Providing straightforward information pertaining to drugs, drug use & drug policy. The Grey Pages promotes drug-related literacy and advocates a system of viable and tolerant drug policies. This is my personal collection of commentaries, essays, tid-bits, and other such writings on everything ranging from drug use, drug policy and drug-myths, to drug-science, addiction, human behavior, and the workings of the human brain. I started this blog with a particular focus on opioids, and over the past year have found my interest gravitate toward the intriguing, ever-changing world of designer intoxicants (i.e. "research chemicals" or "designer drugs").

Sunday, April 29, 2012

IV Drug Use: Risks and Risk Management (Revised)

(Search Keyword: harm reduction, IV drug use, injecting, cellulitis, abscess, necrosis, IV related infection)

General Risks

aftermath of an accidental arterial injection of demerol
Injecting drugs in pharmaceutical tablet or capsule form, as well as street form, presents a significant hazard of injury, infection and death. Tiny particles invisible to the eye may cause blood vessel blockage which can travel to essential organs such as the heart, lungs, or brain, and cause pulmonary embolism or stroke - usually unexpectedly, hours or days after injection.

In addition, foreign particles or bacteria which often leaks into surrounding tissue is likely to lead to cellulitis (a serious infection) and abscess; an abscess is a protective response of the body intended to quarantine the foreign particles/bacteria and prevent infection. Both cellulitis and abscess are serious medical conditions, requiring urgent medical treatment. Both can quickly lead to serious complications, including systemic infection and death.

Treatment of infections such as cellulitis typically involve a 4-7 day course of  oral antibiotics, or in more serious cases, an inpatient 24 hour infusion of intravenous antibiotics. Treatment for an abscess is generally very painful, and involves incision and drainage of the lump, or in cases of deep tissue abscess, possibly surgical removal. Complications of untreated infection or abscess include gangrene, necrosis, sepsis, loss of limbs or worse.

Safety Tips

Use clean, distilled water: Filtered tap water, or better yet, bottled water is a much better choice than tap water. City water contains trace amounts of bacteria as well as fluoride, among other things. 

Avoid injecting in "high-risk" areas: That is, areas such as the feet or genitals which are likely to harbor bacteria or dry, flaky skin. Injections in these areas carry a much greater risk of cellulitis or abscess, even with fresh needles.

Double filter your product: Even when filtered; your seemingly clean liquid contains thousands of microscopic insoluble particles which are invisible to the naked eye. Pills and street dope are full of insoluble fillers including talc, etc. Think about this; 30 milligrams of oxycodone is a miniscule amount of powder which is barely visible to the naked eye; therefore, the VAST majority of a 30 milligram oxycodone tablet will be inactive binder and filler, most if not all of which is non water soluble and will not dissolve no matter how finely crushed. The bigger the pill, the more filler it contains. Using two spoons and filtering twice will assure that less filler makes it into your shot.

Stay Obsessively Clean: Wipe the surface of your skin with alcohol swabs, and ALWAYS wash your hands prior to prepping the shot. Once finished, dispose of your needles. Never re-use your needles. There is no excuse for this. 10 packs of generic insulin syringes will cost you less than two bucks at any chain drugstore.

Use the right filter: I advise against cotton balls and cutips. The THICKER the better. Clean unused cigarette filters are an acceptable choice [though still may lead to cotton particles in your veins] an even better choice is Micron. If you have the money, micron-filter syringes are available either online, or at certain drug stores. I highly reccomend these. 

Never inject into an artery: Veins, arteries, and nerves run together through the body in a big tangled mess. Wherever you inject into a vein, there is the possibility of hitting an artery. Don't ever inject into a blood vessel in which you can feel a pulse - this is likely to be an artery. Also common with arterial injection is immediate pain; if you feel pain or a pulse, stop injecting immediately. Arteries carry fresh blood from the heart to the organs and tissues of the body. Hitting or blocking arterial bloodflow runs the risk of stopping the blood from reaching areas of the body (such as the arms and legs, toes and fingers), leading to gangrene and necrosis - the tissues of these areas will die, rot, and fall off (or if not treated, cause a dangerous systemic infection - i.e. sepsis).

Hardware: Not everyone has access to professional medical supplies, though they can be ordered online or acquired free of charge at a local needle exchange. Insulin syringes are acceptable and most widely used. 28 to 31 gauge is ideal. Your needles should fit no less than 1/2 mL of solution. 1 full mL is ideal. The larger volumes will better accomodate excess filling or high cut heroin.

Needle Length: 8mm (5/8'') tips are not very effective for anything aside from skin popping. They should be avoided by IV or IM users, as multiple missed shots means increased risk of infection or abscess. For IV/IM use, Stick with 1/2 inch tips or longer.

The best way to avoid potential hazards of parenteral drug use is simply not to start injecting.  If you've never tried it, I might reccomend sticking to alternative routes if they're working. Oral, intranasal, rectal, buccal, sublingual - plenty of options here, depending on your substance.

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