4- Drug Injection
There is no completely safe way for drug injection. Injecting a drug, rather than smoking, swallowing or snorting it carries a much greater risk of overdose, vein damage and infections. This page describes some of the health risks associated with injecting drugs.
- Reasons people inject drugs
- Health risks
- Risk reduction
Reasons people inject drugs
- Although there are various methods of taking drugs such as swallowing, smoking or snorting, injection is favored by some drug users because the effects of the drug are enhanced and experienced very quickly, typically with in five to ten seconds of the hit. Injecting drugs is a method of introducing a drug such as heroin into the body with a syringe, which is pierced through the skin into the body. Injection can be intramuscular- into a muscle, subcutaneous- under the skin, or intravenous- directly into a vein. Intravenous injection is the preferred route for the majority of drug users because the drug reaches the brain fastest producing an intense rush of exhilaration.
- When a drug is injected into the body, it bypasses the first pass metabolism in the liver, which is the body’s defense and detoxifying mechanism and so the drug reaches the brain directly resulting in a stronger sense of pleasure. Injection also increases a drug’s bioavailability, which means less drugs, and so less money is required to achieve the same effect. This makes it more attractive for some drug users to inject drugs.
- The most commonly injected drugs are heroin, other opiates, cocaine and amphetamines, but the prevalence of each varies according to country and population groups. In Western European nations, heroin is the most commonly injected drug amongst older users, whilst amphetamine-type stimulants are favored among younger people. Stimulants such as cocaine and amphetamines are also the most commonly injected drugs in Asian countries. Whilst in the Middle Eastern countries due to the scarcity and growing cost of heroin, drug users are increasingly switching from inhaling to injecting methods.
The main health risks associated with injecting drugs are:
1. Risk of infections
There is a greater chance for infection because people who inject usually share their needles with others, which can lead to blood born diseases such as HIV and hepatitis. In addition there is a greater risk sexually transmitted diseases- STD’s and of abscessed infections because drug users inject in unhygienic places and lack aseptic techniques.
2. Risk of overdose
There is a greater chance for an overdose because injection delivers a dose of drug straight into the bloodstream and it is harder to gauge how much to use, as opposed to smoking or snorting where the dose can be increased incrementally until the desired effect is achieved.
3. Scarring of the veins
The peripheral veins of a drug user can become scarred because of using blunt injecting equipment. This is particularly common with users who have been injecting while in jail lacking new syringes or those who re-use disposable syringes. As a result users who use blunt injecting equipment for a long time may suffer from collapsed veins. Though rotating sites and allowing time to heal before reuse may decrease the likelihood of collapsed peripheral veins, this condition may still occur with prolonged drug injections.
4. Arterial damage
Arterial damages can happen on places on the body where the drugs have been injected. The arteries can rupture, potentially resulting in hemorrhage, distal ischemia and gangrene. As veins are exhausted after repeated injection in the same place, drug users use more dangerous places on their body to inject. Injecting into the femoral vein is very common and can cause deep vein thrombosis (DVT), septicemia, arterial bleeding and neuropathic pain. Neck injecting is clearly dangerous because of the presence of major vessels, nerves, trachea and esophagus. If breast veins are used, mastitis is likely to occur. Penile veins are sometimes used by desperate drug users who have run out of places to inject their drug. This is an extremely dangerous practice with the risk of priapism. Cocaine is a particularly risky drug to inject in terms of vein damage. This is due to its local anesthetic properties combined with the high frequency of injection. In addition, the disinhibiting effect of cocaine leads to a bravado approach where knowledge of safe injecting is ignored. Speedballing (injecting a crack/heroin mix) is widespread in some areas and also notorious for vein damage and subcutaneous infections. Temazepam injection is very damaging to the veins. Most street drugs are ‘cut’ with all manner of irritant substances from bleach to talcum powder and citrus acid is sometimes used in the injection process as a solvent. These can all cause sever vein damage.
5. Risk of addiction
Because injecting drugs produces such a heightened sense of euphoria, drug users tend to inject more often. This in turn leads to lead to the development of the disease of addiction. The majority of those who inject drugs, have already become addicted because their bodies has developed tolerance towards the drug and they need a stronger route of administration such as injecting, in order to experience the original “high”.
If you are injecting drugs and are not yet willing to get clean, here are some ways to reduce its health risks:
1) Never use or share syringes, water, or drug preparation equipment that has already been used by someone else.
2) Use a new sterile syringe each time you prepare and inject drugs. In countries under Harm Minimization policies, you can get clean needles from pharmacies or syringe services, often also called needle-exchange programs.
3) Only use syringes that come from a reliable source.
4) Use sterile water to prepare drugs, such as water that has been boiled for 5 minutes or clean water from a reliable source such as fresh tap water.
5) Use a new or disinfected container “cooker” and a new filter each time you prepare drugs.
6) Before you inject, clean the injection area with alcohol or disinfected swap.
7) Safely dispose of syringes after one use.
8) If you engage in sexual activity, reduce your sexual risk factors for HIV infections by using protection.
9) Try and get screened for HIV at least once every year.