Safer Injecting Practices

SAFER INJECTING PRACTICES

Inject properly – Veins can shrink, collapse or shut down completely in the long term if you inject in the wrong way. It can also cause the tissue to break down, resulting in sores and abscesses, which may become infected and spread.

Don’t share – sharing needle equipment can pass on Hep C and HIV. Use different coloured needles so you know who is using which needle. Slamming packs provide these.

Don’t reuse – needles go blunt after a few uses. Once they are blunt they can damage your arms.

PREPARATION

Chose a safe place to inject: one that is private, clean and well lit with running water, if possible. Use soapy water to wipe down the surface where you'll prepare your hit or lay down the paper bag your equipment came in.

Make sure you have everything you need within reach: new sterile fits, new sterile water (or cooled boiled water in a clean glass), new swabs, a clean filter, clean spoon, and a clean tourniquet.

Wash your hands (and your injecting site) with warm soapy water. Hand washing is very important to remove viruses, bacteria, and plain old dirt from your injecting environment. If you can't wash your hands use swabs, wiping in one direction to clean them. Rubbing swabs backward and forward spreads the dirt and bacteria around.

MIXING UP

Clean the spoon by wiping once with a new swab and let it dry. Put the drugs in the spoon. Use your new sterile needle/syringe to draw up water from the new ampule of sterile water (or cooled boiled water in a clean glass).

No matter how well it has been cleaned, never let your used equipment or anyone else's come into contact with a group mix. Unless new sterile equipment is used to mix and divide up, each person must have all their own equipment.

Add water to the spoon and mix. You can use the blunt end of your syringe for mixing.

Add the filter to the spoon. The best filters are a bit of a new swab, tampon or cotton bud.

Injecting pills is bad for your health you can damage your heart, your veins and cause other serious health issues. If you are injecting pills, use pill filters if you can get them; if you can't get them, filter at least three times. Draw the solution up through the filter to remove impurities.

Remove air bubbles by pointing the needle skywards and flicking it on the side. Push the plunger up slowly until the air bubbles escape through the eye of the needle. Injecting air bubbles can cause serious problems with your brain (stroke), heart and lungs that can be fatal.

INJECTING

Wipe the injection site once with a new swab.

Place the tourniquet around your upper arm (or above the injection site). Don't leave it on too long. If you have trouble finding a vein, release the tourniquet and try again. Running warm water over the injection site will help raise a vein. So will opening and closing your hand in a pumping action.

Try not to touch anything that hasn't been cleaned until you have finished injecting. Put the needle into your arm at a 45-degree angle, with the hole facing up. Blood will sometimes appear in the barrel when the needle is inserted in the vein.

Pull back (jack back) slightly the plunger and blood should appear. If there is still no visible blood in the fit, remove the tourniquet and then the needle from your arm, apply pressure (using a cotton ball, tissue or toilet paper) to stop any bleeding, take a deep breath and start again.

When you are sure the needle is in the vein, loosen the tourniquet and slowly depress the plunger. If you feel any resistance or pain, you may have missed the vein and will need to start again.

After injecting, remove the needle, keep your arm straight, and apply pressure to the injection site for a couple of minutes (using a cotton ball, tissue or toilet paper). Don't use a swab to stop the bleeding, it may in fact stop the blood clotting.

Injecting over a long period of time can result in:

• Blocked blood vessels (caused by things mixed or cut with the drugs)
• Inflamed blood vessels and abscesses
• Damage to vital organs such as the liver, heart or lungs
• Periods of psychosis
• Injecting may also increase the risk of becoming dependent on the drug and thereby expose you to serious mental health problems

CLEANING UP AND DISPOSAL

Even if you are disposing of your fit, rinse it with clean cold tap water, straight after your hit. This will remove most of the blood, prevent if from blocking and help reduce the likelihood of dirty hits if you have to use the fit again.

Dispose of the rinsing water immediately, so no one else can use it and contaminate their equipment with your blood. Dispose of your fit in a disposal container or a puncture proof, childproof container and return the container to your NSP. Don't recap other people's fits.

Wipe down the area where you have mixed up your fix with soapy (detergent) water. Where there is a possibility of skin contact, the area should be wiped with household bleach. Don't re-use swabs, filters, or open water ampules - they can become contaminated once opened.

When you have cleaned up, wash your hands and arms with warm soapy water. If this is impossible, use single wipes with new swabs instead. Store all your equipment in a clean, safe place.

CLEANING USED EQUIPMENT

The best way to avoid contracting Hep C and other blood-borne viruses such as HIV/AIDS and Hep B is not to inject. Injecting is the greatest risk factor for contracting Hep C. There is no way of completely eliminating the risk of viral transmission from used syringes.

If you choose to inject:

Use new injecting equipment every time you inject including new needles, sterile water, new swabs, a clean spoon, tourniquet, filter, a clean injecting space and clean hands.

If you can't get a new equipment:

• Choose to wait until you can get new equipment
• Try using your drugs another way like smoking, snorting, swallowing or Booty Bumping (up ya bum)
• Clean equipment that only you have used before
• As the very last resort - clean equipment that someone else has used. This is not recommended - no matter how well you know the person you could get Hep C

If you inject with a needle/syringe used by someone else, you are taking the risk of becoming infected with Hep C, Hep B and/or HIV/AIDS. Even if you are already Hep C positive, cleaning is important, as you can be re-infected with a different or even the same strain of Hep C.

Follow these directions for cleaning used equipment (including your own)

Equipment:
You will need three separate containers:
1. One filled with clean, cold tap water for rinsing blood out of your own fit. Soapy (detergent) water is best. Use water from the cold tap. If the water is too hot or too cold it can cause any blood in the fit to congeal and stick inside the needle where it can shed microscopic particles into your mix
2. One filled with full strength bleach (at least 5.25% sodium hypochlorite, and check the 'use by' date) for soaking/bleaching the used needles; and
3. One filled with clean, cold tap water for rinsing the bleach from your needle/syringe. You will also need a clean work space and a safe area to get rid of fluids - like a sink, bin or drain or whatever

Cleaning process
There are three steps to the cleaning process: rinsing, bleaching and flushing

1. Rinsing

• Draw up water from the first container
• Squirt the water out
• Repeat process until the needle/syringe is clear
• Empty the container of contaminated water

2. Bleaching

• Take the needle/syringe apart and put it in the second container
• Make sure it is covered completely with bleach
• Soak it for at least two minutes
• If you can't soak it, draw the bleach up into the needle/syringe and shake it for at least 30 seconds
• Count slowly to make sure that the bleach has enough time in contact with any virus present. Count "1 000, 2 000"... up to "30 000"
• Squirt the bleach out into your sink, bin or drain
• Repeat this process at least once

3. Flushing

• Draw up fresh water from the third container into the needle/syringe
• Don't use water from the first container: this has been contaminated with blood
• Squirt, flushing the water out
• Repeat this process at least six times, until the bleach is removed
• Flushing your equipment is very important. If you don't flush your needle/syringe at least six times you can risk having a 'dirty hit' from the leftover bleach in the syringe. The symptoms of a dirty hit include; severe headaches, the shakes, fever, pain, vomiting and sweating. Paracetamol can help with the fever and anti-nausea tablets can help with the vomiting. If you or someone with you has these symptoms the person should rest, drink plenty of fluid and seek medical advice if the symptoms cannot be relieved or worsen.

SAFER INJECTING PRACTICES

If you are injecting, it is safer to do it yourself if you can. You then have power over of the situation. You can include safer injecting practices like being hygiene aware, and can stop if you feel something is wrong.

• Remember - never use alone
• Stock up on equipment so you don't run out. Always get more than you think you need
• Always mix up on a clean space (wipe with a clean cloth and soapy water or use new swabs)
• Clean your spoon before mixing up (wipe once with a new swab)
• Wash your hands with warm soapy water before and after injecting
• If you can't wash your hands, use single wipes with new swabs. Remember - rubbing swabs backwards and forwards spreads the dirt and bacteria around
• Stop the flow of blood after injecting with clean cotton wool, tissues or clean toilet paper
• Never let a used fit come into contact with a group mix - no matter how well it has been cleaned - Everyone must have their own fit, water, spoon and filter
• Have your own tourniquet and don't share it. Wash it regularly to remove blood
• Rinse your fit with clean, cold tap water straight after your hit to help remove traces of blood
• If you keep your own fit, mark it and keep it somewhere safe
• Always dispose of injecting equipment in a disposal container or a puncture-proof container with a child-proof lid. If possible return the container to your local Needle and Syringe Program
• Don't re-use swabs, filters or open water ampoules: they can become contaminated once opened. Dispose of them with your fits or inside two plastic bags
• Be aware of blood on sleeves and clothes - if you get blood on your clothes, tourniquet or other washable items wash them immediately
• If someone is helping you inject, make sure they wash their hands before and after

UNSAFE INJECTING

The practice of unsafe injecting (such as sharing or reusing injecting equipment) increases the risk of transmitting a blood-borne virus (HIV/AIDS, Hep B and Hep C). People who inject, or who are injected by someone else with drugs, are especially at risk if sharing or re-using injecting equipment. Hep C is the most common of the possible infections among people who inject drugs, with an extremely high percentage of people who inject likely to be exposed to a new infection and at risk of chronic (long term) infection. Be blood aware and take care.

Safer using means understanding the risks associated with injecting drugs and making sure you protect yourself and others from these risks in any way you can.

Vein care

Stimulants such as tobacco, cocaine, chocolate, coffee and black tea send your body into action mode. They make your heart work harder by causing your veins to tighten and shrink, squeezing more blood towards the heart. When veins shrink, they are harder to find to inject. This could lead to misses, vein damage, and abscesses. Smaller veins also restrict blood flow and increase blood pressure.

Many stimulants are toxic chemicals that can burn and eat away at delicate vein tissue. With frequent injecting, vein tissue becomes inflamed and breaks down. This can cause scarring, abscesses and collapsed veins.

Some chemicals can also make abscesses worse if you skin pop or miss.

Tips for healthier veins

Give your veins extended breaks from toxic chemicals and frequent puncture damage. Your veins will be sure to last longer that way.
The best way to protect your veins is to stop injecting drugs - particularly crystal, or if that's not a real option then try cutting back on injecting, or use in different ways.

Water is your best friend when it comes to veins! Drink at least 8 glasses a day. Fruit juice (100% juice, not juice "drinks") and sports drinks like PowerAde or Gatorade are also good choices.

Drink less coffee, caffeinated soda and alcohol - these make your body lose more fluid than it takes in. Cut down on cigarettes, especially 1-2 hours before having a shot. Nicotine also shrinks veins.

Before you inject

Try to make your veins expand as much as possible. When veins expand, or dilate, they are more visible. Veins you can see are easier and safer to hit. Dilated veins also allow more blood to flow.

If you're already speeding, your veins will be smaller than when you first shot up. So getting a good vein is going to be more difficult than when you had your first shot. Take a hot shower. Or place a hot, wet washcloth on the injection area for 5-10 minutes. The temperature increase will help your veins expand and rise to the surface.

Rotate your injection sites

Each time you shoot up, move at least one inch from your previous hit. Better still - move to a different site altogether. Sticking to your favourite spot is a sure way to cause that vein to scar or collapse.

If possible, clean your injection area thoroughly with hot water and soap. Then wipe the site with a fresh alcohol swab. A good wash with soap followed by an alcohol swab will cut down on bacteria that can lead to abscesses, endocarditis and other infections.

Important:

• Never inject below your waist
• Avoid injecting into veins in your hands or feet
• Never inject deeper than 5mm or you may hit an artery or a nerve. Arteries are deeper and harder to pierce than veins, the blood is brighter and it will spurt rather than ooze
• Never inject into a site that is sore, swollen or tender
• Don't inject into the same spot 2 times in a row. Vary your injecting sites to give the vein a break and a chance to recover
• Don't bend your elbow to stop the bleeding - apply pressure and hold the bleeding site

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