Injecting Drug Use:10 Golden Rules

1. Always Use Sterile Equipment

THIS INCLUDES: paraphernalia not only the obvious items such as Needles, Syringes, & Spoons’ but also Filters, Mixing Tool, Water, Containers, Acids, Drugs, Tourniquets, Swabs, Knife/Razor Blades, Workspace Never share

Blood Borne Virus:
If you use non sterile equipment, or equipment that has been used by another, you run the risk of catching a blood borne virus. Blood borne viruses are viruses which as the name suggests live and multiply in the blood., There are three viruses which you may have heard about, which are Hepatitis C, Hepatitis B and HIV.

These viruses are easily transmitted, through injecting drugs, which is why addiction services push the use of the Needle Exchange network.

Hepatitis C
  • Hep C is an illness caused by a virus that mainly affects the liver & it can lead to cancer of the liver and can be fatal.
  • Hepatitis C can be passed through blood to blood contact between one person to another through sharing injecting equipment for example
  • There is no vaccine available which prevents infection but treatments are available which can cure the virus in many cases.
  • Most people don’t realise that treatment is available
  • A liver transplant may be an option for people who develop advanced liver disease.
  • Hepatitis C Is more infectious than HIV
Hepatitis B
  • Hepatitis B is an infection of the liver caused by the hepatitis B virus.
  • It can cause inflammation (swelling) of the liver, and sometimes significant liver damage.
  • Many people do not even realise they have been infected with the virus, because the typical flu-like symptoms may not develop immediately, or even at all.
  • Hepatitis B is 100 times more infectious than HIV.
  • The incubation period (the time it takes from coming into contact with the virus to developing infection) is between one and six months.
  • In some people, the hepatitis B virus will go on to cause a chronic (longterm) illness, where it lasts for longer than six months. This is very common in babies and young children, but it can also occur in 2-10% of infected adults.
  • The vast majority of people who are infected with hepatitis B are able to fight off the virus and fully recover from the infection within a couple of months.
  • However, most babies infected with hepatitis B have a poorer outlook,as their infection usually becomes chronic
  • A healthy immune system provides a natural defence against disease and infection. If the immune system is damaged by HIV, it increases the risk of developing a serious infection or disease, such as cancer.
  • HIV is a special type of virus known as a retrovirus. The retrovirus reproduces inside the cell and releases copies of itself into the blood. It can be challenging to treat as the virus can rapidly mutate into new strains of virus.Although the body will attempt to produce more CD4 cells, their numbers
  • will eventually decline and the immune system will stop working.
  • Acquired immune deficiency syndrome (AIDS) Is a term that is used to describe the late stage of HIV.
  • This is when the immune system has stopped working and the person
  • develops a life-threatening condition, such as pneumonia (infection of the lungs).
  • The term AIDS was first used by doctors when the exact nature of HIV was not fully understood. However, the term is no longer widely used because it is too general to describe the many different conditions that can affect somebody with HIV. Specialists now prefer to use the terms advanced or late-stage HIV infection.
  • People do not actually die from AIDS; they die from the cancers, pneumonia or other conditions that may take hold when their immune system has been weakened by HIV.

2. Never Share

If sterile equipment is not available then only clean your OWN equipment using bleaching method.
Cleaning equipment used by others is not recommended
Bleaching - needed: 
  • needle and syringe
  • thin, undiluted household bleach
  • clean, cold water
  • two clean cups or wide topped bottles.
  • Pour bleach into one cup or bottle and water into another. If using a disinfecting/bleach tablet e.g. in a prison setting, dissolve it to make up a solution according to the instructions.
  • Draw up bleach into dirty needle and syringe.
  • Expel bleach away down the sink (not back into the cup or bottle).
  • Repeat steps 2 and 3.
  • To remove the bleach, draw up cold water into the needle and syringe.
  • Expel water down the sink.
  • Repeat steps 5 and 6 two or three times.
Important points:
  • The above cleaning advice does not guarantee protection.
  • Bleaching previously used equipment should only be a last resort option.
  • Clean equipment both before and after use.
  • Boiling plastic syringes melts them.
  • Cold water is recommended as warm water may encourage blood to coagulate and hence will be harder to expel through the needle.
  • Thick bleach is impossible to draw up though a needle.
  • Diluted and old bleach can lose its effectiveness.
  • Using new/clean injecting equipment (from a needle exchange) is the safest option.

3. Choose the smallest equipment

The smaller the needle, the less damage to the vein and can also act as a filter. The smaller the barrel, the less chance of damage to the vein and overdose

4. Careful Preparation of the Drug

  • Clean the Work surface &wash your hands
  • Is drug from a regular source?
  • How is it cut?
  • Always test a small amount of the substance

5. Embolisms are dangerous

To prevent air bubbles being injected:
  • Expel all air from barrel
  • Hold syringe & needle vertical
  • Tap any bubbles to surface
  • Expel air gently with plunger
  • When liquid appears at top – don’t lick
  • Re-sheath before looking for site

6. Accessing the Site

Intravenous Veins
  • Hydrated body better than dehydrated
  • Be as relaxed as possible, sitting down or lying down
  • Never inject standing or unsupported.  If you are unsupported, your relaxed muscles may give way and you could hurt yourself in the fall.
Ways To Get Vein Up:
  • Clenching & releasing first
  • Rubbing or slapping skin soaking in warm water
  • Cover with warm towel, squeezing upper arm.  Also some clients have talked about using tourniquets.
  • Ensure veins are as prominent as possible. No rings, watches or bracelets.
  • Clean site with sterile swab - allow alcohol to evaporate
  • Always enter the vein at an angle no steeper than 45° angle indirection of blood flow (which is always towards the heart) 
  • Note slight "pop” as vein is entered, then draw back gently on plunger to confirm you are in – this is indicated by dark crimson blood Remove tourniquet if used (reduces bleeding)
  • Inject half the drug slowly, pull back to ensure still in vein, then inject again slowly
  • Flushing – If possible DON’T.  If need be then once or twice only
  • Gently remove needle and apply pressure to site – IF YOU WITHDRAW TOO QUICKLY THEN THE VEIN MAY COLLAPSE
  • Avoid indiscriminate puncturing of skin in search of veins – this only causes bruising
  • Avoid damage of thrombosed (hard & lumpy ) veins
  • No powders or tablets – steroids only relax muscle
  • Access at 90° ensuring only ¾ of the needle is entered
  • Pull back plunger slowly ensuring not in vein or artery
  • Inject no more than 2mls slowly Remove needle gently & massage site
Skin Popping:
  • Use small amounts – no more than ½ ml each site
  • Enter under skin and inject very slowly
  • Massage injection site

 7. Always rotate Sites

Rotating of injection sites helps any damage at the currently used site to heal. If rotation happens cyclical, by the time the service user gets back to the original site, then the wounds would be healed. Develop ambidexterity – your writing arm has the best veins.
Never use the same site too long – preferably use a site once then change. The longer you refrain from using a vein the healthier it will remain. IF IN DOUBT PULL OUT!

8. Bright Red And Frothy

Arterial bleeding is life threatening, and arterial blood due to the amount of oxygen carried in it appears crimson red, venous blood is Bluish red also when the service user hits an artery, the pain is excruciating, and blood loss can befast and immediate.

If you hit an Artery
  • Pull out needle slowly
  • Put pressure on site
  • Raise site well above heart
  • Stay like this for 10/15 minutes
  • If in doubt seek medical attention

9. Dispose Of Equipment Safely

RESHEATH NEEDLES YOURSELF: When not in use, after drawing up and before selecting site.  After cleaning put needles into Sharps Bin available at all needle exchanges, otherwise use secure container preferably drinks can.  Disposing in fire is not recommended .
Protect yourself and others by segregating or labelling your works and storing separately away from children.

10: Know The Recovery position

Overdose: overdose is a major concern when using any substance, and is caused when you use two drugs from the Depressive group of drugs. These substances cause the nervous system to slow down and include the most common substances of choice such as Alcohol, Methadone & Heroin.

Naloxone training is available for service users and their families to combat the spectre of overdose, and is available through Addiction Services. Naloxone is a drug that is effectively and anti-dote to the opiate drug which is causing the overdose, and is designed to reverse the effect of the drug like heroin, to allow the affected service user to get to an emergency treatment centre for example Accident & Emergency where the client can receive further help.

If you wish to access specific training aimed at preventing overdose, or understanding overdose, and how to recognise it, please ask your drug worker about it or contact your local drug and alcohol service.
Further Information can be found at the Red Cross website

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