Safer Injecting Guide
Contents
1. This guide is aimed at people who inject drugs to help reduce some of the problems caused by injecting a i ii E 4 O l a CONTENTS Safer Injecting Tips Types of Injecting Into the vein Types of Injecting Skin popping Types of Injecting Into the muscle Finding a Vein Vein Care Vein Damage Works Front amp Back Loading Get Help If Overdose HIV Hep c Alternatives to Injecting Polydrug Use Further Information 45 6 7 8 9 10 11 12 15 16 17 18 19 20 23 24 25 26 2 7 28 29 30 31 32 33 34 35 36 37 SAFER INJECTING TIPS 3 ways to reduce risks e Get your own works from your local needle exchange e Ask in your needle exchange for syringe markers ID s e Never share needles or works with another user not even your partner boyfriend or girlfriend e Try not to use alone e Wash your hands first e Don t lick the needle There are bacteria in your mouth which can get on the needle e Always inject yourself Take your time Rushing can mean you make a mistake e If sore take the needle out and start again always using a clean needle e Do not swab the area after injecting just apply pressure e Front or back loading is only ok if all equipment is known to be previously unused see page 24 e If there is clotted blood in syringe consider De the up your bum method see page 32 e Learn to inject with both hands2. DID YOU KNOW MQI run Safer Injecting Workshops Ask staff for more information Avoid mix ups always mark your syringe 9 TYPES OF INJECTING into the vein intravenous Remember e Always inject in the direction of the heart e Never inject into a pulse A pulse means an artery e Always follow safer injecting tips see page 4 e Vein care is very important see page 16 Risks e Blood borne viruses HIV Hep B amp C and many other health problems e Abscesses infections blood clots amp Deep Venous Thrombosis DVT e Overdose Make sure to test the dose and don t inject alone e There is as high risk of gangrene if you inject into a pulse an artery Recommended needle size Baby brown for hands and feet Brown and diabetic for arms Ask staff for more information The bigger the needle size the greater the chance that you will damage your veins O TYPES OF INJECTING skin popping subcutaneous The drug is slower to take effect when you use this way so be patient It is suitable for short term use onl as any bacteria or irritant e g citric or vitamin c lies close to the skin surface and easily causes abscesses and infections Always follow safer injecting tips see page 4 Very important to rotate the injecting sites Drug absorbed slowly This can give germs time to damage skin near where needle went in It can cause abscess and infections
3. easily Always inject yourself May lead to lumps and bumps and long term damage Diabetic DID YOU KNOW 5 ar gt ee E 8 3 ae lt i lt MA ae ads ong nies l a es te i Le E gt oe 2 y inject just below the skin ai gt Always swab the area before injecting TYPES OF INJECTING into the muscle intramuscular This can leave the muscle sore and stiff The drug is slower to take effect when you use this method It is not a good choice for using a lot Always follow safer injecting tips see page 4 Steroids are used this way Contact your local needle exchange for more Scent tion Deep painful abscesses If the wrong needle size is used there is risk of the needle snapping because the muscle tenses as you inject If this happens go straight to the local Accident and Emergency Department Green and Blue Depends on your muscle mass Ask staff DID YOU KNOW INTRAMUSCULAR involves injecting deep into the muscle Avoid injecting into the butt bum muscles as you can t see if you are doing any damage 12 this is a high risk area RISKS ARM e The lower you start the longer the veins will last RISKS e Absesses amp infections e Missed hits HAND e Avoid use of fingers and palm of hand e Remember to take your rings off e Hands have thin veins be gentle e Do
4. less damage to vein e Where possible use new needle and syringe and sterile water every time e If you have to reuse a syringe only reuse your own e Inject slowly Repeated use causes scars to form e Remove needle slowly to prevent vein collapse e Learn to inject with both hands e Always inject yourself e Use only a small amount of citric acid b 111 A oti T vein causes the vein to collapse Rotate sites to let veins recover VEIN DAMAGE Repeated use of the same area site Using old needles or blunt needles Using wrong tourniquet Flushing veins which can cause clots and block veins You do not get an extra buzz from flushing Using lemon or vinegar This can cause infections and lead to blindness or kidney damage Using too much citric will irritate and damage the vein Only use a small amount Missed hits which occur when you miss the vein and inject into the tissue surrounding the area This can cause an infection and abscesses Injecting tablets will seriously damage your veins See Vein Care page 16 More advice at the Safer Injecting Workshop Ask MQI or your local needle exchange WORKS Works means gear spikes needles citric water barrels syringes spoons filters tourniquets alcohol swabs and the surface used to cook up e Viruses can live in any part of your works e Don t assume that if it looks clean it is clean e Single use Ai he are
5. the safest as water and or bleach will not destroy all viruses e Mark your spoon and tourniquet so you don t confuse them with someone else s Water Watel e Always use a fresh filter e Always dispose of your works safely e Return syringes barrels and spikes and ask for a sharps bin sin bin when you are next in your local needle exchange You do not have to see the blood for a virus to be present e Use sterile water from the needle exchange Each vial is for single use only e If you have no sterile water Boil your own water and allow it to cool e Bottled water is not sterile can be full of bacteria and should not be used i Never use water from the toilet bowl i This is full of germs e Only use a small amount of citric Using too much will irritate the injecting site and damage veins e Each citric sachet is for single use only e Generally the amount in the citric sachets is too much for one hit only use enough to break down the heroin e Do not use lemon juice or vinegar This can cause infections and or kidney damage If it is not breaking down it probably is not heroin and you should not inject it e Vitamin C Vit C also known as ascorbic acid can be used to break down heroin however there is no evidence that it is better than citric e The main difference is that you need to use more Vit C than Citric Citric is a stronger acid e They can both cause vein damag
6. 2 4pm Primary Health Care Services include treatment for abscesses ulcers wounds blood testing vaccinations and referrals to hospitals and any health advice needed Stabilisation Settlement amp Integration Services Ask staff for more information Merchants Quay Ireland MQI also has residential drug treatment services Banging Up Coke Booklet A booklet on how to avoid accidental and indirect sharing available from MQI and your local needle exchange Merchants Quay Ireland Phone 01 645 6524 Homeless amp Drugs Services or 01 645 6500 4 Merchants Quay info mqi ie Dublin 8 www mdqi ie SOURCES amp ACKNOWLEDGEMENTS This book was complied by Lynda Haran and Niamh Randall with Pam Hosford and Eugene O Leary 7 Merchants Quay Ireland 2007 Special thanks to all the people who contributed to this guide including Merchants Quay Ireland s Service Users The staff of Merchants Quay Ireland s Open Access Service and in particular Raul Menendez and Emer Patton Ruaidhri McAuliffe Union of Improved Services Sde Ge ete and Education UISCE Andrew Preston and Jon Derricott Exchange Supplies UK Derricott J Preston A amp Hunt N 1999 The Safer Injecting Briefing HIT Preston A amp Hartieet J 2000 The Safer injecting Handbook Second Edition Exchange Supplies Kemplay R 2002 Better Injecting Safer Practices for Injecting Drug Users Lifeline _ Publicatio
7. as a lot of use may damage the inside of your bum Do not use if you suffer from piles You run the same risks of catching H I V Hep B and C if you share any works or front or back load Consider other alternatives such accessing drug treatment or smoking Ask staff in MQI 2 POLY DRUG USE Poly drug use is when you use more than one drug Risks e Mixing pills alcohol methadone and heroin can quickly lead to overdose e Some drugs are slower acting then others You can increase the risk of overdosing by taking too much at once without realising e Some drugs increase the strength potency of others e Using more then one drug can make it hard to make safe decisions about how much to take of each drug e Mixing alcohol and cocaine is particularly dangerous as it forms a third substance in your body called coca ethylene e Remember MQI services cater for users of all drug s Swallowed tablets Cocaine has an anaesthetic effect local pain killer after a small amount has been injected you may not feel the pain of poor injecting technique take up to 4HRS to kick in 36 37 FOR MORE INFO we are here Contact Merchants Quay Ireland Homeless amp Drugs Services 4 Merchants Quay Dublin 8 You can drop into us or phone 01 645 6524 or 01 645 6500 Needle Exchange Times Mon Wed Thurs amp Fri 10am 1pm and 2pm 4 30pm Tues 2pm 4 30pm Safer Injecting Workshop Wed
8. e e Vitamin C sachets are the best option Use as little as possible If you are using Vit C make sure it is Ascorbic Acid BP pure vitamin C 2 SHARING DRUGS front amp backloading e These are two common ways of sharing drugs which should only be used if all equipment is known to have been previously unused e If anything that is used is not sterile everyone is at risk e This is unsafe practice as it s difficult to ensure that everything in the other person s works is sterile e This involves drawing up the whole drug solution once prepared into one syringe which has a needle attached e Then some of the solution is squirted back into the other syringe s either through the front end where the needle is removed frontloading or through the back end where the plunger is removed backloading e It is safer to only use your own works Divide up before you cook up GET HELP IF You have cuts or wounds that need attention The area around the injecting site is raised red hot and painful You think you have an abscess Remember do not cut it open as this can lead to blood poisoning You have painful heavy swollen and or dead leg It may be DVT Deep Venous Thrombosis You hit an artery and it wont stop bleeding Your arm or leg is white cold or there is a loss of sensation Go to your local Accident and Emergency department immediately If you have been jabbed acc
9. identally by a used needle go straight the local Accident amp Emergency The local Accident amp Emergency Your local GP The local Health Centre M AI s Primary Care Unit OVERDOSE not to mix drugs some drugs increase the strength potency of others Look at alternatives to injecting e g smoking If you have been clean for a while remember your tolerance will have dropped Take a test dose to get feel for the strength before you inject the full amount If you are using a new drug for the first time also take a test dose Try not to inject alone Someone has overdosed if they are Not responding to pain Breathing very slowly or have stopped breathing Starting to turn blue Not coming around within three minutes If someone overdoses don t assume they ll come around Call 999 immediately Try not to panic If they are breathing put them in the recovery position This stops them from choking on vomit If the person is not breathing and you know CPR try to resuscitate them Stay with the person until help arrives TIP Swallowed tablets take up to 4 hours to kick in Remember this if you are using more than one drug H I V and HEP B amp C e This is a virus which is passed on through FE blood and body fluids CES si e People can live a long life with HIV with ine Sri medical support ahs e Hep B and C are viruses that can live outside the body e Hepatiti
10. not use wrist big artery veins and nerves here RISKS e If you leave a ring on the swelling can stop the flow of blood and you could lose a finger If you have to try a few times to find a vein TIP always use a clean needle for each attempt 14 FINDING A VEIN 15 GROIN Soe oe high risk area RISKS e ou e vein nerve and artery into the groin They crossover other e Hit the big artery and you could HE severe bleeding e Lots of germs here that can be passed into the body when injecting e Other risks include abscesses blood poisoning and loss of limb due to gangrene DEGoootcror high risk area RISKS e Are difficult to access especially behind the knees ay don t usually last for long e Injecting into varicose swollen veins on legs leads to ulcers e Risks of long term abscesses leg swelling and other infections e The highest risk of clots are in the legs this is a high risk area RISKS e Lots of germs here Swab well e Small veins so inject slowly Only use short term Can lead to very painful feet e Infection and swelling This can be very slow to heal Seek medical help The penis the armpit and breasts are also particularly dangerous sites VEIN CARE ee VEIN COLLAPSED VEIN Start as low as possible e Use tourniquet which is elasticised Do not use a lace or belt as this can twist veins Tourniquets available in MQI e Use small needle as this will cause
11. ns Going into the Groin Injecting i in the Femoral Vein Lifeline Publications Banway up Coke A Booklet on How to Avoid Indirect and Accidental Sharing 2007 Harm Reduction Steering Group Getting Off Right A Safety Manual for Injecting Drug Users Harm Reduction Coalition Up Your Bum An Alternative Guide to Injecting HIT www lifelinepublications org uk www_hit org www exchangesupplies org www mdi ie BRENB net Safer Injecting Booklet Disclaimer Although every effort has been made to ensure the validity of the information contained in this booklet Merchants Quay Ireland cannot guarantee against errors or omissions Merchants Quay Ireland does _ not assume legal or other liability for any inaccuracy mistake mis statement or any other error of whatsoever nature contained herein We also accept no responsibility for how the information in this booklet is used M Q I b ES Merchants Quay Ireland Humeless amp Drugs Services Merchants Quay Ireland Homeless amp Drugs Services 4 Merchants Quay Dublin 8 You can drop into us or phone 01 645 6524 or 01 645 6500 For more info visit our website www mqi ie
12. s B amp C are much more easily passed on infectious than H I V e They are also passed on through blood and body fluids e Know the facts Information available on HIV Fe lech a ates Hep B amp C in MQI and your local health TE he centre e Practice safer injecting techniques e Practice safer sex Condoms are available free of charge from MQI e If you and your partner both have HIV or Hep C you can be passing different types strains to each other e Cover cuts and wounds e Get a Hep B vaccination in MQI or other me pe ed St A eet a ae a ly ge Health Centres ris een Lie 4 ae Oe aR te h e Viruses can also live in snorting equipment E ITALETA AAT ae neait aa gt E peo Wes ao s hes e g tooters straws etc opi a teed kl Moat meee Bea AF ALTERNATIVES TO INJECTING up the bum Quick and easy No needle used Best hit without injecting It takes 30 seconds to be absorbed into bloodstream Prepare your hit no more than 1 5mls in barrel Remove the needle Wipe spit or Vaseline around your bum to ease barrel in Make a farting motion to relax muscles Push barrel in one centimetre This will make it come on faster If you go any deeper it won t work as well Sit squat or stand and gently squirt liquid in Bum muscles act as a double seal so it will not leak out If your syringe is clogged or if it has clotted blood in it consider this method Not advised when using cocaine
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