Injection is a way of getting a liquid drug in to the body using a needle and syringe, usually intravenously (injecting into a vein), sometimes intramuscular (injection in to a muscle) or subcutaneous (just below the skins surface, known as skin popping). The full effects of the drug are experienced very quickly and intensely as it gets the drug directly into the bloodstream and on to the brain. All methods of injecting are potentially extremely harmful – of all the ways to get drugs into the system, injection has the most risks by far as it bypasses the body’s natural filtering mechanisms against viruses, bacteria and foreign objects. There is a greater risk of overdose, infections and health problems.
- Don’t share any injecting equipment; this includes water from pots, spoons or cookers, filters as well as needles and syringes. It is best practice to use a filter for drawing up
- Ensure you have enough needles for repeat injecting
- Rotate injection sites
- Ensure any wounds are treated as soon as possible
- Heat and redness at injecting site are a sign of infection – seek medical attention
- Ensure that your equipment is correct for its intended use (http://www.kfx.org.uk/resources/NeedleSize1pp.pdf)
- Dispose of used needles and syringes safely using a sharps box and return them to your needle exchange.
- Naloxone click and deliver (https://dan247.org.uk/naloxone-click-and-deliver/)
How Are Drugs Prepared For Injection?
Some drugs come in ampoule form ready for injection either as a liquid or sometimes as a powder to which sterile water can be added.
Other drugs come as tablets or capsules which are then crushed or broken open and the contents mixed with water to make a solution ready for injection.
Other drugs, particularly heroin, amphetamine and cocaine are usually supplied as powders of varying consistencies and purities which need to be prepared for injection.
Powders and crushed up tablets need to be prepared by first of all mixing with water. ‘Brown’ street heroin will also need citric acid or vitamin C to be added in order to help it dissolve. Sachets of these are available from needle exchanges. The drug mixture needs to be filtered to remove as many of the impurities, chalk and other dust which may be mixed in with the drug.
Where Are The Drugs Injected?
Injection can be intramuscular (into a muscle), subcutaneous (under the skin). These methods are common with users of anabolic-androgenic steroids, which should never be injected into a vein. Intravenous injection (directly into a vein) is the preferred route for most drug users. This is because the rapid onset of the drug effect produces an intense rush of exhilaration.
What Are The Risks Of Drug Injection?
- Overdose is an ever-constant risk whenever street drugs are being injected. This is due 100% of the drug reaching the brain in one go and the rapid onset of effects.
- The tolerance level will vary from person to person. It will also vary over time. Tolerance rises with repeated exposure to the drug so periods of abstinence will be followed by dramatic reductions in tolerance levels. This is why former drug injectors coming out of prison are at risks of overdose the first time they inject after a period of enforced abstinence.
- Overdose is also more likely if the user takes more than one depressant drug – alcohol, heroin, methadone, pregabalin, diazepam or other benzodiazepines – at a time. Mixing depressants and stimulants, such as a combination of heroin and cocaine known as a ‘speedball’, is also extremely dangerous as the effect is unpredictable and has caused death.
- Injection of crushed or dissolved tablets carries its own set of risks. Tablets must be crushed to a very fine powder before they can be mixed with water and injected. Even though the drug held within the tablet may partially dissolve, the tablet itself will not liquefy completely. If tablets are used continually in this way, particles will eventually build up in the bloodstream leading to blocked veins, kidney problems and other complications, such as thrombosis.
- Repeated injection in the same sites can cause damage to skin and veins, leading to ulceration, abscesses and collapsed veins. As finding a vein becomes more difficult injectors may resort to even more dangerous sites such as the fine blood vessels in fingers or toes, or the femoral vein in the groin.
- The groin is a particularly dangerous site because of the risk of hitting the femoral artery or femoral nerve the consequences of both being very serious. The search for ever more inaccessible sites increases the possibility of hitting nerves or arteries.
- Injection hygiene is important. Injection sites should be wiped once with a sterile swab.
- The most appropriate needle should be used, this usually means the smallest one that will do the job, depending on where you are injecting.
- Regularly rotate injection sites. This means using a different site on the arm or leg each time. This will allow scar tissue to heal fully.
- The risk of infections by blood borne viruses such as hepatitis and HIV is high when using shared and non-sterile injection equipment. It is not just the syringe itself which poses dangers but also the spoons, cookers, filters, water, water pots and other paraphernalia used to make up a drug for injection.
- A network of needle exchange schemes is available across the UK. These provide people who inject drugs with new, sterile equipment.
- Those who cannot get to a needle exchange scheme regularly should at the least clean their equipment. https://www.youtube.com/watch?v=SnsK_4gOYHU