Risks and Hazards

• Risks of infection - The simple act of penetrating one's skin with anything is a way to introduce bacterium, viruses, etc. directly into your body. Be as sterile as humanly possible! Use alcohol swabs to wipe the injection area before and after injection. There is also infection risk if one is injecting impure, adulterated, or unfiltered substances into their body. These drugs are not passing any membrane for filtration and any impurity in the drug will be directly introduced into the body.

• Blood-borne diseases - Sharing needles with other users is the most obvious way to transmit a blood-borne disease or infection, but there are other less commonly thought of ways too. Using multiple needles in the same water supply can easily spread illness and disease. Sharing the same spoons and other equipment used to prepare the injection solution is also a way to contract a blood-borne disease.

• Re-using needles - Reusing needles is not advised for some medically relevant reasons. If upon injection you do not hit a vein, only retry with that same needle one more time IF NEEDED. It is always best to use fresh needles every time you inject.

• Abscessed infections - An abscessed infection is a collection of pus that has built up within the tissue of the body at or underneath an administration site that is usually caused by a bacterial infection. If one recognizes an abscess following an injection it is imperative that they GO SEEK PROFESSIONAL MEDICAL HELP IMMEDIATELY as abscessed infections can lead to severe health complications and not uncommonly, death.

• Injecting into the wrong tissue - Some substances need to be injected into certain types of tissue in order to be effective. This can inform which injection method should be used. For example, heroin has been shown to work "best" when IV'd and can be extremely harmful when injected into the subcutaneous tissue. This is why it is so important that one makes sure they are 'in a vein' before proceeding with the injection.

• Increased withdrawal effects - This can be experienced with substances like opiates, such as heroin. The higher bioavailability and time to peak blood plasma levels (i.e. "rushiness") of the drug when it is injected -- along with increased Cognitive euphoria and Physical euphoria that accompanies it -- is thought to contribute substantially to compulsive use, addiction, withdrawal, and persisting drug cravings long after cessation of use.

Materials

• Milligram scale - It is vitally important to weigh out the substance one is going to inject to help mitigate the risk of overdose.

• Insulin syringe with I.V. needle - Used for I.V. injection, this type of syringe has a short needle meant to penetrate surface veins.

• Syringe with I.M. Needle - This type of syringe is used for the less common intramuscular (IM) injection. These needles are longer than the traditional insulin needles seen for IV use because it is designed to penetrate deep into the muscular tissue and deposit the solution there, instead of in a vein.

An IM needle differs from an IV needle in length.

• Alcohol swabs - For sterilization before and after injection.

• Sterile water - It is important to use deionized water or distilled water when injecting substances as tap water may contain harmful impurities. It is also important to change the water at a regular interval to prevent bacteria growth within the water. Placing a small amount (10ml max) in a shot glass and using this for IV/IM purposes is a good way to ensure a fresh water supply.

• A buddy! - If possible, do your best not to I.V./I.M. alone. Things can go wrong. The risk of overdose is significantly increased when injecting and having someone there to call the emergency services or give you medical aid can literally be the difference between life and death.

• Micron filters - These are used to filter out solid impurities in the drug solution. A cotton filter is better than nothing, but a micron filter is considered to be the best.

Procedure

In the interest of harm reduction, the use of any substance via I.V./I.M. administration is not an advisable from a health and safety point of view. It should be noted that I.M. administration is more commonly found when using drugs like ketamine.

I.V. Injection

1. Dissolve the chosen substance in water, be careful not to exceed the amount of water that your syringe can hold.
2. Heat the solution up, suck the solution into the syringe through the filter. Checking to make sure that no air bubbles are present in the reservoir before the plunger is released is also of dire importance as air bubbles in the bloodstream can easily result in fatal injury.
3. Using a fresh needle, prep your injection site with an alcohol swab.
4. If using the traditional crook of the elbow injection site, you may need to apply pressure above the vein to make the vein stick out more. This is typically achieved through "tying off", which refers to the practice of wrapping a solid band or tourniquet around the upper forearm so that blood constricts and the veins become more visible.
5. The needle will most likely have a slant. It is important to angle the slanted edge toward your skin, so the point of the needle penetrates the vein and injects downwards.
6. Once you have penetrated yourself with the needle, pull back on the plunger of the syringe. If you see blood, you've hit a vein and are good to inject. If you see nothing or feel a suck back, you are not in a vein; you are in subcutaneous tissue, do NOT inject! Repeat steps 1-5 until you hit a vein.
7. Once you are in a vein, push the plunger down *SLOWLY*. Especially if one is IVing a strong opiate, such as heroin, it is highly advised to not not rush the injection no matter what.
8. Once all of the solutions has been injected, slowly remove the needle and use a new alcohol swab to clean the injection site. There may be a little blood.

I.M. Injection

• Injection sites - Common injection sites for Intramusclar injections include the buttocks, the arm, and the thigh.

1. Wipe the area where you plan to give the injection with an alcohol swab.
2. Prepare the needle: Hold the syringe with your writing hand and pull the cover off with your other hand. Place the syringe between your thumb and first finger.
3. Hold the skin around where you will give the injection: With your free hand, gently press on and pull the skin so that it is slightly tight.
4. Hold the syringe barrel tightly and use your wrist to inject the needle through the skin and into the muscle at a 90 degree angle.
5. Let go of the skin with your other hand. Hold the syringe so it stays pointed straight in. Pull back on the plunger a little to make sure you did not hit a blood vessel. The point of intramusclar injections is to inject within the muscle itself. If blood comes back, remove the needle immediately and do not inject. If possible, dispose of the needle and syringe and get a new one. When you give the second injection, use a different injection site than the first.
6. Push down on the plunger to inject the solution. Do not push the plunger down hard and fast, some drug solutions may burn. Injecting at a slower rate reduces the pain.
7. Once the solution is injected, remove the needle at the same angle as it went in. Re-swab the area of injection with an alcohol swab.

See also

• Responsible use
• Routes of administration
• Preparation

External links

• Getting Off Right Safety Manual (harmreduction.org)
• Safer Injecting Guide.pdf (drugs.ie)

References

Responsible drug use index