Safer Injecting

Injection is the most complicated and dangerous way to consume substances. If possible, try a safer method as a way to protect yourself and others!

Contents:

Based on materials from the People's Harm Reduction Alliance.

Plan Ahead
 

Try to use a secure, warm, dry place. If you are relaxed, your veins will come up easier and you will miss your shot less often.

Using alone can be dangerous if something goes wrong. People you trust and who care about you can be helpful hitting veins you can’t reach, sharing safer use tips, and saving your life if you accidentally OD.

If you are in a hurry or frustrated, try taking a small amount in another way like smoking or eating. Then, when you are calm, finish injecting.

Before You Begin

Push up your sleeves to the elbow and wash your hands, arms, and injection site with soap and water for at least 20 seconds, cleaning between fingers and under nails.

Clean the area you will be using to prepare your drugs. Clear a surface. Wipe with disinfectant wipes, rubbing alcohol, or hot water. Lay down a clean dry towel, piece of paper, or shirt.

Remember which parts of your body and your space are clean. If necessary, keep a clean hand and a dirty hand. Hands that touch your face, door handles, etc. should be considered dirty.

Touch your works as little as possible.

 
Skin and Veins
 

Skin needs a couple days to heal before it can resume its job as a barrier to infection. So choose a new place each time!

 

Veins also need a couple days to heal before repeated use. Blown veins happen when there is more than one hole in the vein, either from the needle going all the way through, or a tear due to pressure inside the vein.

 

When this happens, remove the tourniquet and apply pressure and ice to the site. Do not use this vein farther down until it heals. Veins carry blood toward your heart. If you blow all the veins in your upper arm, the shot you put in your lower arm vein will leak out on its way back into the bloodstream.

 

If your circulation is still generally good, use the veins farther away from your heart first. That way if they become unusable, you still have the ones closer to your heart. For example, use your forearm before using your elbow.

Cookers and Handles
 

You can use a sterilized spoon or disposable cookers obtained at your local syringe access program.

 

Handles can be made from wire twist ties (the kind that come on bags of bread and other food) or paperclips, or by peeling back a bit of metal from the edge of the cooker.

 

Some cookers are made to fit the caps that come on the syringe.

 

To bend your own paperclips, use a pair of pliers, or a doorframe or table edge. Practice a few times, because it is a skill! Bent paperclips are used by fitting the loops of the shorter end beneath and inside the cooker.

 

The unbent ones are used by stretching the paperclip into a triangle and placing the cooker in the middle.

 

To use a needle cap as a handle, tear away a little piece of the cooker and stuff it into a needle cap, then melt the cap a little bit with your lighter and squish it down so it sticks. Let it cool.

 

You can also use a roach clip, pliers, etc.

Water
 

Sterile water is best, and is given out by many syringe access programs. If you can’t get sterile water, use unopened bottled water. Water that has been sitting for a long time can grow germs. Running water from a clean sink is better than water that has been in a container for a while. Cool water is better than hot because bugs that like to grow in our bodies like warm temperatures. Bacteriostatic water has had alcohol or another antibacterial added to it. This keeps any bugs from growing in it. If you cook it with your drugs, it is no longer bacteriostatic, because the alcohol will “cook off” very quickly. So this is not harmful. Boiling while cooking your drugs is not long enough to kill germs.

To make your own sterile water for injection use, use a clean pot with a lid. Start timing when the water is at a full boil, and let it boil for 30 minutes. After you turn off the heat, cover the pot while it cools so that no floating germs fall into it. When it is cool, pour it into sterile or clean small bottles with lids. Use latex or nitrile gloves if you have them, or wash hands thoroughly before handling sterile water.

 

It is ok to use sterile saline. Saline is water with a little bit of salt dissolved in it, so it might take more volume to dissolve your substance.

Filters (cottons)
 
Why use a filter?

Filtering your shot helps to strain out particles, which can become emboli. An embolus is a piece of something solid floating in your bloodstream. It can be dirt, undissolved drugs, filter pieces, fat, or a blood clot. These can cause heart attack, stroke, or deep vein thrombosis (DVT).

  • Deep vein thrombosis (DVT) symptoms: heat, pain, swelling, or redness in a limb, usually the lower leg. DVT can become stroke or heart attack if the embolus moves. DVT can cause permanent damage, but usually comes with a full recovery if it is treated before it becomes worse.

  • Heart attack (myocardial infarction) symptoms: trouble breathing, arm, neck, or chest pain, extreme fatigue. Heart attack can come with full recovery, permanent disability, or death.

  • Stroke symptoms: sudden dizziness or confusion, loss of consciousness (passing out). Drooping on one side of the face. Stroke can come with full recovery, permanent disability, or death.

How to use filters

DVT, heart attack, and stoke are emergencies that you cannot safely deal with at home. Please call 911 if you or a friend experiences these symptoms.

Medical grade filters ca sometimes be obtained online, but they are quite expensive.

The best accessible filters are the clean cotton pellets distributed by syringe access programs.

 

To use a cotton, drop it into your cooker and put the needle on top of it so that as you pull up your solution, it has to go through the cotton.

 

Use a fresh cotton with each injection, because they can begin to grow bacteria very quickly. If you use old cottons, you may be injecting this bacteria into your body. 

 

You can make cottons that are almost as good by tightly rolling wisps of cotton torn from Q-tips or tampons with clean hands.

 

Since these items cannot be rolled as tightly as actual cottons, some strands of cotton can get sucked up into your syringe, and clog up your needle.

 

If you inject these little strands of cotton, they can be absorbed by your body or cause blockage in your veins.

Cigarette butts are made of cellulose acetate. They are not good filters

If you must use cigarette filters, please use unsmoked ones. Used filters will have germs, tar, and broken down fibers.

Used or clean, not a good filter
Choosing an Injection Site
 

BEST: arms and legs

Arms and legs have the best circulation so they will heal faster than hands and feet.

BETTER: hands and feet

Hands and feet are farther away from the heart, so the blood is slower moving. They also hurt more and the veins are smaller, making it more difficult to hit them.

WORST: femoral veins, neck veins

Femoral: There are nerves and arteries nearby which can complicate injection. It is a big vein, which can make bleeding a serious problem. An abscess here can cut off blood to your leg, and possibly require amputation.

Neck: Comes with all the problems of the fem. There are also cranial nerves to worry about, and there are 12 of them. You can also hit your windpipe or food pipe. Add to all that that it requires a mirror or another person. Please don’t do it!

Finding a Vein
 

Veins are the blood vessels bringing blood back to the heart after circulation. They become smaller when you are cold or not using a limb and larger when you are warm or exercising.

 

To bring up veins, take a bath or shower, swing your arms, do some pushups, or use a hot pack.

 

Veins closer to your heart have better circulation, but if you blow a vein, you cannot use it again farther from the heart or it will not drain properly.

Always use a tourniquet and clean it with soap or alcohol between uses. Use something stretchy if you can. Belts and shoelaces can cause bruising and vein damage. If you have nothing, a friend’s hand can do the trick. Just have them squeeze above your injection site.

 

Release the tourniquet after you’re in. If you inject too much fluid too fast, you can blow the vein much easier.

You can probably reuse your own tourniquet a few times. Throw it away if it gets dirty, bloody, or if it is used by someone else. If you can’t get another one after a few uses, you can clean it with soap and water or alcohol. This will weaken it, so make sure to get a new one soon.

Cleaning the Skin
 

Soap and water works best. Use a clean towel, paper towel, or air dry.

If using a swab, start where you plan to inject, and wipe in an expanding circle. 

Alcohol swabs have 70% ethanol or 140 proof.

Most liquor is only 40% ethanol, or 80 proof. This not an effective cleanser, but it’s better than nothing. Do not use liqueur, because it can have added sugar and coloring.

Alcohol, chlorhexidine, and iodine need to be allowed time to dry or they do not work.

Chlorhexidine wipes available in the United States have the same amount of alcohol plus a small amount of chlorhexidine.

Chlorhexidine/alcohol probably works better than alcohol alone.

If you can’t access soap and water or a wipe, next best is a cotton ball soaked with hydrogen peroxide, iodine, or bleach, or rubbing the area with hand sanitizer.

Needles
 

Needle shaft sizes become smaller as the number goes up just like piercings. An 18 gauge needle is bigger than a 28 gauge needle.

 

Needle length can also vary.

Any size syringe syringe can be attached to any size needle, but not all syringes  and needles can be detached from each other.

 

27-29 gauge is ideal for medium sized veins, but can also be used for smaller or larger ones or muscling.

 

For large muscles or if there is a lot of fat above the muscle, use a 1 inch needle to be sure you are in deep enough, for smaller muscles like women’s arms, you can use a ½ inch needle.

 

For shooting in larger veins like the femoral, use a larger gauge, like 23-25 gauge, with a longer needle, like 1-1 ½ inch

 

For smaller veins like hands, feet, or women’s veins, it is best to use the smallest needle you can, like a 29-31 gauge with ½ inch needle or shorter.

 

For injection of hormones or to drain an abscess, use a very large needle like 18-22 gauge with at least a 1 ½ needle.

 

Use a new needle and syringe every time if you can. If you must share, limit the number of people you share with.

Needles that have been reused become dull and tear larger holes in your skin and veins.                    

 

Inject with the bevel facing up. (see illustration)

 

Practice injection techniques with both hands so that you can rotate your injection site. To learn this, try to use your other hand on a friend or when you’re not in a hurry. Get comfortable with the equipment by playing with empty stuff in your non-dominant hand.

Tips for buying syringes or biohazard containers:

Dress up in your most boring, respectable outfit. Try to conceal any tattoos or piercings if you can.

Use correct terms: “I would like 100 28 gauge, half inch, 1mL (or 1cc) syringes”

 

In some places, it is legal to buy or have syringes. You could be diabetic or transgender for all they know. Check the laws in your area before you go. Unless specified in the law, you do not have to disclose why you need them or provide proof of a medical need.

Injecting in a Vein

Hold the needle with the bevel up.

 

Insert into the vein at a 45˚ angle. You can get the angle by pointing straight up and down and then lowering the syringe halfway. If you miss, you can pull back a little bit, not enough to remove from the skin, and try again. Don’t dig around in there too much. If you miss repeatedly or blow the vein, remove the needle and start again somewhere else.

 

To check if you are in the vein, you can pull back gently on the plunger to see if you get blood coming back into the syringe. If the blood is slow moving and dark red, you are in the vein. If it is bright red and frothy, you are in an artery.

 

If you hit an artery, it will hurt a lot more than usual. Place a clean tissue or towel over the injection site and pull out slowly. Keep pressure on the site for at least one minute and then check to be sure the bleeding has stopped. If you can’t stop the bleeding, call your healthcare provider or 911. Once bleeding stops, you shouldn’t have anything to worry about other than infection. Keep it clean and covered with a sterile bandage and don’t use this spot again for a couple days

 

Once you are sure you hit the vein, release the tourniquet.

 

Push the drugs in slowly to be sure you don’t overload and break the vein.

 

Place a clean tissue or towel over the site and slowly remove the needle. Keep pressure on the site for a few seconds.

 

If bleeding has not stopped after a few seconds, place pressure with the tissue over the site for one full minute and check again. If you can’t get bleeding to stop, see a healthcare provider or call 911.

 

Cover with a sterile bandage and don’t use this site again for a couple days.

 

This photo is not open access

Injecting in a Muscle

Clean with alcohol or soap and water

 

Pinch the muscle.

 

Insert the needle straight down.

 

Inject the fluid slowly. This decreases pain and makes the pool of fluid inside your muscle smaller, possibly decreasing chances of abscess formation.

 

Place a clean tissue or gauze over the site and slowly remove the needle. Keep pressure on the site for a few seconds.

 

If bleeding has not stopped after a few seconds, place pressure with the tissue over the site for one full minute and check again. If you can’t get bleeding to stop, see a healthcare provider or call 911.

 

Cover with a sterile bandage and don’t use this site again for a couple days.

Injecting in the Femoral Vein
 

Try to use arms, legs, hands, and feet before shooting in your fem. It is very dangerous and increases your risk of abscesses, blood clots, infection, and loss of a leg.

 

Hitting your femoral vein will not make you higher.

 

Hitting an artery can increase injection risks. You know you’ve hit an artery when bright red blood rushes into the syringe without pulling back and it hurts worse than usual. Place a clean tissue or towel over the injection site and pull out slowly. Keep pressure on the site for at least one minute and then check to be sure the bleeding has stopped. If you can’t stop the bleeding, call 911.

 

Once bleeding stops, you shouldn’t have anything to worry about other than infection. Don’t use this spot again for a couple days

 

If you hit a nerve, it will hurt a LOT. Some people report a sharp pain running down their leg. Pull out slowly and put light pressure on the site until bleeding stops. It should feel better in a few days, but this may cause permanent damage to your nerve, affecting movement and feeling.

Clean your groin very carefully. You may need to use two or more swabs.

 

To find your vein, remember NAVY (nerve, artery, vein, your crotch).

 

When you find a pulse, this is your artery. Place your middle finger over the pulse and your pointer finger should be over the vein. (see above)

 

Insert the needle straight down, not at an angle like for arm veins. Pull back on the syringe, looking for dark red, slow blood. Inject slowly.

 

Place pressure with a clean tissue over the site for 1 minute, or until the bleeding has stopped.

 

Cover with a sterile or clean bandage and don’t use this site again for a couple days.

Safe Disposal

It is best to dispose of your used works in a biohazard container. You can buy these from most drugstores. If you can’t get a biohazard bin, you can use any wide mouth hard plastic bottle like sports drink bottles or laundry detergent bottles. Milk cartons and plastic water bottles are usually thin and can be punctured by needles. Please never put dirty rigs into regular garbage or on the ground. If you must, please cap them well to keep others safe. In many cities, it is illegal to throw away used needles in the trash.

 

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The information on this site and in our presentations is offered as public health education.

It does not replace getting individualized care with licensed medical professionals.


The purpose of Harm Reduction is not to encourage or condone the use of substances.


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