Some of us prefer injecting drugs as it’s seen as a way to get a rapid onset of the drug's effects. The downside is that there are a lot of increased risks that come with injecting.
When we inject into our veins we bypass our body’s number one natural defence system; our skin. This leaves us vulnerable to infections and diseases from viruses, bacteria and fungi. These infections can lead to health problems like cellulitis, abscesses and urticaria. More serious infections include things like septicaemia, osteomyelitis or endocarditis and blood borne viruses such as hepatitis C, hep B and HIV.
Injecting drugs also carries an increased risk of harms such as overdose, vein damage, and, according to some ATS studies, an increased risk of dependence.
(McKetin R, Kelly E, McLaren J. The relationship between crystalline methamphetamine use and methamphetamine dependence. Drug Alcohol Depend 2006;85:198 – 204)
Injecting ATS comes with some of its very own risks as well. For one thing, ATS tend to be more irritant or damaging to tissue than other drugs. This means greater potential for vein damage, or if you miss a shot, a much greater chance of getting inflammation or infection in surrounding tissue (eg cellulitis or abscesses).
The other thing to consider with ATS is, because of the positive side effects such as increased energy, euphoria and feelings of invincibility, we’re more likely to inject more drugs more often, particularly if on a binge. This means more vein damage and greater risk of blood borne virus transmission and other infections. The other problem is if you’re injecting when you’re wasted on ATS, and you’re feeling invincible, but maybe a bit shaky with a bit of blurred vision, there’s a good chance your injecting technique will be pretty crappy, putting you at much greater risk of damaging your veins or missing your vein and injecting into tissue. And not only are ATS pretty irritant drugs, our body tissue (eg muscle tissue) doesn’t absorb ATS as well as some other drugs and so a missed shot is again much more likely to result in inflammation and infection.
Plus, the side effects of ATS use can mean we don’t worry about things as much, including important stuff like safe injecting practices (not sharing injecting equipment, washing hands, swabbing, not rushing a shot etc) or unsafe sex; forgetting, or not bothering, to use a condom. And there’s a greater risk of accidentally overdosing if you can’t remember (or figure out) how much you’ve used.
With all of these things in mind, if we are still going to inject, there are some practical things to do. The following guidelines on injecting may help us steer clear of vein damage and injecting related infection and disease.
- The veins on the inside of our elbow are the safest veins to inject in so look after them. Rotate sites as much as possible to keep them healthy and take your time. If you inject too quickly, the vein may not be able to take all the extra fluid, causing your mix to leak into the tissues around the vein, the dreaded missed shot.
- Areas to avoid! Areas that are far from the heart, like the hands and feet, have smaller veins, heal slowly and have really poor blood circulation. Areas close to the heart, like the groin and the neck, have veins that are located near major arteries and nerves which, if accidentally hit, can cause serious, life-threatening damage. Stick to the inside of your arms or consider snorting, swallowing, smoking or shafting.
- Try not to use veins that are tender, hardened, or inflamed. Wait until they heal to avoid giving yourself a nasty infection.
- The larger and more visible the vein, the easier and safer it usually is to hit. Deep veins are harder to hit, and trying to find them increases your chance of hitting a nerve or artery. Take your time; it can be difficult to keep a needle properly positioned in a very shallow vein, you might accidentally skin-pop your hit.
- Avoid injecting near your bones because this increases the chances of swelling and pain
Common injecting mistakes to avoid
- Tourniquet too tight. A tourniquet pumps up your veins by allowing blood flow into your arm (along an artery), but not out of your arm (along a vein). If arterial flow is blocked, the tourniquet won’t work as intended.
- Tourniquet not released or loosened before injecting. The injected drugs have nowhere to go if you don’t loosen your tourniquet. Plus this increases the chance of vein damage as well as missing the vein and injecting into surrounding tissue.
- Licking needle before injecting. Puts bacteria and fungus from your mouth onto your needle.
- Injecting into veins you can see instead of veins you can feel. Many of the veins you can see are actually too small to inject into. Bigger veins are not always easy to see but they’re easier to feel, the best veins to use feel tube like or bouncy.
- Not allowing for vein rolling. Our veins can move about under the skin, especially if you move around after inserting the needle. Stretch your arm out tight, flexing your hand backwards to limit vein movement.
- Digging for a vein. If you jack back and you’re not in a vein, you’re better off completely withdrawing the needle and going again. Digging around under the skin for a vein is less likely to be successful and can cause more damage.
- Going through a vein. By injecting at too steep an angle, the needle can pass right through the vein and out the other side. Go for about a 45-degree angle with the hole facing up.
- Not rotating your injecting site. By continually injecting at the same spot, you damage that spot faster than it can repair itself, increasing the rate of vein collapse. You also increase your chances of getting an abscess or other infection.
- Swabbing after injecting. The alcohol on a swab stops your blood from clotting. This means you bleed more and bruise more (blood leaking under skin). Firm pressure with a clean tissue is your best bet. It is, however, important to swab your skin (and your spoon) BEFORE you inject. This helps remove bacteria that would otherwise be injected along with your drugs.
Though not an amphetamine type stimulant, cocaine’s actions are really similar. But because it’s a much shorter acting drug, there’s a greater likelihood of non-stop binges; meaning lots more injections and a greater risk of damaging veins and surrounding tissue in a shorter period of time. In addition to this, coke has a few features that pose extra risk for injecting:
- Coke acts as a localized painkiller, so if your injecting technique is no good, you may not notice, because the coke will dull any pain you would have otherwise felt.
- Cocaine is a vaso-constricter. This means it constricts blood vessels making it harder to find a vein.
And like ATS, cocaine also makes you more confident and less likely to worry about things like safer injecting technique, safe sex and the risk of vein damage, blood borne virus transmission and bacterial infection.
This injecting harm reduction fact sheet was informed by Anex