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Getting Off Right - Harm Reduction Coalition

1. exercises i Improving Vein Visibility If you re the athletic type engaging in the following activities can help make your veins more visible from outside the body e Push ups pull ups and other exercises that strengthen the arms e Weight lifting particularly bicep exercises e Squeezing tennis balls e Wrist curls some tips It Getting Veins Up If you re having difficulty locating a vein to inject into you might want try one of the following e Put a warm compress on your injection site for five or ten minutes to help bring a vein to the surface When youre cold it can be very difficult to access a vein If youre getting off in a bathroom or somewhere else Getting Off The Basics of Safer Injection where there s not a lot of heat don t unroll your sleeve or uncover your injection site until you re ready to inject e Lower your arms below your heart or swing them in a circle e Lightly slap the injection site e Wrap your limb in Saran Wrap for a few minutes This traps the heat and causes veins to rise to the surface e Remain calm It can be extremely frustrating to be unable to get a hit particularly if you re in withdrawal Chances are getting upset will only increase your diffi D ba el bo E Ww v v ei culty so take a few deep breaths and start over again in a calmer state of mind MUSCLE POPPING INTRAMUSCULAR INJECTION Some drugs including injectable steroids and
2. new sharp needle every time Attempting to and then dispose of sharpen a needle on a matchbook for it this is the gold instance is dangerous because it can cre standard that any ate a burr on the needle that can cause h one who injects significant damage to the veins or weak J en the point and cause it to break off in drugs should also your vein Also new needles and syringes are strive for sterile as opposed to simply clean which means they re free of all biological matter that if present can cause infection Using a new sharp sterile needle and syringe for every injec tion and then disposing of it is simply the safest possible way to go DH AVOID SHARING NEEDLES SYRINGES OR OTHER DRUG INJECTION EQUIPMENT Blood or other matter that remains in a needle and syringe after someone has used it can be passed on to anyone else who uses that same injection equipment The same applies to cookers cottons and spoons In this way life threatening viruses such as hepatitis and HIV can be transmitted from one injector to another The only to definite way to avoid disease transmission of this sort is to never share needles syringes or other injection equipment IO Getting Ready Preparing Yourself 5 Your Equipment It is therefore extremely important for every injector to have his or her own set of works and an ample supply of needles and syringes so that they never have to share or
3. A important as preparing your drugs as cleanly as possible is injecting them as safely and as carefully as possible This section of the manual presents information on proper injec tion technique intravenous intramuscular and subcutaneous injection In addition to mastering proper injection technique regular intravenous injectors must also be sure to practice good vein care and all injectors should be aware of the various things they can do like rotating injection sites that will help them avoid infection and maintain good health z3 CHAPTER 2 TAKING CONTROL It is extremely important for regular injectors particularly those who are physically dependent to be able to prepare and safely inject drugs on their own Having to rely on someone Having to rely on someone else to get you off can open the door to all kinds of abuse Don t let any one have this much power and control over you else to get you off can open the door to all kinds of abuse don t let anyone have this much power and control over you or your ability to function Learn how to safely and properly inject yourself Learning how to inject properly like mas tering any other complicated activity takes practice After a while you will no doubt be able to hit veins you ve never used before on the first try causing min imal trauma to the injection site and leav ing a tiny puncture wound that barely bleeds You will develop
4. E CHAPTER D the shape of a ladle to decrease your chances of spilling your drugs You might want to bend the handle to prevent the spoon from rocking or tip ping over If using a bottle top or something similar be sure you ve removed any plastic or paper lining without scratching the caps finish Always make sure that your spoon or cooker is as clean as possible like needles and syringes it should never be shared with anyone else because doing so can transmit viruses and infections from one person to another You may want to fashion a handle for your cooker with a bobby pin paper clip bag twist tie or something similar so that you don t burn your fingers when cooking your drugs Be sure the handle is securely fastened to the cooker so it doesn t fall off causing you to lose your shot Always make sure that your spoon or cooker is as clean as possible like needles and syringes it should never be shared with anyone else because doing so can transmit viruses and infections from one person to another Always place your spoon or cooker on a level surface and maneuver it carefully so that you don t spill your shot COTTONS FILTERS Most injectors draw their drug solution from a cooker or spoon into a syringe through some type of filter most often a piece of cotton or other absorbent material The filter acts to keep out particulate matter and other foreign objects you
5. a feel for where your veins are and how you need to position and insert your needle in order to get a good hit Perhaps the safest way to learn how to inject is to have some one who knows what they re doing teach you An experienced injector can walk you through the process of injecting or perhaps even demonstrate it and prevent you from making any danger ous mistakes If possible find someone who you trust to mentor you through this process And talk with other injectors about the various tips and wisdom about injecting they ve picked up over the years 26 Getting Off The Basics of Safer Injection Hopefully there are things in If the risk of injecting drugs this manual that will be new and helpful even to those of seems too dangerous after us who have been injecting you ve read this booklet for a long time However deciding not to administer reading about how to inject drugs via injection is a harm and actually doing it are two reduction response that we diffe t things If Nee eee En YOU ES whole heartedly support new to injecting we can only caution you to read this manual thoroughly before you begin and to go slow and be aware of everything you re doing If the risk of injecting drugs seems too dangerous after you ve read this booklet deciding not to administer drugs via injection is a harm reduction response that we whole heartedly support MAINLINING INT
6. or a standard tuberculin set with a 25G needle frequently referred to as a bluetip because of its color The smaller gauge needle you use the smaller the punc ture wound and therefore the less opportunity for infec tion to occur Using a smaller gauge needle is also likely to Getting Ready Preparing Yourself 5 Your Equipment result in less bleeding Intramuscular injections must be given with larger gauge needles frequently 21G or 23G and cer tain substances such as injectable steroids and hormones can only be administered intramuscularly Intravenous injec tors typically use needles no larger than 25G and whenever v is v bo w LA v U possible needle gauge should be matched to the size of the vein into which you re injecting If youre using small delicate veins like those in the hands for instance a thinner needle such as a 28G is the safest choice Drugs that are cut with a lot of impurities like white pow der or tar heroin may clog the point of the syringe The higher the gauge therefore the thinner the needle and the smaller the hole the more likely it is that the point may get clogged This is particularly true with brown tar heroin NEEDLE LENGTH Insulin needles are typically 4 inch in length and tuberculin needles are typically of an inch in length lengths that most intravenous drug injectors find adequate if not ideal A needle that is too short may miss your vei
7. other particles that can obstruct a blood vessel which results in the blockage of blood flow Particles from injected pills that were not completely pulverized and clumps of bacteria are two exam ples of things that can cause emboli Emboli can be extremely serious particularly if they travel through the blood vessels to the heart or lungs or lodge in the small capillaries of the fingers eyes or toes where severe circulation damage can occur Emboli can be avoided by filtering out any particles in your shot and refraining from injecting pills no matter how pulverized they appear to be TAKING CARE OF YOUR HEALTH Because they re involved in the daily struggle to procure their drugs many users often aren t able to fully care for their health and the added stress to the body of injecting daily results in chronic poor health Each new injection of drugs potentially showers your bloodstream with all sorts of infectious agents and contaminants which can weaken your immune system Not getting proper Potential Health Complications of Injection Drug Use nutrition or adequate flu ids enough sleep and reg ular medical care can compound this situation To the extent possible follow basic common sense steps Proper nutrition adequate flu ids enough sleep and regular medical care are essential to maintaining anyone s health to take care of your health In the near future the Harm Reduc
8. which you can also purchase at a drug store and then covered with dry gauze and tape Properly dressing an abscess will help keep it free from further infection and speed healing 3 Health 4 When removing the dressing dampen the gauze that s touch ing the wound so you don t pull off newly formed tissue 5 Warm compresses and salt soaks will encourage the abscess to drain and promote healing Do not soak or use a compress once the wound is open or draining After the abscess has drained and scabbed over antibiotic creams and preparations like aloe vera gel can be helpful 6 Let the area heal completely If the abscess refuses to drain completely or pain and swelling persist seek medical attention Only use the emergency room as a last resource for getting your abscess drained Chances are the trauma or surgery doctor you 2 CHAPTER 3 see will not be too sympathetic to your plight under medicate you for pain make a large incision and provide no follow up or after care Instead try to go to a community clinic where the care might be more humane although there are certainly no guarantees when it comes to people s views about injection drug use Try to find a wound clinic where you can get your dressing changed on a regular basis and make sure the abscess is healing properly This will help insure that minimal scarring occurs EMBOLI An embolism is something such as air fat impurities dirt or
9. You can switch buttock cheeks to avoid bruises and sores After you inject into these muscles you might be sore for a day or two Do not inject more than the prescribed amount it will not speed up your treatment process You can cause serious liver damage and increase the risk of blood clots Blood clots can appear in the veins of the legs and can travel to the lungs this is called Pulmonary Embolism see p 64 which can be fatal People who smoke cigarettes and inject hormones are more likely to develop Pulmonary Embolism This section taken from Positive Health Project s Safety Guidelines for Injecting Hormones SKIN POPPING SUBCUTANEOUS INJECTION AA Skin popping is the injection of drugs between the body s skin and fat layers Like muscle popping the effects of your drug will come on much more slowly than if you d injected it intravenous ly and you will not experience a rush Skin poppers should follow all of the infection control and other safety precautions that intravenous and intramuscular Getting Off The Basics of Safer Injection injectors should follow Although like with muscle popping skin popping When skin popping results in little or no bleeding at the it is critical to use site of the injection the risk for bacte only a solution that rial or viral infection is real if injection js as particle free as equipment is shared or drugs are not possible prepared
10. and injected hygienically Also skin poppers are at greatly increased risk for abscesses espe cially if injecting crushed pills or another solution with particles in it When skin popping it is critical to use only a solution that is el bo E E Ad v Vu ei as particle free as possible CHOOSING AN INJECTION SITE The upper and lower arms and legs are probably the best loca tions for skin popping CLEANING THE INJECTION SITE As always thoroughly clean the injection site with alcohol soap and water or other detergent or disinfectant prior to injection INSERTING THE NEEDLE Slide the needle under your skin at a shallow angle maybe 15 to 45 at the most Inject no more than cc of liquid half of the volume of a cc syringe to form a little bubble under the skin If your hit is more than 4 cc inject into two or more sites The bump from the solution you injected will slowly decrease as the liquid is absorbed into the body and should disappear complete ly within a few hours Skin popping can be uncomfortable and the bump you create may hurt a bit If you skin pop where the skin is loose pinch the skin between your thumb and forefinger and put the needle into the skin you ve pulled up 45 gt CHAPTER 2 PULLING OUT Pull your needle out in the same direction as it went in There should not be much bleeding at the injection site when skin pop ping but you might want to apply a B
11. call 802 655 3415 to order it HUMAN IMMUNODEFICIENCY VIRUS HIV Human Immunodeficiency Virus HIV is the virus believed to cause AIDS Acquired Immune Deficiency Syndrome an immune system disorder that causes the body to lose its ability to ward off infection and fight disease HIV can be spread through the exchange of infected semen or vaginal fluids during unprotected sex the exchange of blood via the sharing of drug injection equipment or accidental needlesticks and from mother to infant during pregnancy childbirth or breastfeeding Blood to blood contact is one of the most efficient means of transmitting HIV from one individual to another and the shar ing or re use of drug injection equipment is extremely risky in terms of HIV transmission It is important to point out that injection drug use itself does not cause HIV rather HIV is trans mitted like hepatitis and other viruses when infected blood from one individual is left in a needle syringe cooker cotton or water and injected into the bloodstream or body of a second individual who uses those same works HIV from injection drug use is therefore 100 preventable as long as you always use your own sterile works and never share them with anyone Anonymous or confidential HIlV antibody tests are available from virtually all municipal county and or state health depart ments local health and family planning clinics AIDS service organizations needle ex
12. constrict shrink so if you re shooting coke you should be extra careful to register properly and make sure you re in a vein before you inject your drugs Also chances are that if you re shooting coke you ll be injecting many times in a short period of time with perhaps only several minutes elapsing between each injection This can be traumatic on the veins and the surrounding tissues and result in a lot of bleeding e Try to use a sterile sharp needle for each injection e make sure you keep your injection equipment separate from anyone else s you re getting off with and try to give the area a good rest for a few days You may experience some pain and swelling after such intense activity 32 Getting Off The Basics of Safer Injection MAINLINING CRACK Because crack comes in a solid form rock it is necessary to dissolve it first The safest way to do this is with powdered citric or ascorbic acid ask your local needle exchange or health food store where to find it Avoid lemon juice or vinegar as these can lead to serious infections To dissolve crack put crack and citric or ascorbic acid about a pinch to a slab in the cooker add plenty of water mash and mix well SHOOTING SPEED Because speed is often cut with such dangerous chemicals it is very impor tant not to miss your shot Skin popping speed is extremely painful may cause an abscess and will take a long time for the body t
13. don t want in 14 Getting Ready Preparing Yourself 5 Your Equipment your shot and enables you to get just about every drop of the drug solution into your syringe so that none of it is wasted gt Clean 100 cotton from a Q Tip or cotton ball is the safest thing you can use to filter your drug solution Filter paper gt v is v bo w LA v U or a small piece of tampon are safe alternatives gt Rayon and other synthetic fibers often dont absorb liq uid as well as cotton and may prevent you from being able to adequately draw up all of your drug solution gt Cigarette filters are not safe to use since they contain tiny pieces of glass and if from a cigarette that has already been smoked substances from the smoke that can be harmful if injected gt Pocket lint may work if it s all you ve got gt You might consider skipping the filter altogether if you have nothing safe to use gt Use a fresh cotton every time you shoot up and as with needles syringes and cookers never use someone else s cotton or let them use yours infections bacteria and viruses can all be transmitted through sharing cottons gt Make sure your fingers are as clean as possible before you tear off and roll up your cotton gt Finally many of us cook up our old cottons to squeeze what we can out of them when we have no more money for drugs Unfortunately fungi and bacteria can live and grow
14. for every injection Using dull needles will cause trauma to the veins and surround ing tissue cause a much larger puncture wound and increase bleeding at the site 57 CHAPTER 3 Sharpening a used needle can cause it to develop a burr which will tear the vein and surrounding tissue and result in unnec essary trauma to the injection site If you keep resharpening your point it becomes less flexible and can break off into your vein If this happens seek medical attention immediately gt Use the highest gauge thinnest needle you can find to make the smallest puncture wound possible gt Alternate and rotate your injection sites Always try to inject at least one inch from your previous injection site Give your veins a chance to rest in between injections Stay away from veins that are red or tender until they heal gt Always inject in the direction of the body s blood flow toward the heart gt Use a soft flexible easy to open tourniquet and remove it after you ve registered but before you inject to help prevent bruising gt Use emollient rich or antibiotic creams on injection sites once they ve closed or scabbed over Aloe vera gel and vitamin E oil are two commonly available prepara tions that can help reduce the appearance of track marks VEIN COLLAPSE Vein collapse occurs when veins close up due to repeated injec tions into the same site repeated local infections or trauma to
15. from the tank never use water from the bowl 16 Getting Ready Preparing Yourself 5 Your Equipment gt Using water from a stagnant non moving source like a puddle or old tire can cause serious infec tions instead use water from a fire water source by hydrant stream or other moving sticking a used body of water even water flowing syringe in it in a gutter is safer than a puddle if Don t contami nate your entire this is all you can find THIS WATER CAN STILL GIVE YOU VERY SERIOUS INFECTIONS Be sure the glass or whatever you have your water in is clean Don t contaminate your entire water source by sticking a used syringe in it Pour some water into anoth er container if you want to rinse your syringe out and always be sure to discard the water you use to flush your injection equipment so no one else accidentally uses it Sharing contaminated water can transmit viruses and bacteria Make sure everyone s got their own Finally as mentioned above you might want to get into the habit of carrying a little bottle of water as part of your works in case you need to get off in a place where there s not a sink or other clean water supply TOURNIQUETS TIES Intravenous drug injectors usually need something to tie off with out making them more accessible for injection Elastic tourniquets like the kind that are used in hospi tals or stockings are kinder t
16. overdosing If possible try to purchase your drugs from a regular source that to the extent possible given the situation you can trust Establish wA 4 Overdose CHAPTER 4 a relationship with a dealer who you feel you can talk to about his or her product Some people overdose because they simply do too many drugs which build up in their system Let your drugs work first before you do more and perhaps plan to use only a certain amount maybe even purchasing just the amount you re going to use at a given time Take your time to prepare your drugs right even if youre in withdrawal or in a hurry Minimize uncertainty by thinking through each step of your drug taking Deep breathing may help focus you and sniffing or smoking a little bit of the drug may help calm you before preparing your injection gt Take control of your own drug preparation and intake Different users have different tolerances to drugs so a dose that s fine for one person could be lethal to some one else Make sure you know what you re putting into your own body gt A person can overdose if they haven t used for a while even for a short time After detoxing or spending some time in a rehabilitation center your body is no longer used to the same amount of drugs One of the conse quences of jailtime is that your tolerance decreases and you re a lot more sensitive to dope so be careful if youre getting high after release Tak
17. re use their own but especial ly others injection equipment H IF YOU ABSOLUTELY MUST SHARE NEEDLES SYRINGES OR OTHER DRUG INJECTION EQUIPMENT BE SURE TO CLEAN IT THOROUGHLY BEFORE RE USE If you find yourself in a situation where you must use someone else s injection equipment or they must use yours follow the cleaning instructions on page __ of this manual to reduce the likelihood of trans mitting a blood borne illness Sharing injection equipment even after it has been cleaned is definitely a second best choice because blood and other matter can remain in a needle or syringe even after cleaning Cleaning needles and syringes is a complicated process that even if done according to the best scientific advice currently available is not a 100 fool proof method of avoiding harmful bacteria viruses and other blood borne pathogens H FLUSH YOUR NEEDLE AND SYRINGE WITH WATER SEVERAL TIMES AFTER USE IF YOU PLAN TO RE USE IT AT A LATER TIME While it is safest to use a new needle and syringe for every injection if you know that you ll have to re use your injection equipment at some later time be sure to flush it several times with cold or room tempera ture water so that it doesn t become clogged with blood or other matter see cleaning instructions on following page HOW TO CLEAN A NEEDLE amp SYRINGE As already mentioned the only sure way for drug injectors to avoid contracting bl
18. they take to care for a person who has overdosed Overdose and Other Medical Emergencies This chapter will help you or someone you love avoid overdosing in the first place and give you some basic information about what to do in case you re with someone who overdoses There is no reason you should die just because you get high HOW DO O D s HAPPEN Anyone who uses drugs can overdose from the first time user to the person with many years experience There are numerous reasons a person can overdose gt One of the effects of drugs being illegal is that there is no quality control in other words you don t know what youre getting Drugs you buy on the street especially drugs like heroin that unlike pills are not made by drug companies can be a different strength from day to day Sometimes a drug may be cut a lot and sometimes it s hardly cut at all and therefore much stronger If you re using drugs of unknown strength and you are every time you purchase from a different dealer or new batch do a tester shot first to see how strong they are You can always do more later Many people overdose when they do a full hit of a strong drug Warn people you re using with or have gotten drugs for if you come across something that s unusually potent gt Sometimes dope speed and coke are cut with other cheaper drugs which can be dangerous and unpredictable and increase your chances of
19. viral drugs to prevent infection with the virus You may also be offered a tetanus shot If not you may want to request one if your vaccination is not current If you re around needles and syringes regularly you may want to get a tetanus booster every five years and be vaccinated against hepatitis B Overdose and Other Medical Emergencies There is no reason that accidental needlesticks should happen gt If at all possible never handle injection equipment that was used by someone else especially if it is uncapped gt NEVER try to re cap a needle that was used by someone else gt ALWAYS re cap your own needle immediately after use gt Do NOT break the needle off with your fingers gt Always store your used needles and syringes safely see chapter 5 4 Overdose IN THIS CHAPTER m Safe Storage amp Handling of Injection Equipment m Proper Disposal of Used Equipment m Where to Get New Materials For your safety and the safety of others it is extremely important to store and dispose of used injection equipment properly CHAPTER Sigs 7 TOOLS OF THE TRADE WHERE TO GET NEW EQUIPMENT AND WHAT TO DO WITH THE OLD Fo your safety and the safety of others it is extremely important to store and dispose of used injection equip ment properly There is no excuse for being lazy or sloppy about how you get rid of your potentially contaminated needles and syringes Throwing y
20. where you can make the process safer CHAPTER ID 7 GETTING READY PREPARING YOURSELF amp YOUR EQUIPMENT age for and planning your injection drug use or any drug use is one of the most important things you can do to achieve your desired results and to prevent potentially harmful mistakes from occurring in the process Drug injection is a rather complex activity There are many steps along the way where something can go wrong but equally as many places where you can make the process safer Before inject ing you should 1 assess the safety of your setting and eval uate your state of mind 2 make sure you have the best materials you can get and enough of them and 3 prepare your drugs as cleanly as possible aj CHAPTER 1 SETTING ENVIRONMENT amp MOOD Unfortunately we don t always have complete control over how were feeling when we want or need to get high or the circum stances under which we use While we may not always be aware of it where we use who we use with if anyone and our state of mind when were getting high can all have an impact on injection safety WHERE YOU USE Some places are safer for injecting than others and you should always choose from among your options the safest one possible The ideal location for injecting is one that is relatively clean dry warm and well lit and where gt your chances of getting caught by the police are minimal gt you feel
21. you could help someone who has overdosed survive We owe it to ourselves and to each other WHAT IS AN OVERDOSE Drugs that people take to get high work by affecting the brain Because the brain controls other parts and functions of the body like the lungs which enable oxygen to get to the blood the kid neys and liver which remove toxins from the body and the heart which pumps blood to all parts of the body using drugs can affect one or more of these crucial activities in addition to mak ing you high For example cocaine speeds up your heart rate and heroin slows down your breathing A person s body can usually adjust to these changes but if you take too much of a particular drug such changes may overwhelm the body s ability to adjust to them and very dangerous side effects can occur Some side effects that occur from taking a lot of drugs are often serious but not immediately life threatening such as the damage that can result to the liver and kidneys from making them work hard to remove drugs from the body over a period of years But if too much of a drug gets to the brain or other organs too fast dangerous side effects such as unconsciousness stopped breathing heart failure or seizures may occur any of which can be deadly This is what is known as a drug overdose od Overdoses are very serious but do not have to be fatal Often the difference between life and death depends on who is around and what actions
22. A Safety Manual for Injection Drug Users HARM REDUCTION COALITION working towards individual and community health Contents Introduction ee ON Hehe oe Bd Ce ebe elt i l GETTING READY PREPARING YOURSELF amp YOUR EQUIPMENT Setting Environment amp Mood 2 WHETE YOU USE EE 2 Who You Use With 5 ccc5 cscninunncandnasiisinen sacs akeaabon aoe gota saaaan 4 Assessing Your Mood 5 Choosing Your Materials 5 Needles amp Syringes ENKER a OM cd ol Ras aes 6 Guidelines to Safer Injecting 10 How to Clean a Needle amp Syringe lI Cookers amp SPOONS a errr rerepi ir E AAEE EEEE 13 Cottons FilteTS aa 14 Mixing Rinse Watt EEN See 16 RT ee UE 17 Lighter or Matches eoar behav ete AM helt heheh ot 19 Other Helpful Materials 20 Preparing Your Shot 20 EISE ED eege AAA AA WAWEKA 20 Cooking Your Shot 21 Dividing Drugs aaa 23 2 GETTING OFF THE BASICS OF SAFER INJECTION 25 Taking e EE 26 Ma inlining 2s 2 2806 cans oxeneee nreenscascaie AAA AAA 27 Choosing an Injection Site 28 Cleaning the Injection Site 28 Tying D EE 29 Inserting
23. C can either be chronic but asymptomatic with out symptoms which means you barely even notice you have it or chronic active which means disease will develop over a long period of time several years or perhaps even decades Unlike acute HBV infection HCV is never com pletely cleared from the body People with active hepatitis C may have elevated liver function tests LFTs fatigue and jaundice and active disease can result in cirrhosis liver can cer and ultimately liver failure all of which can be fatal 3 Health Hepatitis C is an extremely serious health risk for injec tion drug users many of whom it is now being discov ered have been exposed to the virus at some point in their lives Currently there is only Interferon alfa 2B is the only therapy prevention with use of currently approved for the treatment sterile injection equip of chronic hepatitis B and C in the ment by not sharing United States However many people injection equipment use a variety of alternative therapies and through safer sex for hepatitis treatment including west ern and Chinese herbal therapies or acupuncture The Hepatitis C Handbook by Matthew Dolan is a very compre hensive book covering a variety of hepatitis therapies from Western to Chinese medicine and other alternative therapies 5 gt CHAPTER 3 It is available through Catalyst Press RO Box 13036 London NW 3 WG or you can
24. EE Y 48 Blood Poisoning Septicimia mmmee 48 Endocarditis wa 49 Etape eh erna A E A T EEE TEET T 49 Necrotizing ai 50 Wound Botulism ia N EE 51 La WALA UTAWA EE E E eas earn 52 II 56 Injection Related Injuries 57 Tracking amp Bruising 57 Vein Collapse aa 58 EEN 59 Erol e deiere de ee deiten NAME Wak 62 Taking Care of Your Health 62 4 OVERDOSE AND OTHER MEDICAL EMERGENCIES 65 What Is an Overdose 66 How Do O Ds Happen 67 How Can You Tell if a Person Has Overdosed 70 What to Do if Someone Overdoses 71 What You Should Not Do if Someone Overdoses 74 Natania 75 Accidental Needlestick Injuries 76 d TOOLS OF THE TRADE WHERE TO GET NEW EQUIPMENT amp WHAT TO DO WITH THE ODL 79 Safe Storage and Handling of Injection Equipment 80 Proper Disposal of Used Eguipment 80 Where to Get New Materials 80 A compilation of medical facts injec tion techniques junky wisdom and common sense this manual re
25. ER 3 BACTERIAL VIRAL AND OTHER INFECTIONS DIRTY HITS A dirty hit is a general term for a shot that makes someone sick abscess as or causes an a result of being contaminated with infection caus or toxic subs ing microbes tances Dirty hits can be caused by any number of th gt contami ngs such as nants in the water you used to dissolve your drugs Dirt and bacteria get trapped in the cracks of a dried out plunger Dirt and bacteria also get trapped in S small places at the base of the needle ii Cutaway section of a syringe showing frequent dirty spots gt bacteria fungi or other microbes from old cottons gt chemicals in a cigarette filter that was used to filter a shot gt adulterants or contaminants in the drugs themselves or gt not properly cleaning the skin prior to injection A dirty hit can result in a fairly quick and intense reaction or might take days or weeks to produce an effect Symptoms often include sweating headache fever and trembling While the effects of a dirty hit may pass by themselves you should seek medical attention if they are particularly strong or persistent BLOOD POISONING Septicemia Blood poisoning septicemia is a bacterial infection of the blood stream that can be caused by injecting with contaminated water re using old cottons or failing to clean the skin prior to i
26. RAVENOUS INJECTION Intravenous injection mainlining or injecting a substance direct ly into the bloodstream through a vein is one of the fastest ways to deliver a drug into your system It is also the riskiest method to use in terms of overdose as opposed to sniffing smoking or oral administration because the entire dose enters the body all at once and very quickly Injecting intravenously usually gives the user a rush that many people report to be extremely pleasur able a sensation that does not occur with intramuscular or sub cutaneous injection While each injection method carries its own risks mainlining is arguably the riskiest since it creates a direct opening between the bloodstream and the outside world Heroin cocaine and amphetamine are three drugs that are com monly administered intravenously EZ CHAPTER 2 CHOOSING AN INJECTION SITE People who inject drugs often have one or two favorite places to inject sites that feel the most comfortable are easy to access and where you almost always get a clean hit on your first try While it may seem awkward at first it is important to learn how to inject in other places that may not seem as comfortable or accessible on your first couple of tries If you keep injecting in your favorite spots over and over without letting the veins repair themselves they will become leaky making your shot less satisfy ing and harder to hit could become seriously infecte
27. Your Needle 29 REGISTERING Jo2 ce ande clase acacia KE eegend 29 EG Geen e ee 31 Missed Shots amp Aftercare 32 Mainlining Cocaine Ia 32 Mainlining Crackass ua 33 Shooting Speed i eege Eed geo deep erences 33 Hierarchy of Safety for Choosing Intravenous Injection Sites 34 More Tips for Choosing an Appropriate Injection Site 38 Veins VS DEER Eer 38 Veins Vs N ss edd eee hut sande dd den 40 Exercises for Improving Vein Visibility 40 Some Tips for Getting Veins Up 40 Muscle Popping 41 Choosing an Injection Site 42 Cleaning the Injection Site 43 Inserting the Needle ii Ia 43 Pulling IA EE 44 Muscling Hormones ww wwamwnmwnawnnwana 44 Skin Pop pins AA aa 44 Choosing an Injection Site 45 Cleaning the Injection Site 45 Inserting the Needle 45 Pulling Outs aa 46 3 POTENTIAL HEALTH COMPLICATIONS OF INJECTION DRUG USE 47 Bacterial Viral amp Other Infections 48 Ditty Hits ii teh stake toga dnt
28. agent or disinfectant Be sure not to touch the injection site with your fingers after you ve cleaned it Routinely cleaning the skin prior to injection is one of the most important things you can do to reduce your risk of endocarditis blood poi soning and similar infections discussed in chapter 3 TYING UP Use gravity to bring blood to the limb you re going to use to inject D ba 0 bo E Ad v Vu amp before applying your tourniquet tie swing or hang your arms make a fist etc Tie your tourniquet in such a way that it can be easily removed if necessary see illustration p 24 Try to secure rolling veins like those in your forearms before you inject into them Finally be sure not to leave the tourniquet on for too long If you feel your limb becoming numb or notice it turning blue undo your tourniquet and don t retie it until you re ready to inject INSERTING YOUR NEEDLE Insert the needle into your vein with the needle bevel opening fac ing up at a I5 to 35 degree angle and always in the direction of the heart The more perpendicular the needle is to the injection site the greater chance you have of sticking the needle through the vein instead of into it See illustration on following page REGISTERING Once you think you re in a vein pull the plunger back to see if blood comes into the syringe If so and the blood is dark red and slow moving you know that you ve hit a vein You can now u
29. ame than matches do and can be ignited using only one hand Also a lighter won t give off a sulfur smell like matches do which could give you away if you re getting off in a public bathroom CHAPTER 1 OTHER HELPFUL MATERIALS While the needle syringe cooker or spoon cotton tourniquet and a lighter or matches are all necessary for preparing and injecting drugs there are a few other materials it s helpful to have if you can get access to them gt Alcohol pads are extremely helpful for cleaning an injec tion site prior to getting off to prevent baceria and dirt on the skin from entering your bloodstream gt To prevent blood from getting all over your shirtsleeves or clothes a situation that will require a lot of explaining if you re at work or visiting a friend who doesn t know you use carry tissues with you and maybe even a Band Aid to apply after you ve gotten off PREPARING YOUR SHOT FIRST 20 Preparing your shot as cleanly and as hygienically as possible can help you avoid of illnesses and infections some of which can be quite serious and require hospitalization see chapter 3 Every time you inject youre creating the means by which bacteria and other infection causing microbes can directly enter the body and if you mainline the bloodstream itself The skin is the body s first immune system component and we open ourselves up to potential infection every time we break it That s why it s so im
30. and experience in properly administering it Some clinicians prefer not to administer Narcan in the event of an overdose because of its disturbing and harsh effects The major problem for people overdosing on opiates is that they stop breathing as long as emergency measures are taken to keep an overdose victim breathing most people will wake up and come 7 gt CHAPTER 4 to within a few minutes without the profound shock caused by Narcan administration ACCIDENTAL NEEDLESTICK INJURIES The risk of infection from hepatitis and tetanus is far greater than the risk of HIV from an accidental needlestick There is a remote chance of being infected with HIV if you are pricked or scratched with a used needle The risk of infection from hepatitis and tetanus are far greater if the needle was contaminated with either of these pathogens both of which are much more infectious than HIV If you are accidentally stuck with a needle that was used by some one else try not to panic and take the following precautions Encourage the wound to bleed by squeezing the punc ture site This will help keep any pathogens from entering your body Wash the wound with soap and water as soon as possible Apply an antiseptic and a sterile bandage Seek medical attention from an emergency room or clin ic If the person whose needle you were stuck with is HIV you may be encouraged to take a short regimen of anti
31. and Aid to prevent infection 46 IN THIS CHAPTER E Bacterial Viral amp Other Infections m Injection Related Injuries Em Taking Care of Your Health This section of the manual describes some of the medical and health problems that can result from injecting drugs and offers sugges tions for how to prevent them CHAPTER RR POTENTIAL HEALTH COMPLICATIONS OF INJECTION DRUG USE WM if not all of the things that can go wrong during the process of preparing and injecting drugs fall into one of three categories drug related technique related and hygiene related mishaps Because were forced to use blackmarket unreg ulated drugs we ll never have control over the quality or purity of the substances we use But while we may not be able to do much about the actual drugs we use we can work to improve our injection technique and hygiene which can have far ranging effects on our health There are numerous and potentially very serious health complica tions associated with injecting illicit drugs from injection related injuries like tracking and bruising to bacterial and fungal infections from communicable diseases to drug overdoses and other medical emergencies This section of the manual describes some of the medical and health problems that can result from injecting drugs and offers suggestions for how to prevent them Overdose preven tion and survival are addressed in chapter four a7 CHAPT
32. ase to make water a perma nent part of the works you carry bullding or seeing Most importantly always try to stay bloody tissue in a as calm as possible no matter where public toilet and you re injecting While it can be there s no reason nerve wracking getting off in a pub they should have to lic or semi public place or some where else where you re afraid of getting caught it s important to keep your wits about you so that you don t end up knocking over your shot spilling your drugs being unable to get a hit because youre so nervous or getting blood all over So use common sense and planning when choosing a location to inject If at all possible wait to get off until you ve found a place where you feel relatively comfortable and can minimize the risk of getting arrested Make sure you have all the materials you need before you begin and dont assume you ll always have access to water Finally be considerate of others no one likes coming across a used needle and syringe in their apartment building or seeing bloody tissue in a public toilet and there s no D CHAPTER 1 reason they should have to Drug injectors have a bad enough rap as it is Let s not give people the ammunition to keep us marginalized and oppressed WHO YOU USE WITH Although it is not always and for some people ever desirable or possible to inject with someone else present having another per son around when you get high
33. ave a seizure or stop breathing you want them to be in an ambulance or at a hospital when it happens Don t wait for them to just come out of it If the person is conscious but experiencing nausea chest tightness shortness of breath or other such symptoms convince them to call o or call ou for them When you call 911 you don t have to tell the operator that the person has overdosed This will prevent a lot of police from arriving with the ambulance While you re waiting for the ambulance check to see if the person s airways are clear but do not stick anything into their Overdose and Other Medical Emergencies mouth unless you can see something blocking their throat like vomit or food Never leave someone alone who has overdosed If you need to remove drugs or smoking or injection equipment before the ambulance arrives don t let the person out of your sight If you absolutely must leave the person alone for some reason put them in the recovery position call OI before you leave or from another nearby location and make sure the ambulance technicians will be able to gain access to where the person is When the ambulance arrives tell the emergency med ical technicians EMTs that the person sometimes uses x drug They can best help the person if they know what has happened The EMTs will need to know how to treat the person but you don t have to tell them you used drugs with your friend The amb
34. can be a safety net particularly in terms of surviving overdose For those who live alone however It is important to try to put together a support system of people who know you use and who you can rely on for sup port or in case of an having someone else present every time you inject may be unrealistic and some people simply prefer using by themselves Another complication is that many of us use in secret for fear that we ll be reject ed or judged by those we come out to It is important to try to put together a sup port system of people who know you use and who you can rely on for support emergency or in case of an emergency This may be easier said than done however and even though injecting drugs may have become a mundane activity for you it is frequently shocking for non users to learn that someone they know engages in this activity Disclosing your use to the wrong person could add untold stress to your life so make this decision carefully Try to make yourself available to other users who may need support H you re worried that a friend has been using too much for instance have them check in with you by phone after they get high to make sure everything is okay And finally avoid using with people you don t like or who could care less about what happens to you if you were to overdose Getting Ready Preparing Yourself 5 Your Equipment ASSESSING YOUR MOOD The quality of any drug exp
35. change programs and many other types of providers General symptoms of HIV infection may include a low grade fever and fatigue The longer a person is HIV infected Potential Health Complications of Injection Drug Use the more likely they are to develop one of the many bacter ial fungal or viral infections cancers neurological disorders or other conditions that afflict people with HIV and AIDS Traditional Western and alternative therapies are available for fighting replication of the HIV virus in the body and for pre venting and treating some of the numerous opportunistic infections that people with HIV and AIDS commonly get There is no cure for HIV or AIDS at this time INJECTION RELATED INJURIES TRACKING AND BRUISING Track marks are the scars that appear along Skin Layers the veins of someone who injects frequently vern Fatty Tissue 3 Health and repeatedly uses the same injection sites SE Bruising occurs when blood leaks out from the vein under the skin in the process of injecting Damage to the veins including tracking and bruising can be minimized or prevented alto gether by practicing the following safer injection guidelines These are especially important for those individuals who are worried about family friends an employer or someone else find ing out about their drug use Track marks are one of the most visible signs that you use gt Use a sharp sterile needle
36. comfortable that there will be no surprise inter ruptions or unwanted observers gt you can take as much time as you need gt you have adequate space for yourself and your equipment gt you have access to a sink or other source of clean water gt you are sheltered from the wind and weather All of these factors should be weighed against each other when choosing a place to get off It is clear then that using in your own home if you re fortunate enough to have one or the home of a friend is safer than using in a public bathroom However a public bathroom particularly if it s a single room with a door that locks is usually safer than injecting in a place such as a public park or the stairwell of an apartment building In general but not Getting Ready Preparing Yourself 5 Your Equipment always indoor locations are safer than outdoor ones and defi nitely preferable in terms of wind and weather If you re injecting in a relatively public place like a toilet stall in an public bathroom try to make it look like you re changing your v is v bo w A4 v 6 clothes or freshening up If you know you ll have to be getting off in Be considerate of a location like this where there is no others no one likes direct access to a sink bring along a coming across a used small bottle of water to mix your A P needle and syringe in shot with its probably a good idea their apartment in any c
37. cs is crucial to survival although even appropriate therapy does not prevent death in all cases Wounds must be kept impeccably clean Always using new sterile injection equipment never sharing injection equipment thoroughly washing your hands and clean ing the skin prior to injection and preparing your drugs on a clean surface will all help prevent necrotizing fasciitis infections Potential Health Complications of Injection Drug Use WOUND BOTULISM Wound botulism is caused by a bacteria that produces a toxin on the skin where a puncture would is made and that eventually stops your breathing by paralyzing your muscles Recent cases have been associated with the subcutaneous injection of black Heroin Users If you skin pop cr mainline MEXICAN TAR HEROIN There s a new germ on the rise called WOUND BOTULISM You cannot kiikit by cooking the depelll ya 7 gIrean be fatall The fet signa ei Wound Rahten mabegi in 36 48 hours Shorrect epamsh blurred oben waitin Shamness of brecth Sere throm difficult awaloe of bretha Wek muscles heavy eye ics Laning Coro of your muscios D you egaperlence any possible symptoes ge to the emergency room Tell ihe doctor mai you speet WOUND SOTULISM 3 Health tar heroin on the West Coast The source of the botulism could be the drug itself a cut in the drug dirty injection equipment or contamination during the preparat
38. d and will eventually collapse or scar so badly that they become altogether unusable and interfere with circulation So it is very important to rotate the sites you use to inject Try to use a new site for each new injection and go back to sites you ve already used only after they ve had time to rest and repair themselves In addition to learning to inject in new places it is also important to learn how to inject with either hand so that if the veins on one side of your body need a rest or are otherwise unusable you re able to inject into the veins on the other side of your body even if you need to use your non dominant hand to do it The next time you re in withdrawal and really need to get off but can t find a vein in your usual spot you ll be thankful you taught yourself how to inject into the other arm CLEANING THE INJECTION SITE 28 Any time you inject intravenously you risk pushing bacteria fungi and any other infection causing microbes that are on your skin directly into your bloodstream It is therefore extremely impor tant to thoroughly clean your injection site prior to getting off Alcohol pads work well for this purpose but be sure to wipe in Getting Off The Basics of Safer Injection only one direction and not in a circular motion which will cause the dirt and germs to stay on your skin Plain old soap and water also work fine as do rubbing alcohol hydrogen peroxide or any other type of cleaning
39. d information about the use of illicit drugs with the goal of reduc ing harm and promoting individual and community health Drug use is a complex experience and issue which affects those who use their loved ones and the communities in which they live We hope that this manual will serve to reduce the associat iii INTRODUCTION ed dangers for people who use drugs or who are affected by drug use While we can As injectors we should always be in control of our own drug preparation and intake and not have to rely on anyone else for this we should always be in con trol of what goes into our own bodies and how t predict every possible scenario you might encounter we hope the exam ples presented in this manual show you how common sense and planning can make any drug using experience safer The Harm Reduction Coalition HRC is committed to publishing non judgemental information that is relevant to the lives and health of drug users HRC will be fol lowing through on this commitment with future publications Please let us know what in this manual is useful what isn t useful what you would like more information about and any other comments or suggestions you might have IN THIS CHAPTER m Setting Environment amp Mood m Choosing Your Materials Em Preparing Your Shot There are many steps along the way where something can go wrong but equally as many places
40. dose and Other Medical Emergencies NARCAN Narcan naloxone is an opioid antagonist that when injected into a person who is overdosing on heroin methadone or other synthetic opiates immediately counters the effects of these drugs and brings the person to Narcan can be given intravenously or by intramuscular injection Ambulances and other emergency response vehicles often carry Narcan to use in the event of an opiate overdose and some detox programs still use Narcan to initiate withdrawal when a patient is admitted Narcan is restrict ed for use by medical and health professionals only and will only help someone who has overdosed on heroin or another opiate Giving someone who has overdosed an injection of Narcan can get pretty hectic because the persons body is thrown into severe withdrawal almost immediately causing them extreme dislocation and discomfort The person who is overdosing may become quite upset begin to thrash around and scream become physically aggressive and even refuse to go to the hospital Encourage med ical personnel to administer Narcan slowly to make the transition to withdrawal less painful and more gradual Because Narcan is short acting and wears off relatively quickly the person can revert back to a state of euphoria and if they still have enough 4 Overdose drugs in their system begin to overdose again It is therefore important to have an adequate supply of the drug on hand
41. dosing is that their face or lips will turn blue They may also look very pale be very limp be able to breathe and look at you but not be able to talk be breathing but very slowly and shallowly stop breath ing altogether have a slow pulse heartbeat or no pulse at all foam at the mouth vomit be shaking or have a seizure complain of chest pain pressure tightness or shortness of breath or sud denly collapse and become unconscious You have about 4 min utes from the time your lips turn blue to coma Overdose and Other Medical Emergencies A person who is overdosing isn t usually aware of what is hap pening because of the effects of the drug they re on They are helpless and need someone to act quickly If a person stops breathing it can take only a few minutes for them to die Just waiting for them to get over it is the worst thing you can do if someone is overdosing Immediate action must be taken to help them survive WHAT TO DO IF SOMEONE OVERDOSES Anyone who uses drugs should develop an overdose plan in the event that something happens If someone is overdosing follow these steps Zi 3 4 Check to see if the person is able to open their eyes or speak to you Shake them and call their name Check the person s pulse and breathing Does a mirror held under their mouth fog up Can you feel their breath on your hand Is their chest moving up and down Can you detect a heartbeat w
42. e a smaller dose if you re using after a break until you figure out how much you need Someone who s using a drug for the first time should also be extremely careful since they will have no tolerance to it at all You might try using the drug in a way that makes it come on more slowly sniffing heroin Overdose and Other Medical Emergencies or cocaine rather than injecting it for example And make sure you use with someone who knows what they re doing and has experience with the drug Mixing drugs like heroin pills and alcohol can be very dangerous One of the most common reasons for death from an o d is mixing drugs since drugs that are taken together can be much stronger than if they re taken alone You may get a stronger high when you mix but youre also putting Alcohol is one of yourself at much greater risk of having the most common an overdose Mixing drugs also amp most dangerous increases the risk of passing out and drugs mixed with vomiting and vomit can block your other drugs airways and cause you to suffocate Finally some pharmaceuticals may interact with street drugs in dangerous ways If you feel comfortable doing so you might want to talk to your doctor about this issue Changes in your health may cause you to be at higher risk for an o d If you have lost a lot of weight a smaller amount of a drug will get you high and if your liver or kidneys aren t working well yo
43. ed that cause damage to muscle tissue and skin If you notice a hard warm lump developing at an injection site apply warm compresses at least three times a day to either make the abscess that is forming go away or come to a head soften and fill with pus If it comes to a head you can get the abscess opened and drained at a hospital or clinic If you experience fever chills extreme fatigue or pain associated with an abscess seek medical attention immediately because you could have a blood infection Pain in the groin or armpits also means 22 CHAPTER 3 Wile bipi cehs atac par Wim Dead white bori zclh mie wara Afs fCa ceting absses Ei Since Ze bat rna brsoran infec Ia on Au hi st tae D AC Cam RUSS getraut HOW AN ABSCESS IS FORMED Potential Health Complications of Injection Drug Use you most likely have an infection for which you should seek med ical treatment If youre unable or unwilling to seek medical care for an abscess take the following steps Clean the area with soap and water and be sure to keep it as clean as possible at all times 2 If the abscess is draining let it continue to do so 3 Keep the area covered with sterile gauze you can buy in a pharmacy and change the dressing twice a day until the pus stops draining and at least once a day until the abscess is completely healed Dressings that directly touch the wound should be dampened with sterile saline
44. ed a process known as cooking Different drugs dissolve differently If you re using something like injectable mor phine or hormones that are already in liquid form cooking is completely unnecessary Some drugs will dissolve in water with out being heated some people cook their cocaine for instance 77 v is v bo w LA v U CHAPTER 1 while many more do not because it can clot Inject pills only as When heated mess up your shot and clog injecting the parti a last resort your needle Though brown heroin will dissolve without an cles from a pill can aig heating it along with an acid like pow cause all sorts of dered vitamin C will help dissolve it more problems particu easily DON T USE LEMON JUICE because it can larly abscesses cause fungal infections that can damage the 22 eyeball Finally pills must be crushed up or pulverized as finely as possible before being dissolved for injec tion Many drug manufacturers now formulate their pills so that they re not able to be dissolved in water at all but just sort of clump up when you heat them If you re going to try to inject a pill dissolve a small corner of it first so that you don t waste the entire thing And inject pills only as a last resort injecting the particles from a pill can cause all sorts of problems particularly abscesses For this reason you should avoid muscle popping or skin popping pil
45. ei Illustration courtesy of Positive Health Project CLEANING THE INJECTION SITE Be sure to carefully clean the injection site prior to injecting see Mainlining section above for more detail INSERTING THE NEEDLE Try to relax the muscle prior to injec tion This will result in a less painful You definitely want injection and may prevent the sore to draw your plunger ness you usually feel the following day back slightly to or two When injecting into a muscle make sure no blood insert the needle in one quick stab comes into the straight into the injection site at a 90 syringe angle to the body Nearly the entire needle should enter the muscle You definitely want to draw your plunger back slightly to make sure no blood comes into the syringe If blood does appear you ve hit a blood vessel and need to pull out and try again Inject your substance slowly CHAPTER 2 PULLING OUT Pull your needle out in the same direction and angle at which you inserted it Because you injected into a muscle there should be little if any bleeding You might want to apply a Band Aid in any case to prevent infection Massaging the area lightly for a few minutes will help the drug absorb and reduce the pain MUSCLING HORMONES Hormones are to be injected only into the thigh or buttock mus cle When injecting be careful of nerves veins and bones The buttock is the most common place people inject
46. erience is determined not only by the drug itself including factors like potency and purity but also depends on how the drug is administered the environment in which it is taken and the mood or mindset of the individual at the gt v is v bo w d v U time he or she takes the drug It is therefore important for anyone who is going to take a drug to assess their mood and mindset before they get high You should always be aware of how you re feeling prior to altering your consciousness Feeling relaxed confident and calm will help insure that you will take your time to inject hygienically and properly If you re in with drawal panicked about getting high in a public bathroom or oth erwise anxious and upset the chances of something going wrong increase Take a few deep breaths and try to gain some compo sure before you begin to prepare and inject your drugs in order to prevent accidents and make sure you get a hit without harm ing yourself in any way CHOOSING YOUR MATERIALS There are a lot of materials needed to inject drugs what those of us who use refer to as our works Ideally the type of equip ment someone uses to inject will be appropriately matched to the drug they re using where they plan to inject it the condi tion of their veins if they re mainlining and other factors Unfortunately drug injectors do not always have regular legal access to the materials they need and are freque
47. flects HRC s commitment to providing accu rate and unbiased information about the use of illicit drugs with the goal of reducing harm and promoting individ ual and community health INTRODUCTION Ox of the results of the United States zero tolerance approach to drug policy is a serious lack of accurate information about drugs and drug use This lack of information makes it extremely difficult for people to make rational and informed deci sions about using drugs Just say no is an inadequate message to give anyone about drugs but is especially dangerous for those indi viduals already using them Drug users and those thinking about using drugs need unbiased non judgmental reliable information about the desired effects and undesired risks of the drug s they are using or contemplating using D INTRODUCTION In addition to the benefits they may experience some individuals experience extremely negative consequences as a result of using Contrary to popular users can do to take care of ourselves and reduce the possible health and illicit drugs Some of these harms may be attributable to the effects of opinion there are many the drug itself on the body and the things that we as drug mind More often drug related harm is the result of the numerous social economic legal cultural and political factors that shape the way illicit ille gal drugs are made available and the other ri
48. for fiv spasms or rigidity especially in the years so you might neck and jaw tetanus is commonly consider getting one called lockjaw Tetanus is fatal if not treated 22 CHAPTER 3 Tetanus spores live in the soil and on rust which is why a tetanus shot is recommended if you step on an old nail or other rusty object Most local health departments offer free tetanus boost ers which will protect you from tetanus for five years so you might consider getting one If your needle syringe or other injec tion equipment is contaminated with tetanus spores due to dirt or rust you could infect yourself Skin poppers and muscle poppers are particularly susceptible to tetanus infection and should always use new sterile equipment NECROTIZING FASCIITIS Flesh Eating Disease Necrotizing fasciitis is a bacterial infection commonly known as flesh eating disease that enters the body through broken skin and then affects the surrounding tissue and nearby muscle It can be transmitted by the exchange of blood during needle sharing and has recently been traced to black tar heroin on the West Coast Symptoms of necrotizing fasciitis include increasing redness and swelling and extreme pain at the wound or injection site accom panied by a fever The flesh around the site of infection begins to decay and looks as if it had been eaten away Since this infection is fatal early treatment with antibioti
49. g page gt Frontloading The drug is carefully squirted into the front of each person s syringe that still has the plunger in it but from which the detachable needle has been removed See illustration on following page gt Always be sure any equipment you use to cook up and divide drugs is new preferably sterile or as a second best option properly cleaned CHAPTER 1 BACKLOADING PIGGYBACKING U Remove the plungers from two 9 Carefully replace both plungers syringes Using a third syringe draw up the hit and empty half into each of the syringes FRONTLOADING Photograph Jean Paul Grund and Rene Overbeek from Drug Sharing and HIV Transmission Risks The Practice of Frontloading in the Dutch Injecting Drug User Population Journal of Psychoactive Drugs Vol 23 1 Jan Mar 1991 24 IN THIS CHAPTER m Taking Control m Mainlining Intravenous Injection m Hierarchy of Safety for Choosing Intravenous Injection Sites m Veins vs Arteries m Veins vs Nerves m Exercises for Improving Vein Visibility m Some Tips for Getting Veins Up m Muscle Popping Intramuscular Injection D ba el bo E Ww v Vu ei m Skin Popping Subcutaneous Injection This section of the manual presents information on proper injection technique intravenous intramus cular and subcutaneous injection CHAPTER d j GETTING OFF THE BASICS OF SAFER INJECTION
50. g the pulse Then move a short distance toward the inside of your leg to find the femoral vein Because it lies fairly deep you will probably not be able to see it but will have to inject into it blind The jugular vein in the neck is the riskiest place to inject because it lies very close to the carotid artery a major blood vessel that brings blood directly to the brain Accidentally hitting the carotid artery could be fatal and damaging the jugular vein in any way can interfere with blood circulation to the brain more safe less safe HIERARCHY OF RISK 33 Y el bo E Ad v Vu ei CHAPTER 2 FIRST CHOICE Mecian Cubital ein Accessory Cephalic Ven Basic Ven Aynitebrachial Wein Cephalic Vein Radial vein SAFEST INJECTING LOCATION THE ARM Numbered in order of safety 36 Getting Off The Basics of Safer Injection Cephalic ein ie bo c Z v g dors ei d N a Metazarpa Basilic Mem Veins LOCATION OF VEINS IN HAND Know Where You re Hitting CHAPTER 2 more tips i Choosing an Appropriate Injection Site e Taking proper care of the veins in your arms and other safer locations will prevent you from having to shoot up in more dangerous ones e You should avoid using veins that are tender hardened or inflamed until and if they heal Warm compresses and the use of appropriate creams can help speed the heal i
51. hen you put your ear to their chest If the person doesn t respond or seems to have stopped breathing try to bring them around by pinching their earlobes or rubbing their breastbone with your knuck les Try to get them up and walking around even if you have to hold them up Talk to them It is important to keep someone who has overdosed as alert as possible If the person has stopped breathing they need attention immediately or they will die within minutes if they don t get air Keep them alive by giving them mouth to mouth resuscitation Helping with breathing is relatively harm 4 Overdose CHAPTER 4 less it s the pumping the chest that can be harmful and that should only be done by someone who knows how Call o anaes and tell them that the person ia Lee St roy has stopped breathing Put them in the recovery posi The Recovery Position tion on the floor If you can t get them in the recovery position tilt the body forward instead of leaning back so that their air way will be clear and fluid will come out of their mouth REMEMBER vomit carries virtually no communi cable diseases as it s acidic and kills bacteria So clean out their mouth with your hand dont use water because they may choke and GET TO IT It may be gross but it could save someone s life If the person is unconscious that is you can t wake them up no matter what you do call 911 immediately If they are going to h
52. hormones must be injected into a muscle instead of a vein but heroin and other opi ates can also be administered using this method The physical and psychoactive effects that result from an intramuscular injec tion of a drug come on much more slowly than those of an intra venous injection half an hour to forty five minutes versus almost imme Most if not all of the diately although the overall cumulative infection control and intensity of the effects and the experi other safety precau ence are virtually identical Also the tions intravenous drug rush that is produced when drugs like injectors should follow heroin are administered intravenously is also apply to individu not experienced by individuals who CR DEE als who inject drugs inject intramuscularly intramuscularly an CHAPTER 2 Most if not all of the infection control and other safety precautions intravenous drug injectors should follow also apply to individuals who inject drugs intramuscularly Muscle popping produces much less bleeding than intravenous injection if any at all but the risk of transmitting viruses and other blood borne bacteria as a result of needle sharing is as serious as it is with intravenous injection In addition muscle poppers are at high risk for abscess formation especially if what they inject has any particles in it whatsoever When muscle popping it is extremely important to inject only a solut
53. if e The plunger of your syringe is forced back by the pres sure of the blood D ba el bo E w v Vu ei e When you register the blood in your syringe is bright red frothy and gushing Blood in veins is dark red slow mov ing and lazy e You feel an electric burn along your limb You can avoid hitting an artery by e Never injecting where you feel a pulse e Injecting only into surface veins and not trying to hit those that lie deeper What to do if you hit an artery e Untie your tourniquet and pull your needle out immediately e Raise the limb above your head to stop the bleeding if possible e Apply firm pressure to the wound for at least IO minutes e If bleeding continues apply a bandage or cloth wrapped very tightly around the wound and seek medical attention immediately The loss of blood from hitting an artery can be life threatening if it s not stopped 32 CHAPTER 2 40 veins vs nerves Unlike some veins nerves are not visible from outside the body although you will definitely know if you ve hit one while injecting because you ll experience extreme pain and no blood will enter the syringe when you pull back to register Hitting a nerve can be very dangerous and result in paralysis or the loss of a limb It s a good idea to know where your major nerves are so that you can avoid them when getting off
54. in these old cottons which because they are moist after use provide ideal environments for microbes and cause cotton fever when re used at a later time Cotton 15 CHAPTER 1 fever is an infection characterized by chills sweating fever and other flu like symptoms It may go away on its own or if it persists or worsens require medical attention MIXING AND RINSE WATER You ll need water in which to dissolve your drugs and to flush out your needle and syringe after you ve gotten off This is particu larly important for people with HIV AIDS or other serious health conditions to use the cleanest water you can find Remember you re putting the stuff straight into your bloodstream gt Using sterile water to dissolve cook your drugs is your safest option You can buy it at any drug store or pharmacy DON T buy sterile saline salt water because your drugs may not dissolve in it gt After sterile water your next best option is using water that you boiled for at least I0 min utes and stored in a sealed jar Don t use water that you boiled several days ago and which has been sitting in a pot or kettle gt If sterile or boiled water are not viable options for you fresh cold tap water or bottled water are the next best MAMAA NAA choices card to the bowl gt If youre getting off in a location without a sink or other fresh water source try to find a toilet and use the water
55. injecting drugs carries too many risks and that snorting or smoking are more preferable alternatives Such a decision would be a valid and important way of reducing drug related harm Share this booklet and what you learn with other injectors Most of us taught ourselves how to inject through a process of trial and error that undoubtedly included lost shots painful misses swollen limbs and a great deal of frustration This manual is intended to help minimize these problems We need to take responsibility for helping each other live safer and more satisfying lives free from unnecessary disease and illness and with dignity The Harm Reduction Coalition HRC does not condone or con demn the injection of illicit drugs Rather we recognize that drug injection is a potentially haz ardous and intensely stigmatized This manual challenges behavior which many people those of us who shoot already engage in and will contin drugs to take a close look ue to engage in In many at all the steps we engage instances for years at a time A in when preparing and and a behavior that many others will experiment with or come to injecting drugs in order to adopt in the future A compila figure out if that process tion of medical facts injection can be made safer any techniques junky wisdom and where along the way common sense this manual reflects HRC s commitment to providing accurate and unbiase
56. ion process Wound botulism can be prevented in the same ways as necrotizing fasciitis by following excellent sterile technique when preparing and injecting your drugs 5 CHAPTER 3 Symptoms of wound botulism include droopy eyelids blurred or double vision and a dry sore throat which may progress into dif ficulty speaking and swallowing a weakness of the neck arms and legs and difficulty breathing If untreated wound botulism will cause death by paralyzing the muscles used for breathing Early treatment for wound botulism is essential If you experience any of the symp toms listed above seek medical attention immediately Treatment usually involves an antibiotic regimen and the draining of any abscesses or infected wounds HEPATITIS Hepatitis is an inflammation of the liver that can be caused by certain toxic drugs alcohol or street drugs iatrogenic or chem ically induced hepatitis or that is the result of infection with a By preventing hepatitis you can prevent most other infectious diseases transmitted by injec tion drug use hepatitis virus viral hepatitis While there are numerous types of hepatitis viruses hepatitis B and hepatitis C are the two that most fre quently affect injection drug users with hepati tis A coming in third General symptoms of hepatitis include fatigue loss of appetite nausea mild fever and muscle aches and if you smoke cigaret
57. ion that is as particle free as possible Many of the substances that require intramuscular injection come pre prepared in liquid form To prevent contaminating your entire supply especially if you re sharing it with someone else be sure to use only a sterile needle and syringe when drawing the liquid up from the bottle in which it s stored Muscling speed or cocaine is very painful and dangerous and is likely to cause an abscess CHOOSING AN INJECTION SITE A2 The buttocks thighs and upper arms are the three best sites respectively for intramuscular injection The best is in the deltoid the muscle on your upper outer arm where your shoulder and your arm meet If injecting into the butt mentally divide each cheek into four equal sections and inject into the top right or top left outer section of each cheek see illustration below You can also use the front surface of your thighs about six inches above your knee to about six inches below your hip or the outer sur faces of your upper arms between your shoulder and your elbow Always be careful to avoid nerves blood vessels or bones and rotate injection sites to avoid bruising abscess formation and the Getting Off The Basics of Safer Injection ike It is not uncommon for your muscle to be sore for a few days after an injection WHERE TO HIT THE BUTT amp THIGH h Shaded areas show where to inject needle D ba el bo E Ww v Vu
58. ls altogether see pages 41 and 44 Ideally your drug solution will be clear and particle free If it s not you may want to try to re cook it although sometimes street drugs contain cuts that will not dissolve no matter what you do In this case use your cotton to filter out as much of the cut as you can Lastly don t re cook a shot with a lot of blood in it as the blood can coagulate and clog your needle After you ve cooked up your drugs draw the solution into your syringe through your cotton Tap out all the air bubbles and push the liquid to the tip of the needle Getting Ready Preparing Yourself 5 Your Equipment DIVIDING DRUGS If you ve bought drugs with someone else you need to ensure that everyone gets their fair share in a safe way There are sever al ways this can be done gt v is v do w LA o U gt The safest way to divide drugs is to split the powder or tar and have each person cook up their own drugs with their own materials gt If this first option is for some reason not acceptable the drugs can be cooked up first using sterile equipment and then divided using sterile syringes after they re in liquid form gt Backloading Piggybacking A single sterile syringe can be used to draw up equal amounts of the liquid which can then be carefully squirted into the back of each per son s sterile syringe after the plunger has been removed See illustration on followin
59. n and one that is too long may go right through it or be difficult to properly position Longer needles are often appropriate for intramuscular injections As inscribed on packaging needle length appears after the gauge number 28G refers to a 28 gauge needle that is inch long BRAND Most drug injectors find that if given the opportunity to try out different brands of needles and syringes they will find one that they prefer over all others Different manufac turers create needles and syringes of varying quality Some brands of needles are more comfortable to inject with than 7 CHAPTER 1 others and the plungers on some brands of syringes are easier to manipulate than on others ONE PIECE SETS VERSUS TWO PIECE DETACHABLE SETS With some types of injection equipment the needle detaches from the syringe resulting in two separate pieces Standard insulin injection equipment is typically one piece while tuberculin nee dles and syringes are often detachable Detachable two piece equipment often has a larger reservoir above the needle in id which a lot of blood can collect If youre using a two gi ece set make absolutely sure F the needle is securely fas to the syringe so that it does nt detach while you re injecting causing you to lose your shot Lastly you might find that using a butterfly set often used for drawing blood from hospital patients is helpful when getting off in
60. nd bruises on the hands Circulation in the legs may be poor especially in people who don t use theirs a lot Veins in the legs are more likely than those in the arms to develop clots that can obstruct circulation and eventually break off and lodge in the lungs or heart Also damaging the valves in the leg veins is more serious that damaging those in the arms since they play a greater role in get ting blood back to the heart As with the hands the veins in the feet are generally smaller than in other parts of the body and close to nerves cartilage and ten dons which you want to avoid hitting when you inject Because they are farther from the heart than the veins in the hands arms and legs blood circulates more slowly in the foot veins and they Getting Off The Basics of Safer Injection HIERARCHY OF SA Continued therefore require more time for healing and repair In addition foot sweat and dirty socks act prevent wounds from healing and increase the chance of infection from bacteria The femoral vein in the groin area is a large and fairly easy vein to access but its location near the femoral nerve and the femoral artery make it quite a risky place to inject Among the three the femoral vein is located closest to the groin with the artery and then the nerve located as you move outward If you re going to inject into the femoral vein first locate your femoral artery where you do not want to inject by findin
61. ng process es The larger and more visible the vein the easier and safer it usually is to hit Deep veins are harder to hit and trying to access them increases your chance of hit ting a nerve or artery in the process On the other hand it may be difficult to keep a needle properly posi tioned in a very shallow vein causing you to accidental ly skin pop your hit e Areas that are farthest from the heart like the hands and feet heal the slowest and have the poorest circula tion Areas nearest to the heart like the groin and the neck have veins that are located near major arteries and nerves which if accidentally hit can cause serious life threatening damage e Injecting near a bone increases the chances that swelling and pain will occur veins vs arteries You always want to inject into a vein and never into an artery Veins are blood vessels that carry blood from the extremities of the body back to the heart and lungs where it becomes re oxy 38 Getting Off The Basics of Safer Injection genated Veins have no pulse and the blood they carry is a deep dark red because it is low in oxygen Arteries carry blood rich in oxygen from the lungs and heart to all the other parts of the body Arteries have a pulse and the blood in them is bright red and frothy Arteries are located deeper in the body than veins and so are not visible as many of your veins are You ll know you ve hit an artery
62. njection Potential Health Complications of Injection Drug Use Early symptoms include chills fever and extreme fatigue If you experience these symptoms seek medical attention Septicemia can be fatal ENDOCARDITIS Endocarditis is an infection of the heart lining that is caused by bacteria fungi and other infection causing microbes that enter the bloodstream during injection and build up around the valves of the heart weakening them as well as other parts of the heart muscle Endocarditis can eventually cause a heart murmur as well as fever chest pains fainting spells shortness of breath and heart palpitations It can be treated with antibiotics if detected early but can be fatal if it goes untreated You can help prevent endocarditis septicemia and dirty hits by always using clean water and a clean water glass when preparing your shot using new clean cottons for every injec tion making sure your spoon or cooker is clean and thorough ly washing your hands and cleaning your skin prior to injection 3 Health TETANUS Tetanus is a bacterial infection that occurs when tetanus spores enter a Most local health wound and release tetanus bacteria departments offer free usually after a scab has already tetanus boosters formed The bacteria then enter the i f which will protect you bloodstream and cause an infection Bic om tetanus for five which is characterized by muscle fr
63. ntie your tourniquet and proceed to inject your drugs If no 22 CHAPTER 2 CORRECT NEEDLE INSERTION Correct ragrtion sechniqua bocd lovt freely irto reede INCORRECT NEEDLE INSERTION Ko Basel oon vsin loan wal doac por i a ba bhas re Tyra Mendke par baly iia ted caita Hecd hakyps iri tiss Le Sa S ees vu vo appa wall hoc Dip alisa Hood pe Boa Getting Off The Basics of Safer Injection blood or only a very tiny amount of blood comes into the syringe when you pull back you re not in a vein and will have to untie your tourniquet pull your needle out and try again If you proceed to inject without being properly positioned in a vein you ll be putting your drugs into the tissue surrounding the vein under the skin or some other place It will probably be painful and become swollen and the effects of your drugs will come on much more slowly You also risk abscess formation and other possible problems If there s too much blood in your shot to tell if you re properly D ba e bo E Ww v v ei registering split the shot into two and dilute each half with water Some people like to boot their syringe after they ve injected their drugs that is pull back the plunger draw blood into the syringe and re inject it Some injectors like to do this several times ostensibly to rinse out any drug solution that remains in the syringe Because of all the blood involved you migh
64. ntly forced to make do with what they can get This section of the manual dis cusses what materials are best for injecting drugs and how to use D CHAPTER 1 6 them safely and offers suggestions for second best options when the safest equipment is for some reason unavailable NEEDLES AND SYRINGES The needle and syringe is arguably the most important piece of equipment needed to inject drugs Due to legal restrictions on possession and over the counter sale it can also be the most dif ficult piece of equipment to obtain Needles and syringes are not all the same It is important to find a needle and syringe that you feel comfortable with so if you have the opportunity experiment with different types sizes and brands of injection equipment until you ve found the one that works for you Or you may find that you ll use different equip ment at different times depending on what and where you re injecting Among the things you should consider when choosing a needle and syringe are NEEDLE GAUGE which refers to the size of the bore or hole in the needle With needles it is important to remember that the higher the gauge the thinner the needle and the small er the hole A 28 gauge needle abbreviated 28G is there fore thinner than a 25 gauge needle which is in turn thinner than an l8 gauge needle Most intravenous injectors use either a standard insulin set which typically has a 27G or 28G needle and an orange cap
65. o absorb If you get the shakes after doing a few shots it may be helpful to have a friend inject you if you are not Skin popping speed is extremely painful may cause an abscess and will take a long time for the body to absorb using alone Because the quality of speed varies so dramatically a tester shot is a good idea 22 D ba el bo E Ad v Vu ei CHAPTER 2 HIERARCHY OF SAFETY for Choosing Intravenous Injection Sites 34 The following is a breakdown of possible intravenous injection sites beginning with the safest options and moving toward the least safe ones Arms first upper then lower are the safest sites for injecting You should be careful to secure the rolling veins in the forearms before you inject into them Arms are also good if you re con cerned about hiding your injection or track marks although wear ing long sleeves in the summer can be a drag Hands are somewhat less safe than arms because the veins are sig nificantly smaller and more delicate and therefore more likely to bruise or become damaged Circulation is also slower in the hands causing healing to take longer If you re getting off in your hands be sure to use the thinnest needle possible highest gauge or if you can find one a butterfly needle see illustration on page 8 Be vigilant about rotating the sites and keep in mind that it is difficult to conceal injection marks a
66. o your skin than leather belts or similar ties They re also better at securing rolling that will restrict blood flow and cause the veins to bulge 27 v is v bo w w o U CHAPTER 1 TYING OFF Getting Ready Preparing Yourself 5 Your Equipment veins like the ones in your forearm Neckties lubricated condoms and socks are other items that because they re softer and more pliable than leather make better tourni quets than a belt v is v bo w LA v U gt Use a slip knot when tying up so that you can remove the tourniquet quickly if necessary see illustration Never leave the tie on for too long to prevent your circulation from getting cut off If you lose sensation in your limb or notice it turning blue remove the tourniquet immedi ately If you ve already tied up but need to re cook your shot or transfer it to another syringe take the tourniquet off and re tie it just before you re ready to inject See illustration on preceding page LIGHTER OR MATCHES If youre using tar heroin or crack you ll need something to heat your drug solution with in order to make it dissolve gt A gas stove works fine if you have access to one although carrying your spoon or cooker to the stove after you ve filled it may result in a spilled shot so prepare everything at the hopefully reasonably clean stove gt Lighters produce a larger hotter easier to control fl
67. of container Don t flush your used equipment down the toilet because it may end up on a beach or in the ocean some where or stick the plumber who has to unclog the pipes WHERE TO GET NEW MATERIALS Fortunately many communities now have needle exchange programs where you can get new sterile equipment for free and dispose of your used works Definitely check out your local needle exchange if POTENTIAL HEALTH COMPLICATIONS OF INJECTION DRUG USE there is one and get involved It s a great way to help out yourself and other users You may live in a place where you can buy injection equipment over the counter Try to find a cooperative pharmacist and let him or her know you appreciate their assistance Let other users know what drug stores will sell equipment to them If there are no other options you can usually find injection equip ment on the black market If you purchase needles and syringes on the street however clean them before you use them sometimes dirty equipment is re packaged and sold as new 18 kal Harm Reduction Coalition 22 West 27th Street 9th Floor NY NY 10001 Phone 212 213 6376 Fax 212 213 6582 Email hrc harmreduction org WRC HARM REDUCTION COALITION 22 WEST 27 ST 9 FLOOR NEW YORK NY 1000 PHONE 212 213 6376 FAX 212 213 6582 EMAIL HRCWHARMREDUCTION ORG
68. ol such as vodka or rum if it s all you ve got IMPORTANT In order for bleach to kill hepatitis B that might be in the syringe and or cooker you must leave the bleach in the syringe and cooker for a full two minutes It is unclear whether bleach kills hepatitis C even after two minutes This should also kill any HIV that might be in the equipment 30 seconds is believed to do this Be sure to clean the cooker with bleach if its going to be shared Split whatever cotton you have in two before you use it it s virtually impossi ble to clean such a filter And remember that sharing water is one of the Getting Ready Preparing Yourself 5 Your Equipment most efficient ways to pass on or contract a virus or other infection caus ing organism Rinse your equipment with cold water after you ve used it in order to pre vent any residual blood from clotting especially if you plan to re use it later If you purchase needles and syringes on the street clean them before you use them sometimes dirty equipment is re packaged and sold as new Do not clean equipment that is sterile something that is sterile is as clean as you can get it and cleaning it could actually contaminate it photograph Kif Design Cookers and spoons are used to dissolve cook up powdered and solid drugs for injection gt If using a spoon try to find one that is rounder and deep er than an average teaspoon or tablespoon closer to
69. ood borne infections and diseases like hepati tis and HIV is to never use someone else s works including nee dles and syringes cookers cottons or water or let someone else use yours Even though injection equipment might look clean to v is v bo AM AM o U CHAPTER 1 I2 the naked eye tiny amounts of blood can remain in the works which can result in infection If you find yourself in a situation where you absolutely must use someone else s works or they must use yours you can reduce the likelihood of disease transmission by carefully cleaning the equip ment before you use it Follow these instructions carefully Rinse the needle and syringe with cold water several times hot water will cause blood to clot making it hard er to remove If you re using a detachable needle and syringe you might want to take the equipment apart to clean it more thoroughly Be sure to discard the water you use to rinse the equipment 2 Flush the needle and syringe with undiluted household bleach Be sure to fill the syringe all the way up Keep the bleach in the syringe for a full two minutes while shaking it Discard the bleach 3 Thoroughly rinse the needle and syringe with clean cold water to remove any remaining bleach Discard the water If you do not have bleach you can substitute hydrogen peroxide a solution of dishwashing liquid and water or rubbing alcohol Use high proof drinking alcoh
70. our equipment in an empty lot park public bathroom playground or anywhere else where someone might get stuck endangers the health of others gives all of us a bad name and fuels discrimination against drug users Be considerate of the people who take away your garbage and think about where those needles and syringes that you flush down your toilet end up Take the time to dispose of your equipment right 72 CHAPTER 5 SAFE STORAGE AND HANDLING OF INJECTION EQUIPMENT Particularly if you have small children always store your injection equipment dirty or clean in a location where others are not likely to come across it Keep your new equipment in its package until you re ready to use it so that it remains sterile and store your needles and syringes in a cool dry place Always carefully store your used needles and syringes in a coffee can spaghetti sauce jar sharps container polyurethane soda bot tle or similar container to prevent accidental needlesticks If you live with another injector be sure to keep your equipment sepa rate to prevent accidental sharing You might also want to mark your syringes so you can tell them apart PROPER DISPOSAL OF USED EQUIPMENT It s best to take your used equipment to a needle exchange program or some other place where it will be properly disposed of If you dont have access to such a program throw it in the garbage but only after you ve securely packaged it in a puncture pro
71. portant that the equipment and the process we use to shoot up is as clean and safe as possible STEPS There are a few common sense things you should do before preparing and injecting your drugs Getting Ready Preparing Yourself 5 Your Equipment gt First if at all possible thoroughly wash your hands with soap and water Any bacteria or germs you have on your hands can contaminate anything you touch when prepar ing your drugs At the least rinse your hands with water wipe them with a moistened towelette or otherwise try to get your hands as clean as possible gt Inject your drugs in as clean a place as you can find and always try to use a level surface so you don t tip anything over and lose your shot gt If they re not brand new make sure all of your materials are thoroughly cleaned and don t unwrap or uncap your needle and syringe especially if it s sterile until you re going to use it gt If you re getting off with someone else make sure each person s equipment is clearly separate from yours so that accidental mix ups and sharing don t occur nee dles syringes and water glasses all look the same gt Finally calm yourself down if youre upset for some rea son Consider whether smoking or sniffing a little bit of your drug will help you relax if you re in withdrawal or otherwise freaking out COOKING YOUR SHOT Powdered drugs must be dissolved into a liquid form before they can be inject
72. regimen with 3 Health the second injection taken 6 to 12 months after the first HepatTiTIs B also called serum hepatitis or HBV is spread through blood to blood contact of the kind that occurs when drug injection equipment is shared contact with infected body fluids like semen blood urine saliva and mucous sex that involves contact with semen and from a mother to her infant at birth Hepatitis B infection can be acute short term and intense and or chronic long term chronic HBV can cause serious liver damage including cir rhosis scarring liver cancer and death from liver failure and results in premature death in about I5 to 25 percent of individuals affected Hepatitis B is much more infectious than HIV which means it is spread much easier It is one of 22 CHAPTER 3 the most important reasons drug injectors should never share injection equipment of any kind A vaccine that will protect you against injectors should think about getting it A vaccine that will protect you against hepatitis B if youre exposed to it is avail able and all drug injectors should think hepatitis B if you re about getting it The vaccine involves a exposed to it is avail series of three intramuscular injections with able and all drug the second shot being administered 30 days after the first and the third shot being administered 4 to 6 months after the sec ond The vaccine i
73. s safe and effective If you ve had hepatitis B in the past you ve developed anti bodies to it and will not catch hepatitis B again in the future and do not need the vaccine You can get your blood tested to see if you ve ever been exposed to the hepatitis B virus and get the vaccine at your local Department of Public Health or your doctor HEPATITIS C formerly known as non A non B hepatitis and also referred to as HCV is spread mainly through blood to blood contact and is very infectious which means you can acquire it quite easily if exposed to it There is a blood test ELISA available that detects whether or not you have antibodies to the hepatitis C virus in your blood which if positive should be confirmed with a second test called the RIBA the only way to test whether or not you have the actual virus in your blood is by getting a polymerase chain reaction PCR RNA test but these tests are not terribly sensitive and interpretation of the results may differ depend ing on who s reading them There is as yet no vaccine for Potential Health Complications of Injection Drug Use hepatitis C and antibodies are not protective that is they dont make you immune to re infection as with HBV Scientists estimate the arrival of a vaccine in to 2 years Currently there is only prevention with use of sterile injec tion equipment by not sharing injection equipment and through safer sex Hepatitis
74. sks associated conditions under which they are with using illicit drugs used Poverty racism social isolation Ka past trauma sex based discrimina tion and other social inequalities all affect people s vulnerability to and capacity for dealing with drug related harm Punitive laws social policies and the intense social stigmatization of and dis crimination against illicit drug users serve to drive us away from friends and family as well as health and social services These are just a few of the factors that increase the dangers associated with using illicit drugs Contrary to popular opinion there are many things that we can do to take care of ourselves and reduce the risks associated with using illicit drugs This manual challenges us to take a close look at all the steps we engage in when preparing and injecting drugs in order to figure out if that process can be made safer anywhere along the way Even if you ve been injecting for years chances are that there are things you can change about the way you do it to help you avoid disease and maintain good health reduce your likelihood of experiencing injection related injuries or accidents help make the fact that you inject drugs less noticeable if this is something that concerns you or ensure that injecting remains a viable comfortable and safe option for administering your drugs INTRODUCTION in the future Reading this manual might also make you decide that
75. t want to refrain from booting if you know you re going to be clean ing your needle and syringe and allowing someone else to use it Be sure to thoroughly flush your needle and syringe with water after booting if you plan to re use it at a later time so that blood doesn t clog the needle PULLING OUT After you ve successfully injected your drugs carefully pull the needle out of the injection site at the same angle at which it went in To minimize bruising you should have untied your tourniquet before you injected your shot Apply pressure to the injection site to stop any bleeding If you re getting off in a public place it is a good idea to have some tissue or Band Aids around so you 33 CHAPTER 2 don t get blood all over your clothes Don t use alcohol pads on a fresh injection wound alcohol will cause it to bleed more not less MISSED SHOTS amp AFTERCARE Don t apply creams salves or oils you use to treat your track marks or bruising until the injection wound has begun to close a couple of hours after injecting otherwise you might cause an infection Treat missed shots those that ended up somewhere other than in your vein immediately with a warm water soak or compress to reduce the likelihood of irritation and abscess for mation Warmth will open the capillaries and bring disease fighting white blood cells to the affected area MAINLINING COCAINE Cocaine has a numbing effect on the veins and causes them to
76. tes you ll notice that they taste unpleasant More severe symptoms of hepatitis include dark tea colored urine light colored stools and jaundice a yellowing of the skin and the whites of the eyes HEPATITIS A also called infectious hepatitis is excreted in feces shit and spread by fecal oral contact feces to hand to mouth contact Hepatitis A can be spread from contam inated food water hands and eating utensils for example by Potential Health Complications of Injection Drug Use a restaurant worker who didn t wash his hands after using the bathroom and who then prepared food Unlike hepati tis B and C hepatitis A is not transmitted by blood to blood contact that occurs when needles or other drug injection equipment is shared and is not generally spread through sexual contact unless rimming oral anal contact is involved Hepatitis A illness resembles the flu and can last from four to six weeks It causes an acute short term infection only and never develops into a chronic condition like hepatitis B or C You develop antibodies to hepatitis A after you ve been infected with it so your chances of ever getting it again are slight A hepatitis A vaccine gamma glob ulin should be administered within 72 hours after exposure to the virus Gamma globulin is often used as treatment after an exposure but can also be used as a preventative vaccine The most complete prevention is a two shot
77. the veins and surrounding tissues Using barbed or dull needles can precipitate vein collapse You know you have a collapsed vein when you can t draw blood from it or when the vein disappears Thrombosis is the formation of an obstruction of a blood vessel by Potential Health Complications of Injection Drug Use a blood clot Don t use veins that do not bend when pushed as they may have blood clots that can break off and lodge in the lungs or other parts of the body and cause serious damage You can avoid vein collapse by always rotating and alternating your injection sites and by injecting in the direction of the body s blood flow toward the heart Using the same injection site over and over without letting the vein heal is one of the surest ways to cause vein collapse Also insert your needle at a I5 to 45 degree angle with the bevel of the needle facing upwards Taking oral vitamin C may help your veins repair themselves and reduce bleeding and bruising NEVER inject viatamin C only swallow it ABSCESSES Abscesses begin with redness swelling and tenderness at an injection site and develop into an infection with a hard pus filled 3 Health core Abscesses result from missed hits injecting into the tissue surrounding the vein injecting a solution with a lot of particles in it failing to clean the injection site prior to injecting using dirty injection equipment or skin popping drugs like coke or spe
78. the hands or feet but this type of set can be difficult to obtain Ask your local exchange if they have any SYRINGE SIZE Standard insulin and tuberculin syringes are typ ically Icc in size and are calibrated by JD cc s along the bar rel of the syringe Most drug injectors find this size ideal and would rarely need use of a larger syringe although some drug injectors like to use cc syringes Syringes other than lcc in size may be difficult to obtain 8 Getting Ready Preparing Yourself 5 Your Equipment mo Bevel 3 on Je Lumen T z o Meedke E Meade Hub Shaft Plunger STANDARD DETACHABLE TWO PIECE NEEDLE AND SYRINGE CHAPTER 1 N As important as choosing an appropriate needle and syringe is how you use them Below are some very important guidelines you should follow in order to make the process of injecting as safe as possible DH ONE SHOT ONE NEW NEEDLE AND SYRINGE In the same way that hospitals will use a needle and syringe only once and then dispose of it this is the gold standard that anyone who injects drugs should also strive for Needles dull quickly even after just a few uses Using dull In the same wey needles causes unnecessary trauma to the that hospitals will veins and surrounding tissue results in a larg use a needle and er puncture wound and increased bleeding syringe only once and is simply not as comfortable as using a
79. tion Coalition will be creating a small booklet that reviews basic health maintenance and first aid suggestions for drug users 3 3 Health IN THIS CHAPTER m What Is an Overdose m How Do O D s Happen m How Can You Tell if Someone Has Overdosed m What to Do if Someone Overdoses m What You Should Not Do if Someone Overdoses E Narcan m Accidental Needlestick Injuries Whether or not an individual survives an over dose depends mostly on what those present do or don t do to help CHAPTER Magenta OVERDOSE AND OTHER MEDICAL EMERGENCIES On of the most serious health consequences associated with using illicit drugs is the risk of overdose While overdose is indeed serious it doesn t have to be fatal Anyone who uses illicit drugs should take the time to talk with friends and develop an overdose plan in the event that something happens Whether or not an individual survives an overdose depends mostly on what those present do or don t do to help All users should learn how to perform cardio pulmonary resuscitation CPR for example and be aware of the necessary steps they should take if someone they re with overdoses Most overdoses occur in the presence of another person so often we have the opportunity to help our friends and loved ones survive if we CHAPTER 4 know what to do Read the following section carefully and do what you need to do to feel confident that
80. u can overdose easier Your body is less able to protect itself after you ve been 4 Overdose sick so help it out by using less and giving it a chance to recover Eat and sleep well always drink a lot of fluids and get that annual physical Using drugs alone increases the chance that if you over dose it will be fatal because you can t take care of your self or call for help If you find yourself alone in an overdose situation and have called 911 remember to 22 CHAPTER 4 unlock your door so that the paramedics can get inside If possible use with people who care about you and who you trust and sit down and talk with them about an overdose plan Try to put together a support system for yourself of people who know you use and will be there for you if something happens HOW CAN YOU TELL IF A PERSON HAS OVERDOSED DEPRESSANT DRUGS like opiates e g heroin and Dilaudid and sedatives e g Valium and alcohol slow down the body s functions A person who overdoses on a depressant will experience respiratory arrest that is their breathing will become life threateningly slow or stop altogether leading to heart failure STIMULANT DRUGS such as cocaine and speed can cause a person who has overdosed to have a heart attack or expe rience cardiac arrest collapse from exhaustion have a seizure or become so disoriented that they accidentally hurt themselves One of the clearest signs that someone is over
81. ulance service will generally not call the police unless they are physically threatened Be respectful of the EMTs and they will usual ly just do their job 4 Overdose CHAPTER 4 WHAT YOU SHOULD NOT DO IF SOMEONE OVERDOSES There are also some things you should NOT do if someone youre with has overdosed gt Do NOT inject a person who has overdosed with salt water This is an old junky myth and will do nothing to help revive the person gt Do NOT inject a person who has overdosed on heroin with cocaine or speed or vice versa It will just waste valuable time and probably make them worse gt Do NOT give CPR this is the heart compression part the pumping the chest unless you know how You may do more harm than good Mouth to mouth resuscitation is okay If you want to learn CPR call your local Red Cross or see if your needle exchange offers classes Learning CPR is one of the most important things you can do to help someone survive an overdose Every user should learn CPR gt Do NOT put the person in a cold water bath because it may cause them to go into shock or to drown You can put them in a cool shower to wake them up but you must stay there with them Do NOT put ice on their genitals down their pants gt Again do NOT leave someone alone who has over dosed even after you ve called an ambulance Your friend will need you to see them through this very scary experience Over

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