Getting Started with Safer Injection
Learning how to safely inject yourself is a critical part of safer drug use. If you know how to get yourself off, you can get high on your own terms! If you don’t know how to safely inject yourself, you are dependent on someone else to get well. This can put you at risk of being taken advantage of by people who might not always be there to help. Self-injection also means you are in charge of your own dose, and know, to the best of your ability, what you are putting in your body.
We distribute Getting Off Right, an amazing short book about safety for injection drug users. If you ever need a replacement, you can request one. We’ve included an abbreviated guide here, and are always happy to answer any questions you might have via text, email, or a note in your order.
Learning to inject yourself can be difficult and will take practice. If you know an experienced, trusted person who injects drugs, ask them to show you how it’s done. However, remember that even experienced folks do not always follow safer injection practices. The only reliable way to prevent the possible spread of bloodborne infections, like Hepatitis C or HIV, is to avoid using equipment (needle,cotton, or cooker) that has been used by someone else, even a sexual partner or if the equipment has been thoroughly cleaned.
Before You Inject
When you’re getting ready to get off, it’s important to consider your setting (the physical space you’re in, the people you’re with, and how you’re feeling) and the drug you are using (including its purity or contamination, dose, and route of administration).
Your Drug of Choice
Depressants, like opioids, alcohol, and benzos, can cause sedation, euphoria, and slowed down thinking. They carry the risk of impaired judgment as well as overdose, or respiratory depression. Stimulants, like cocaine/crack, and methamphetamine, cause increased energy and pleasure, but also may induce anxiety, overamping, panic attacks, or heart problems. Both kinds of drugs are known to carry high addictive and dependence potential, which makes you want to use more often and in higher doses.
In the United States, most drugs are illegally produced and distributed, which means there are no laws guaranteeing their purity. Recent years have seen an increase in synthetic opioids, like fentanyl, which has led to a sharp rise in accidental overdoses, or other adulterants like Xylazine, which can cause dangerous and destructive wounds. You can obtain test strips from NEXT in order to help you identify some of what is in your drugs, allowing you to make informed choices about what you are putting in your body and when to take extra precautions.
The way you take your drugs, or the Route of Administration, can affect how safe your high is. See our ROA one-sheet for information on the pros and cons of different methods of getting off.
Setting
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. This might be your house, or a trusted friend’s place. Spots like subway cars, stairwells, and public parks are riskier and can lead to rushed shots and misses. If you are using in a public restroom, try to choose a private stall with a door that locks to avoid strangers walking in but, make sure to unlock the door as soon as you finish your hit.
Who You Are With
Whenever possible, get high in the company of someone you know and trust. If you are both using, stagger your shots, so that you can offer each other help and support if one of you becomes sick or accidentally overdoses.
It is sometimes better to inject alone than with someone you don’t trust to respect or help you in an emergency. If you do have to use alone, make sure to tell someone you trust, even if they are somewhere else. Make a plan for what they should do if you become unresponsive and leave the door unlocked in case paramedics need to get in. If you are using opiates, leave some naloxone in a visible place, so someone who comes to help will have easy access to it.
If you don’t have someone you can call, Never Use Alone is a support hotline and a great option. Staffed entirely by volunteers with lived experience, someone will stay on the line with you while you use. Call (877) 696-1996 24/7 to access their services.
Mindset
Before you get out your injection equipment, pause 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 and avoid accidents (injury, unsanitary injection, or spilling your drugs). Remember to start low and go slow.
How to Inject
Injecting is the riskiest route of administration, carrying the highest potential of accidental overdose and infection. However, many people 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.
New and Clean Equipment
Before you begin, wash your hands with soap and water or use hand sanitizer and get out your new and sterile equipment. 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 and shared equipment.
Injection with used needles is the most common way infections and viruses are transmitted between people using drugs. Even if you are only reusing your own needles, their tips get dull after just a few injections, causing trauma to your skin and veins, a set up for pain and infections.
If you must reuse a needle, make sure it has been cleaned thoroughly, ideally using household bleach, followed by a thorough rinse with cold water. No matter how well you clean used equipment, it is still possible to transmit bloodborne infections, which is why obtaining new equipment is the ideal and safest option.
Preparing Your Shot
Dissolve your powdered or solid drugs into liquid form.
Using a fresh cooker or a metal spoon (ideally one which hasn’t been used by anyone else), mix a single dose with a small amount of clean water from the tap, an unopened bottle, or a sterile water ampoule.
Some drugs, like black tar or powdered heroin, will require heating to fully dissolve, while others, like meth, will dissolve without heat. Still others, like crack cocaine, might need some help to dissolve from an additive like citric acid.
If your cooker still contains solid material after heating it, try reheating it. If there is still solid material after a second heat, it may be contaminants, which you can filter out with a cotton.
Filter your shot
Draw your cooked drugs up into the syringe through a cotton filter, which will catch particles and contaminants that may be unsafe to inject.
The best filters are 100% cotton, which you can order from us, or take off of a Q-tip. Cigarette filters and most tampons are not good options, since they can contain fiberglass and other synthetic materials.
Some people like to save old cottons to cook up later when the stash is running low, but this can be dangerous. These old wet cottons quickly grow bacteria and fungus and reusing them can cause “cotton fever”, a fever and flulike illness that comes with infection. You might try eating 100% cotton filters instead of reusing them — they can give you a mild high without the risk of infection.
Once you’ve drawn your drugs into your syringe, hold the syringe with the 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.
Preparing the Injection Site
To prevent your favorite veins from being damaged, leaky, or scarred, it is important to rotate between veins. If you’re new to injection, start with a large arm vein before moving to more difficult veins (ex. hand or leg veins).
Sterilize the Injection Site With an Alcohol Swab
Beside using a new sterile syringe, this is the most effective way to reduce skin and blood infections. If you don’t have an alcohol swab, clean the site with soap and water.
Tie Off Your Limb With a Tourniquet
To inject into a vein, you typically need to cut off blood flow downstream. This makes your veins bulge, becoming more visible and easier to hit. If you are having trouble finding a vein, make sure you are hydrated, or use a hot compress to bring your veins to the surface before tying off. You can also clench your fist when the tie is on to make your veins easier to see.
Tie the tourniquet around your limb, making sure it is easy to remove. Once you successfully hit a vein, remove your tie immediately — it will cut off your circulation if you leave it on for too long and could cause nerve damage.
If you’re turning blue or losing feeling in your limb, remove the tie, rest and try again in a few minutes, with a new needle. If you don’t have a proper tourniquet on hand, you can use socks, stockings, or condoms — make sure whatever you use can be easily removed. We do not recommend using something like a belt, because it can be hard to take off.
Find a Good Vein
Once you’ve tied off and can see your veins, choose where you are going to inject. The best vein in one that is relatively straight, easily seen, and that you haven’t recently used.
The Injection Process
It’s important to insert the needle correctly to prevent misses or injecting in dangerous places.
Inserting the Needle
Hold your syringe and needle so that the needle opening, or the bevel, is facing upwards. Always insert the tip into your vein in the direction of the heart.
Enter the vein slowly with the needle almost flat to the skin, at approximately a 30 degree angle. Make sure not to insert at too high an angle, as this may push the needle all the way through your vein.
Registering and Injecting
When you feel that you’ve entered the vein, pull the syringe plunger back to see if blood is pulled up into the barrel of the syringe. If you see a generous amount of blood when you pull back, you know you’re in a vein. Bright red or “frothy” blood may mean you’ve hit an artery, which you shouldn’t inject into.
If you do not see good pull back, or see this frothy blood, 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 always untie your tourniquet before injecting. This ensures you do not accidentally leave your arm tied for too long, cutting off circulation to your limb. Once you’ve injected your shot, slowly pull out the needle at the same angle that it went in. Always make sure your tourniquet is untied first — if not, blood might squirt out due to high pressure in the vein.
Aftercare
Taking care of your injection site after your shot is an important part of preventing infection and keeping your veins and skin happy.
Apply Pressure
Use clean tissue, gauze, or a clean cloth to apply pressure at the injection site, stopping any bleeding. Do not use an alcohol swab on your injection wound, as it will prevent clotting and healing.
Prevent Infection
You may want to wipe the site with a BZK pad or put a clean bandage over your needle mark to protect it from infection. Avoid applying alcohol, lotion, or salves to the wound for the first few hours after injection to avoid irritation.
Taking Care of Misses
If you see that your injection missed the vein and has pooled in your arm, soak the site in clean warm water, or apply a warm compress to reduce irritation and prevent abscess formation.
Cleaning Up
Enjoy your high, but when you’ve come down it is absolutely necessary to clean up. Best practice is to safely dispose of your equipment in a poke proof container immediately after use, but if you plan to reuse any of it in the future, you must clean it immediately and carefully.
Rinsing Syringes
Ideally you will use a new syringe every single time. If you know you may need to reuse your syringe, 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 the needle and syringe with clean cold water. Remember that reusing syringes is not encouraged. Even when properly rinsed, using a dull needle increases your risk of pain and infection.
Cleaning Cookers
If possible, you should use a new cooker every time. If you cannot use a new cooker every time, clean them with bleach, hydrogen peroxide, rubbing alcohol, or soap, before rinsing off with water. Avoid using someone else’s cooker, even if it has been cleaned.
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 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!
