Many, if no all, that the points that have the right to go wrong throughout the process of preparing and also injecting drugs autumn into among three categories: drug-related, technique-related, and hygiene- related mishaps. Due to the fact that we’re forced to use blackmarket, control not controlled drugs, we don’t have manage over the top quality or purity of the substances us use. While we might not have the ability to do much around the yes, really drugs we use, we deserve to work to boost our injection an approach and toilet which deserve to have far-ranging impacts on our health.

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There space numerous and also potentially very serious health and wellness complications associated with injecting illicit drugs, from injection-related injuries like tracking and also bruising, to bacterial and fungal infections, native communicable diseases, to drug overdoses and other clinical emergencies. This ar of the manual defines some of the medical and health difficulties that can result from injecting drugs and also offers suggestions for just how to stop them. Overdose prevention and also survival space addressed in thing four.


B A C T E R ns A l , V ns R A together , A N D O T H E R i N F E C T i O N S 



A “dirty hit” is a basic term for a shoot that renders someone noble or reasons an abscess as a result of being contaminated with infection-causing microbes or toxic substances. Dirty hits deserve to be caused by any variety of things, such as:

contaminants in the water you used to dissolve your drugs;bacteria, fungi, or other microbes from old cottons;chemicals in a cigarette filter that was supplied to filter a shot;adulterants or contaminants in the medicine themselves; ornot correctly cleaning the skin prior to injection.

BACTEREMIA (bacteria in the blood) 

Bacteremia is once bacteria entersthe blood- stream that have the right to be brought about by injecting through contaminated water, re-using old cottons, or failing to clean the skin before injection.

Early symptoms encompass chills, fever, and also extreme fatigue. If you suffer these symptoms, seek medical attention. Bacteremiacan be fatal!



Endocarditis is an infection of the love valves the is resulted in by bacteria, fungi, and other infection-causing microbes that get in the bloodstream throughout injection and build up about the valves of the heart, weakening them and other components of the love muscle. Endocarditis can eventually reason a heart murmur, and fever, chest pains, fainting spells, shortness of breath, and heart palpitations and congestive heart failure. Early signs incorporate flu-like symptoms. It deserve to be treated v antibiotics or antifungal agents if recognize early, however requires numerous weeks, or months, that IV antibiotics and/or heart valve replacement surgical treatment if not detected early. Endocarditis have the right to be deadly if the goes untreated.



Tetanus is a bacterial infection that occurs as soon as tetanus spores enter a wound and release tetanus bacteria, normally after a scab has currently formed. The bacteria then go into the bloodstream and also cause one infection, which is identified by muscle spasms or rigidity, specifically in the neck and jaw (tetanus is typically called “lockjaw”). Tetanus is deadly if not treated.

Tetanus spores live in the soil and on rust, which is why a tetanus shooting is recommended if you action on one old nail or various other rusty object. Most local health and wellness departments offer free tetanus boosters, i m sorry will protect you native tetanus for five years, for this reason you should r get one. If her needle, syringe, or other injection devices is contaminated through tetanus spores due to dirt or rust, you can infect yourself. Skin-poppers and muscle- poppers are particularly susceptible come tetanus infection and also should constantly use new, sterile equipment.



Necrotizing fasciitis is a bacterial infection commonly known together “flesh-eating disease” that enters the human body through broken skin and also then affect the bordering tissue and nearby muscle. It deserve to be transmitted by the exchange that blood during needle sharing, and has to be traced come “black tar” heroin on the West Coast.

Symptoms of necrotizing fasciitis encompass increasing redness and also swelling and also extreme pain in ~ the wound or injection website accompanied by a fever. This might look a few different ways, the flesh about the site of infection will certainly be an extremely red, swollen, with significant pain, and feasible fever. . Over the food of days the skin can turn from red-purple to blue-gray and the skin could break down within 3-5 days. Since this infection is fatal, early treatment with antibiotics is an important to survival, back even ideal therapy does not prevent fatality in all cases. Wounds need to be maintained impeccably clean.

Always using new, sterile injection equipment; never sharing injection equipment; extensively washing your hands and clean- ing the skin prior to injection; and also preparing her drugs ~ above a clean surface will all aid prevent necrotizing fasciitis infections.



Wound botulism is led to by a bacteria the produces a toxin top top the skin whereby a puncture wound is made and also that ultimately stops your breathing through paralyzing your muscles. Instances have been connected with the subcutaneous injection the “black tar” heroin ~ above the West Coast. The resource of the botulism might be the medicine itself, a reduced in the drug, dirty injection equipment, or contamination throughout the preparation process. Wound botulism have the right to be impede in the same means as necrotizing fasciitis–by complying with excellent sterile method when preparing and also injecting her drugs.

Symptoms that wound botulism encompass droopy eyelids, blurred or dual vision, and a dry, sore throat which might progress into an obstacle speaking and swallowing, a weak of the neck, arms, and also legs, and an obstacle breathing.

If untreated, wound botulism will reason death by paralyzing the muscles used for breathing. Beforehand treatment for wound botulism is essential. If you experience any of the symptoms listed above, seek medical attention immediately. Treatment usually involves an antibiotic regimen and also the draining of any type of abscesses or infected wounds.



Hepatitis is an inflammation that the liver that have the right to be caused by specific toxic drugs, alcohol, or street medicine (iatrogenic or chemically-induced hepatitis); or that is the result of infection through a hepatitis virus (viral hepatitis). While there room numerous types of hepatitis viruses, hepatitis-B and also hepatitis-C room the two that most frequently influence people who inject drugs, through hepatitis-A comes in third.

General symptom of hepatitis include fatigue, loss of appetite, nausea, mild fever, and also muscle aches, and if you smoke cigarettes, you may notice that they taste unpleasant. More severe symptom of hepatitis incorporate dark (tea-colored) urine, light-colored stools, and also jaundice (a yellowing of the skin and also the white skin - man of the eyes).

HEPATITIS A ( “HAV”) is excreted in feces (shit) and spread through fecal-oral contact (feces-to-hand- to-mouth contact). Hepatitis A have the right to be spread out from contaminated food, water, hands, and also eating utensils, because that example, by a restaurant worker who didn’t wash their hands after using the bathroom and who then prepared food. Over there have also been outbreaks in areas like encampments where people may not have access to to run water for handwashing. Unlike hepatitis B and also C, hepatitis A is no transmitted through blood-to- blood contact that occurs once needles or other drug injection tools is shared, and is not typically spread with sexual contact unless rimming (oral-anal contact) is involved. 

Hepatitis A illness resembles the flu and also can last from four to six weeks. It causes an acute (short-term) infection only and also never creates into a chronic condition like hepatitis B or C. You develop antibodies to hepatitis A after you’ve to be infected with it, for this reason your chances of ever before getting that again space slight. A hepatitis A vaccine is obtainable and is . A two-shot regimen, v the second injection bring away 6 come 12 months after the first.

HEPATITIS B ( “HBV”) is spread out through blood-to-blood contact of the type that occurs when injection devices is shared; call with infected body fluids favor semen, blood, quality fluids s; and also from a parental to their child at birth. Hepatitis B infection have the right to be acute (short-term) and/or chronic (long-term); chronic HBV can cause serious liver damage, including cirrhosis (scarring), liver cancer, and death indigenous liver failure. Hepatitis B is much an ext infectious 보다 HIV, which method it is spread out much much more easily. It is among the most vital reasons civilization who inject should avoid share injection tools of any kind.

A vaccine the will safeguard you versus hepatitis B if you’re exposed to it is available, and also all world who inject drugs must think around getting that . The vaccine requires a collection of 3 intramuscular injections, v the second shot being administered 30 days after the first, and the third shot gift administered 4 to 6 months after the second. The vaccine is safe and also effective. If

you’ve had actually hepatitis B in the past, you’ve developed antibodies come it and also will not capture hepatitis B again in the future and do not require the vaccine. You can gain your blood tested to see if you’ve ever been exposed to the hepatitis B virus, and get the vaccine at her doctor, local Department the Health,, or also your syringe organization program.

HEPATITIS C (formerly well-known as “non-A, non-B“ hepatitis and likewise referred to together “HCV“) is spread through blood- to-blood contact and is really infectious, which way you can get it quite quickly if exposed to it. There are oral and also blood tests accessible that detect whether or no you have actually antibodies to the hepatitis C virus in your blood, which, if positive, need to be shown with a 2nd test. . The only means to test whether or no you have the actual virus in your blood is by getting a confirmatory test which reflects whether you have a existing infection or not. There is together yet no vaccine because that hepatitis C, and antibodies room not protective—that is, they don’t make you immune come re-infection just like HBV. Currently, over there is just prevention by staying clear of blood-to-blood call with usage of sterile injection equipment, by no sharing injection equipment, and through more secure sex.

Hepatitis C deserve to either it is in chronic but asymptomatic (without symptoms, which means you right even notice you have actually it), or chronic-active, i m sorry means condition will build over a long period of time–several year or perhaps also decades. As much as a quarter of world who end up being infected with HCV will certainly clear the virus on your own and also not develop chronic hepatitis C. This go not median you’re immune, or that you’ll be able to clear it if you re-infected. Civilization with active hepatitis C may have elevated liver duty tests (LF Ts), fatigue, and also jaundice, and active disease can an outcome in cirrhosis, liver cancer, and ultimately liver failure, all of which have the right to be fatal. The hepatitis C virus deserve to be clearing from the body through medication, and also over time, the liver may have the ability to regenerate itself. Constant testing help to protect against hepatitis C native going unnoticed. Hepatitis C is a serious health and wellness risk for world who inject drugs, numerous of whom have actually been exposed to the virus in ~ some suggest in their lives.

In the past hepatitis C treatment was mainly ineffective and had major side effects. Because 2013, there have been highly effective, all-oral, cures for hepatitis C. Hepatitis C treatment can, and should, be available to everyone. However, it might be difficult to access treatment based upon where you live, your clinical coverage, and also your liver damage.



Human Immunodeficiency Virus (HIV) is the virus thought to reason AIDS (Acquired Immune Deficiency Syndrome), one immune device disorder that reasons the body to lose its ability to ward off infection and also fight disease. HIV deserve to be spread out through the exchange of particular fluids (if they contain the virus). These fluids are: semen (including pre-cum), vaginal, and also rectal fluids (during unprotected sex); blood (via childbirth, the sharing of drug injection tools or inadvertently needlesticks); and also breastmilk.

Blood-to-blood call is among the many efficient means of transmitting HIV native one separation, personal, instance to another, and also the sharing or re-use of medicine injection equipment is extremely risky in terms of HIV transmission. It is vital to allude out the injection drug usage itself walk not cause HIV; rather, HIV istransfer (like hepatitis and also other viruses) when infected blood indigenous one individual is left in a needle, syringe, cooker, cotton, or water and also injected into the bloodstream or human body of a second individual who uses those same works. HIV indigenous injecting medicine is because of this 100% preventable as long as you always use your very own sterile works and never share them v anyone.

General symptoms of at an early stage HIV infection (soon after ~ the allude of transmission) may include a low-grade fever and fatigue. The much longer a person has HIV and does not obtain medication,, the much more likely they room to build one that the numerous bacterial, fungal, or viral infections, cancers, neurological disorders, or other conditions that influence people through HIV and also AIDS. There are numerous medication regimens consisting of one pill variation that have the right to keep the HIV virus undetectable in the body HIV virus in the body so the you deserve to live a continuous lifespan.

 In July 2012, the Food and Drug management (FDA) authorized the use of tenofovir + emtricitabine (TDF/FTC), generally known as Truvada, because that HIV prep (Pre-Exposure Prophylaxis) in adult who room at high danger for becoming HIV infected. An uninfected human who might end up being exposed to the virus is detailed a prescription for antiretroviral drugs to protect against from ending up being infected through HIV. Prep Eligibility includes: world who inject drugs and who re-superstructure injection equipment, individuals who use stimulant drugs linked with high-risk behaviors, such as methamphetamine, and also individuals who trade sex because that money, drugs or housing. Prep is only for clients through a documented negative HIV check result. HIV and STI testing, and blood exam to inspect on the liver, are recurring every 3 months. PEP (Post-Exposure Prophylaxis) is an choice for individuals who have actually come in call with fluids that might contain the HIV virus within the previous 72 hours. Similar to PrEP, it is a course of antiretrovirals, yet it is only taken for the month following the exposure.




Track marks space the scars that show up along the veins that someone that injects frequently and also repeatedly offers the very same injection sites.



How a bruise is formed

Bruising occurs as soon as blood leaks out from the vein under the skin in the process of injecting. Damages to the veins, consisting of tracking and bruising, can be minimized or prevented altogether by practicing the following safer injection guidelines. (These are specifically important for those people who are worried around family, friends, an employer, or someone else finding out around their medicine use. Track marks are one of the most visible indications that friend use.)

Use a new, sterile needle for every injection. Re-using needles, also once will reason them come dull. Dull needles will reason trauma to the veins and surrounding tissue, reason a much larger puncture wound, and increase bleeding in ~ the site.Use the highest possible gauge (thinnest) needle friend can uncover to make the smallest puncture wound possible.Alternate and also rotate her injection sites. Always try to inject at least one inch “up” from your previous injection site (for her arms, this method moving away from the hand and also toward the shoulder, and also for the legs, this would typical away from your feet and also toward the hips). Provide your veins a opportunity to rest in in between injections. Stay away from veins that room red or tender till they heal.Always inject in the direction of the body blood circulation (toward the heart).Use a soft, flexible, easy-to-open tourniquet and also remove that after did you do it registered but before you inject to help prevent bruising.Use emollient-rich or antibiotic cream on injection website once they’ve closed or scabbed over. Aloe vera gel and vitamin E oil room commonly-available and also can assist reduce the appearance of track marks.


Vein fallen occurs when veins close up due to repeated injections into the same site, repeated neighborhood infections, or trauma to the veins and surrounding tissues. Using barbed or dull needles deserve to precipitate vein collapse. You know you have actually a broke down vein when you can’t draw blood from it or once the vein “disappears.” Thrombosis is the development of an obstruction the a blood vessel bya blood clot. Don’t usage veins that carry out not bend when pushed as they may have blood clots that can break off and also lodge in the lung or various other parts of the body and also cause severe damage.You can avoid vein please by constantly rotating and alternate your injection sites and also by injecting in the direction of the body blood circulation (toward the heart). Making use of the same injection website over and also over there is no letting the vein heal is among the surest methods to cause vein collapse. Also, insert her needle at a 15 come 45 degree angle v the bevel the the needle encountering upwards. Taking oral vitamin C may aid your veins fix themselves and reduce bleeding and bruising. Never ever inject vitamin C, just swallow it.



Abscesses start with redness, swelling, and tenderness at an injection site and also develop right into an infection through a hard, pus-filled core. Abscesses result from missed hits (injecting into the tissue surrounding the vein), injecting a solution with a lot of particles in it, no cleaning the injection site prior to injecting, re-using injection equipment, or skin-popping drugs favor coke or speed that cause damage come muscle tissue and skin.If you’ve simply missed her shot and also are worried about getting an abscess, ice cream the area immediately later on and progressive the injection site for at least 30 minutes, if girlfriend can. This will not prevent an abscess if one is developing, however will assist to ease the swelling. If any kind of abscess does develop, move from icing the area come heat.If you notification a hard, warmth lump arising at one injection site, use warm compresses at least three time a day to either do the abscess that is forming go far or involved a head (soften and also fill through pus). If it pertains to a head, friend can get the abscess opened and drained in ~ a hospital or clinic. If you endure fever, chills, extreme fatigue, pain linked with one abscess, or a thin dark line moving from the abscess, seek medical attention immediately because you could have a blood infection. Pain in the groin or armpits (where her lymph nodes are)also method you most likely have an infection for i m sorry you need to seek clinical treatment.




If you’re unable or unwilling to look for medical treatment for an abscess, take it the complying with steps:

Clean the area v soap and also water and also dry it well e sure to keep it as clean and also dry as possible at all times.If the abscess is draining top top its very own (pus is coming out of it), permit it proceed to do so. Perform not touch the abscess (except come clean it), to express it come extract the pus, stick your syringe right into it, or inject above or below it.Keep the area spanned with sterile gauze you can buy in a pharmacy, and adjust the dressing twice a day till the pus stops draining and at the very least once a day till the abscess is completely healed. Dressings that directly touch the wound should be dampened through sterile saline (which girlfriend can additionally purchase at a drug store) and then extended with dried gauze and also tape. Properly dressing an abscess will assist keep it cost-free from more infection and also speed healing.When removing the dressing, dampen the gauze that’s emotional the wound so you don’t pull turn off newly formed tissue.Warm compresses and salt soaks will certainly encourage the abscess come drain and promote healing. Carry out not soak or use a compress as soon as the wound is open or draining. After the abscess has actually drained and also scabbed over, antibiotic creams and preparations prefer aloe vera gel can be helpful.Let the area heal completely. If the abscess refuses come drain completely or pain and swelling persist, seek medical attention.

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 If you execute seek medical treatment to have your abscess drained, shot to discover a wound clinic where you can gain your dressing readjusted on a regular basis and make certain the abscess is healing properly. If over there isn’t a wound clinic available near you and you require your abscess drained, shot a community clinic or emergency room.. If you perform seek treatment for your abscess at the emergency room or a ar clinic, understand in breakthrough that the physician may reduced into her abscess and also scoop the pus out through their (gloved) fingers, and that they should administer you with lidocaine to numb the area. If they carry out not sell lidocaine, you are well within your rights to ask because that it! depending upon what the epidemic is like, friend may likewise be prescribed antibiotics. Shot to take it the full course the medication. And remember, although there are absolutely no guarantees as soon as it comes to people’s views around injection medicine use, you worthy compassionate treatment and are permitted to advocate for yourself. 



An embolism is miscellaneous such together air, fat, impurities, dirt, or other particles that deserve to obstruct a blood vessel which outcomes in the blockage the blood flow. Corpuscle from injected pills that were not completely pulverized and also clumps the bacteria room two examples of points that can cause emboli. Emboli can be very serious, specifically if lock travel with the blood vessels to the heart or lung or lodge in the tiny capillaries that the fingers, eyes, or toe where severe circulation damages can occur. The threat of emboli deserve to be reduced by filtering out any particles in her shot 



We’ve gained some tips for people who use drugs to accessibility healthcare and also advocate for you yourself with medical care providers – inspect out Quality medical care Is Your appropriate resource.