Getting Started With Safe Injection - English

Getting Started with Safe Injection • Addictive potential: Depressants and stimulants

Why should I learn how to inject myself?

For people who inject regularly, knowing how to safely inject alone is vital. Learning the ins and outs of drug injection not only helps you to stay safe, but also helps you develop self-reliance, empowering you with the tools and knowledge to get high on your own terms.

For people who inject regularly, knowing how to safely inject alone is vital. Counting on others to help you inject puts you in a place of vulnerability, in which you are dependent on someone else for your high. This may put you at risk of being taken advantage of by others who know that you need them to get off. It can also make you dependent on people who may not always be there to help. No matter who you are, life is unpredictable. People may come and go, relationships may change. Learning how to inject yourself safely and independently allows you to face these changes head on without putting yourself at risk. It allows you to control your dosage, as we all have different levels of tolerance, requiring different amounts to get the right high without danger of overdose. Adulterated or contaminated drugs are increasingly common, which makes it all the more important to know where your drugs come from and how to get off safely.

are commonly known to carry a high addictive and dependence potential, increasing intense physical and psychological craving after repeated use. For all classes of drugs, increased frequency of use and higher doses can lead to increased risks for some people.

• Contamination: As most drugs are illegally produced

and distributed, there are no laws preventing adulteration and contamination of products. In recent years, heroin bought and sold in the US increasingly contains synthetic opioids, primarily fentanyl, which has led to a sharp rise in accidental overdoses. Also, agents like baking soda or talcum powder(baby powder) are often used to dilute street drugs, and may cause additional health risks.

• Fentanyl test strips can be obtained from most syringe exchange programs and help you to identify a riskier product. This can empower you to decide what goes into your body and when to be cautious with dosages, preventing accidental overdose.

• Route of Administration: The route of

Preparing to Inject

administration (ROA) can affect how safe a drug experience is. Oral ROA is one of the safer ways of getting high, but the drug’s desired effects are delayed until the drug is absorbed by the gut. Smoking drugs provides a quick onset, but may cause lung discomfort with heavy, regular long-term use. Snorting also provides a rapid high, but may damage the membranes on the inside of the nose over time without any care. Intravenous injection is the most risky route of administration, as it is easier to accidentally overdose and open wounds from injecting are sensitive to infection . However, many choose to inject for the rapid and intense rush.

For those who choose to inject, proper technique, new equipment, and careful dosing is essential to maintain health and safety.

Drug, Set, & Setting

Your set and setting includes the physical space you’re in, the people you’re with, and how you’re feeling prior to injecting. Your drug includes the type of substance used, the purity or contamination of your drug, frequency of use, and route of administration.

Drug

• Types of drugs: Depressants (opioids, alcohol, or

benzodiazepines) can cause sedation, euphoria, and slowed down thinking. They carry the risk of impaired judgement as well as overdose, in which one may stop breathing or may breathe in vomit.

Stimulants (cocaine/crack, and methamphetamine) cause increased energy and pleasure, but also may induce anxiety, overdose, panic attacks, or heart problems for those prone to them.

This resource is a living document that we will continue to update and refine. If you have input about how the information contained here could be improved or if you have new content to add, please email us at content@nextdistro.org.

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Environment

infections. If you must reuse a needle, make sure it has been cleaned thoroughly, ideally using household bleach (hydrogen peroxide or rubbing alcohol are also acceptable), followed by a thorough rinse with cold water. No matter how well you clean used equipment, it is still possible to transmit blood-borne infections, which is why obtaining a stock of new equipment is the ideal and safest option.

• The best physical environment is one where you have

privacy, can take as much time as you need, have access to clean running water, have protection from the weather, and are unlikely to encounter law enforcement.

• Safest locations: your home or the home of a trusted friend or family member with naloxone close by.

• High risk locations: subway cars, stairwells, public parks • If you are using in a public restroom, try to choose a private room with a door that locks to avoid strangers walking in BUT make sure to unlock as soon as you finish your hit.

Injection Instructions 1. Cooking: Dissolve your powdered or solid drugs into liquid form so they can be injected • Using a fresh cooker or metal spoon (ideally one which hasn’t been used by anyone else), mix a single dose with a small amount of clean water • Many drugs (ex. black tar or powdered heroin) require heating to dissolve fully, while others (ex. meth) will dissolve without heat.

• If your cooker still contains solid material after cooking, try reheating it. If reheating does not work the solid material may be contaminants, which you can filter out with a cotton.

Who You Are With

• When possible, it is ideal to get high in the

company of someone you know and trust, who could offer help if you become sick or accidentally overdose. However, being high could put you in a vulnerable position with certain people. It is better to inject alone than with someone you don’t trust to respect you or to help you, if you needed it. If alone, make sure to tell someone you trust even if they are somewhere else. Never Use Alone is a support hotline and great option if there isn’t anyone you can tell! Call Never Use Alone Hotline at (800) 484-3731 and someone will stay on the line with you while you use.

2. Filtering: Draw your cooked drugs from cooker to syringe through a cotton filter, which will catch particles and contaminants that may be unsafe to inject • Good filters: Cotton swabs or the cotton from a Q-tip. Syringe exchange programs can provide 100% cotton filters, which are safe and effective.

• Risky filters: Cigarette filters, which contain small pieces of fiberglass, or tampons that contain synthetic material (100% cotton tampons are safe to use) • Some like to save old cottons to cook up later when drugs are limited, but this can be dangerous! Old wet cottons quickly grow bacteria and fungus, which may cause fever and a flu-like illness when injected.

• To avoid wanting to reuse old filters, you may try eating 100% cotton filters after use. It will pass through your body safely and can give you a mild high from the cotton’s residue.

• Once you’ve drawn your drugs into your syringe, hold the syringe with needle tip facing up, tap out any air bubbles you see in your syringe, and carefully push the liquid contents to the tip of the needle

Mindset

• Before you get out your injection equipment, pause

for just a second to assess your state of mind. If you are feeling panicked or are experiencing intense withdrawal, consider sniffing a small amount of your drugs to take the edge off. Calming yourself down will help you inject safely, avoiding accidents (injury, unsanitary injection, or spilling your drugs) which may happen in a state of panic. Remember to start low and go slow.

New and Clean Equipment Before you begin, wash your hands with soap and water or use hand sanitizer, if possible. Needles and syringes should ideally never be reused. Injecting with used needles is the most common way infections and viruses are transmitted between people using drugs. Even if it looks like blood has been cleaned off, infectious diseases can be transmitted by microscopic amounts of blood, which are inevitably left behind on used equipment. Additionally, needles grow dull after just a few injections and dull needles cause trauma to your skin and veins, a set up for pain and

3. Finding an injection site: To prevent your favorite veins from being damaged, leaky, or scarred and potentially unusable, it is important to rotate 2

between different veins.

• If you’re new to injection, start with a large arm vein before moving to more difficult veins (ex. hand or leg veins)

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Try to rotate which spot and vein you use to avoid damaging veins and causing scarring.

7. Inserting your needle • Once you’ve cleaned 4. Sterilize the injection site: Clean your injection your injection site and site with alcohol pads, hydrogen peroxide, rubbing tied off, you’re ready to alcohol, or just soap and water prior to injection. insert your needle This is one of the most effective ways to reduce skin • Hold your syringe and and blood infections. needle so that the needle opening (the bevel) is facing upwards 5. Tying off: to inject into a • Always insert the needle tip into your vein in the vein, you typically need direction of the heart to cut off blood flow • Enter the vein slowly with the needle almost flat downstream to make your to the skin, making sure not to insert at too high veins bulge, becoming more an angle, as this may push the needle all the way visible and easier to hit with through your vein your needle • The needle is inserted with the bevel side • Tie the tourniquet around (needle opening) facing up, entering at a 25° your limb, making sure it angle with the needle advancing into the vein in is easy to remove the direction of the heart • Once you’ve successfully advanced your needle into the vein, you should remove your tie immediately, as it will cut off circulation if left on for too long • If you’re turning blue or losing feeling in your limb, remove the tie immediately, rest, and try again in a few minutes with a new needle, if possible.

8. Registering and injecting • You may try clenching your fist to make veins • When you feel that you’ve entered the vein, easier to see pull the syringe plunger back to see if blood is • If you do not have a proper tourniquet on hand you pulled up into the syringe can use socks, stockings, or condoms • If you see generous amount of blood when you pull back, you know you’re in a vein • If you do not see good pull back, you are not in a vein and you should untie your tourniquet, carefully pull the needle out at the same angle it went in, and try again (ideally with a new needle) • Injecting drugs with a needle that is not inside a vein will not have the same desired effects and may cause pain, swelling, and infection • Once you’ve confirmed proper needle placement with adequate blood pull back, it is time to untie your tourniquet and then slowly push down the plunger to inject your shot • Make sure you untie your tourniquet BEFORE injecting. This ensures you do not accidentally leave your arm tied for too long, cutting off 6. Finding a good vein circulation to your limb • The best vein is one that is relatively straight and easily seen 9. Retracting your needle • Once you’ve injected your shot and untied your 3

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tourniquet, slowly pull out the needle at the same angle it went in • If you pull out your needle without first untying, blood may squirt out due to high pressure in the vein Use clean tissues, gauze, or a clean cloth to apply pressure at the injection site, stopping any bleeding

follow safe injection practices. Remember, proper cleaning and avoiding sharing or re-using equipment is your best bet to safer injecting. If you find the process of injecting intimidating, you always have other options.

Snorting or smoking your drugs may be easier and can get you a similar high without the some of the risks related to injection. At the end of the day, it’s important that you get off in a way that works for you. Your health and safety are in your hands!

10. Aftercare • To prevent wound infections you may want to wipe the site with a BZK wipe or put a clean Band Aid over your needle mark.

• Avoid applying alcohol, lotion, salves, or other preparations to your wound for the first few hours after injection, as they may cause irritation • If you see that your injection missed the vein and has pooled in your arm, soak the injection site in clean warm water or apply a warm compress to reduce irritation and abscess formation (infection) 11. Cleaning up: Enjoy your high, but when you’ve come down it is absolutely necessary to clean your equipment, especially if you may need to re-use any of it in the future • Rinse off your needle and syringe under cold water and then (with needle and syringe still attached), flush the entire syringe with household bleach (hydrogen peroxide or rubbing alcohol are also acceptable) letting the bleach sit in the syringe for 2 minutes, before discarding your cleaning solution and thoroughly flushing out needle and syringe with clean cold water.

• Clean your cooker with either bleach, hydrogen peroxide, rubbing alcohol, or soap, before rinsing off with water. If possible, use a new cooker every time you use.

• It is good practice to always clean your needle and syringe, unless you plan to dispose of them immediately after use.

• The only way to reliably prevent sharing or getting blood-borne infections, like Hepatitis C or HIV, is to never use a piece of equipment (needle, syringe, or cooker) that has ever been used by someone else, even if they are a sexual partner or the equipment has been thoroughly cleaned.

This resource is a living document that we will continue to update and refine. If you have input about how the information contained here could be improved or if you have new content to add, please email us at content@nextdistro.org.

For more information & resources about safer injection and use, visit: www.nextdistro.org/saferinjection

Learning to inject yourself can be difficult and will take practice. If you know an experienced person who injects drugs that you trust, ask them to walk you through the process and show you how it’s done. However, remember that even experienced folks do not always

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