Many type of, if not all, of the points that can go wrong in the time of the process of preparing and also injecting drugs fall right into among three categories: drug-connected, technique-associated, and hygiene- associated accidents. Because we’re required to use blackmarket, unregulated drugs, we don’t have actually control over the top quality or purity of the substances we use. While we might not have the ability to perform a lot about the actual drugs we use, we can occupational to improve our injection technique and also hygiene which can have actually far-varying effects on our health and wellness.

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There are countless and also perhaps very serious health complications connected through injecting illicit drugs, from injection-connected injuries favor tracking and also bruising, to bacterial and fungal infections, from communicable illness, to drug overdoses and also other medical emergencies. This area of the manual explains some of the medical and wellness troubles that can result from injecting drugs and supplies suggestions for exactly how to prevent them. Overdose avoidance and survival are addressed in chapter 4.


B A C T E R I A L , V I R A L , A N D O T H E R I N F E C T I O N S 



A “dirty hit” is a general term for a swarm that provides someone sick or causes an abscess as an outcome of being contaminated with infection-resulting in microbes or toxic substances. Dirty hits deserve to be brought about by any kind of number of things, such as:

contaminants in the water you offered to dissettle your drugs;bacteria, fungi, or other microbes from old cottons;chemicals in a cigarette filter that was provided to filter a shot;adulterants or contaminants in the drugs themselves; ornot appropriately cleaning the skin prior to injection.

BACTEREMIA (bacteria in the blood) 

Bacteremia is as soon as bacteria entersthe blood- stream that can be caused by injecting through contaminated water, re-utilizing old cottons, or failing to clean the skin before injection.

Early symptoms incorporate chills, fever, and also extreme fatigue. If you endure these symptoms, look for medical attention. Bacteremiacan be fatal!



Endocarditis is an infection of the heart valves that is caused by bacteria, fungi, and other infection-bring about microbes that enter the bloodstream throughout injection and also develop up around the valves of the heart, weakening them and other components of the heart muscle. Endocarditis have the right to ultimately cause a heart murmur, and fever before, chest pains, fainting spells, shortness of breath, and heart palpitations and also congestive heart faiattract. Early indications incorporate flu-favor symptoms. It can be treated via antibiotics or antifungal agents if detected early on, however needs numerous weeks, or months, of IV antibiotics and/or heart valve replacement surgical treatment if not detected early on. Endocarditis deserve to be fatal if it goes untreated.



Tetanus is a bacterial infection that occurs as soon as tetanus spores enter a wound and release tetanus bacteria, usually after a scab has actually already formed. The bacteria then enter the bloodstream and also reason an infection, which is defined by muscle spasms or rigidity, especially in the neck and jaw (tetanus is commonly called “lockjaw”). Tetanus is fatal if not treated.

Tetanus spores live in the soil and also on rust, which is why a tetanus shot is recommfinished if you action on an old nail or various other rusty object. Many regional health and wellness departments offer complimentary tetanus boosters, which will safeguard you from tetanus for five years, so you need to r acquire one. If your needle, syringe, or other injection devices is contaminated with tetanus spores because of dirt or rust, you could infect yourself. Skin-poppers and also muscle- poppers are specifically at risk to tetanus infection and also must constantly use new, sterile devices.



Necrotizing fasciitis is a bacterial infection frequently recognized as “flesh-eating disease” that enters the body via damaged skin and also then affects the neighboring tworry and also surrounding muscle. It deserve to be transmitted by the exchange of blood throughout needle sharing, and has been traced to “black tar” heroin on the West Coast.

Symptoms of necrotizing fasciitis encompass increasing redness and also swelling and too much pain at the wound or injection site accompanied by a fever before. This may look a few various methods, the flesh about the website of infection will certainly be very red, swollen, through serious pain, and possible fever before. . Over the course of days the skin can turn from red-purple to blue-gray and also the skin can break down within 3-5 days. Since this infection is fatal, beforehand treatment through antibiotics is important to survival, although even appropriate therapy does not proccasion death in all instances. Wounds should be preserved impeccably clean.

Always making use of new, sterile injection equipment; never before sharing injection equipment; thoaround washing your hands and clean- ing the skin prior to injection; and preparing your drugs on a clean surconfront will all assist prevent necrotizing fasciitis infections.



Wound botulism is led to by a bacteria that produces a toxin on the skin wbelow a puncture wound is made and also that inevitably stops your breapoint by paralyzing your muscles. Cases have been linked with the subcutaneous injection of “babsence tar” heroin on the West Coast. The resource of the botulism can be the drug itself, a cut in the drug, dirty injection equipment, or contamicountry during the preparation procedure. Wound botulism deserve to be prevented in the same ways as necrotizing fasciitis–by complying with great sterile strategy once preparing and injecting your drugs.

Symptoms of wound botulism encompass droopy eyelids, blurred or double vision, and also a dry, sore throat which may development right into challenge speaking and swpermitting, a weakness of the neck, arms, and legs, and challenge breapoint.

If untreated, wound botulism will cause fatality by paralyzing the muscles supplied for breapoint. Early treatment for wound botulism is crucial. If you suffer any type of of the symptoms detailed above, seek clinical attention automatically. Treatment normally entails an antibiotic regiguys and the draining of any kind of abscesses or infected wounds.



Hepatitis is an inflammation of the liver that can be resulted in by particular toxic drugs, alcohol, or street drugs (iatrogenic or chemically-induced hepatitis); or that is the result of infection via a hepatitis virus (viral hepatitis). While there are many types of hepatitis viruses, hepatitis-B and also hepatitis-C are the 2 that many generally influence human being who inject drugs, via hepatitis-A coming in 3rd.

General symptoms of hepatitis include fatigue, loss of appetite, nausea, mild fever, and also muscle aches, and also if you smoke cigarettes, you may notice that they taste unpleasant. More serious symptoms of hepatitis encompass dark (tea-colored) urine, light-colored sdevices, and jaundice (a yellowing of the skin and the whites of the eyes).

HEPATITIS A ( “HAV”) is excreted in feces (shit) and also spreview by fecal-oral call (feces-to-hand- to-mouth contact). Hepatitis A deserve to be spread from contaminated food, water, hands, and eating tools, for instance, by a restaurant worker that didn’t wash their hands after making use of the bathroom and who then ready food. Tright here have also been outbreaks in locations choose encampments wright here world might not have actually accessibility to running water for handwashing. Unprefer hepatitis B and C, hepatitis A is not transmitted by blood-to- blood contact that occurs as soon as needles or other drug injection tools is common, and is not generally spcheck out via sex-related call unmuch less rimming (oral-anal contact) is involved. 

Hepatitis A illness resembles the flu and have the right to last from 4 to 6 weeks. It causes an acute (short-term) infection only and never before establishes into a chronic problem like hepatitis B or C. You develop antibodies to hepatitis A after you’ve been infected with it, so your possibilities of ever gaining it aobtain are slight. A hepatitis A vaccine is accessible and is . a two-shot regimales, via the second injection taken 6 to 12 months after the first.

HEPATITIS B ( “HBV”) is spcheck out through blood-to-blood call of the type that occurs as soon as injection tools is shared; contact through infected body fluids choose seguys, blood, vaginal fluids s; and also from a parent to their infant at birth. Hepatitis B infection deserve to be acute (short-term) and/or chronic (long-term); chronic HBV deserve to reason severe liver damages, consisting of cirrhosis (scarring), liver cancer, and death from liver faientice. Hepatitis B is a lot even more infectious than HIV, which suggests it is spreview a lot even more easily. It is among the the majority of important reasons civilization that inject should avoid sharing injection devices of any kind of sort.

A vaccine that will certainly protect you versus hepatitis B if you’re exposed to it is available, and also all human being that inject drugs need to think around getting it . The vaccine involves a collection of 3 intramuscular injections, via the second swarm being administered 30 days after the first, and also the 3rd swarm being administered 4 to 6 months after the second. The vaccine is safe and also reliable. If

you’ve had hepatitis B in the previous, you’ve arisen antibodies to it and will certainly not capture hepatitis B again later and do not require the vaccine. You deserve to obtain your blood tested to watch if you’ve ever before been exposed to the hepatitis B virus, and acquire the vaccine at your medical professional, local Department of Health,, or even your syringe business regime.

HEPATITIS C (previously known as “non-A, non-B“ hepatitis and likewise referred to as “HCV“) is spcheck out with blood- to-blood contact and also is incredibly contagious, which means you have the right to get it fairly conveniently if exposed to it. There are dental and blood tests easily accessible that detect whether or not you have actually antibodies to the hepatitis C virus in your blood, which, if positive, need to be shown through a 2nd test. . The just way to test whether or not you have actually the actual virus in your blood is by obtaining a confirmatory test which mirrors whether you have a existing infection or not. Tbelow is as yet no vaccine for hepatitis C, and also antibodies are not protective—that is, they don’t make you immune to re-infection as via HBV. Right now, tright here is only avoidance by staying clear of blood-to-blood contact through use of sterile injection equipment, by not sharing injection tools, and with safer sex.

Hepatitis C have the right to either be chronic yet asymptomatic (without symptoms, which implies you barely even notice you have actually it), or chronic-energetic, which indicates disease will construct over a lengthy period of time–several years or maybe also decades. Up to a quarter of people that come to be infected with HCV will certainly clear the virus on their very own and not construct chronic hepatitis C. This does not intend you’re immune, or that you’ll be able to clear it if you’re re-infected. People with active hepatitis C might have elevated liver function tests (LF Ts), exhaustion, and jaundice, and active illness can lead to cirrhosis, liver cancer, and eventually liver faientice, every one of which can be fatal. The hepatitis C virus deserve to be cleared from the body with medication, and over time, the liver might be able to regeneprice itself. Regular testing helps to proccasion hepatitis C from going unnoticed. Hepatitis C is a major health risk for world that inject drugs, many of whom have been exposed to the virus at some suggest in their resides.

In the previous hepatitis C treatment was mostly ineffective and had severe side effects. Since 2013, tright here have been very reliable, all-oral, cures for hepatitis C. Hepatitis C therapy have the right to, and also need to, be obtainable to everyone. However, it might be hard to accessibility therapy based on wbelow you live, your medical coverage, and your liver damage.



Human being Immunodeficiency Virus (HIV) is the virus thought to cause AIDS (Acquired Immune Deficiency Syndrome), an immune mechanism disorder that reasons the body to shed its capability to ward off infection and also fight condition. HIV can be spread through the exchange of particular fluids (if they contain the virus). These fluids are: semen (consisting of pre-cum), vaginal, and rectal fluids (throughout unprotected sex); blood (using childbirth, the sharing of drug injection tools or accidental needlesticks); and also breastmilk.

Blood-to-blood call is one of the many effective implies of transmitting HIV from one individual to another, and the sharing or re-usage of drug injection equipment is exceptionally risky in regards to HIV transmission. It is essential to allude out that injection drug use itself does not reason HIV; rather, HIV is transmitted (prefer hepatitis and various other viruses) once infected blood from one individual is left in a needle, syringe, cooker, cotton, or water and injected right into the bloodstream or body of a second individual who supplies those very same works. HIV from injecting drugs is therefore 100% preventable as lengthy as you always usage your very own sterile functions and also never before share them with anyone.

General symptoms of at an early stage HIV infection (quickly after the suggest of transmission) may encompass a low-grade fever before and also fatigue. The longer a perchild has HIV and does not get medication,, the more most likely they are to construct one of the many bacterial, fungal, or viral infections, cancers, neurological disorders, or various other conditions that influence human being with HIV and AIDS. Tright here are numerous medication regimens including one pill version that can save the HIV virus undetectable in the body HIV virus in the body so that you deserve to live a constant lifeexpectations.

 In July 2012, the Food and also Drug Administration (FDA) apshowed the usage of tenofovir + emtricitabine (TDF/FTC), generally known as Truvada, for HIV PrEP (Pre-Expocertain Prophylaxis) in adults that are at high hazard for becoming HIV infected. An uninfected person that might become exposed to the virus is gave a prescription for antiretroviral medications to proccasion from becoming infected through HIV. PrEP Eligibility includes: civilization who inject drugs and also that share injection tools, individuals who use stimulant drugs associated via high-threat habits, such as methamphetamine, and also people who profession sex for money, drugs or housing. PrEP is only for clients through a documented negative HIV test result. HIV and STI experimentation, and also blood tests to check on the liver, are repeated eextremely 3 months. PEP (Post-Exposure Prophylaxis) is an alternative for individuals that have come in contact via fluids that might contain the HIV virus within the past 72 hrs. Similar to PrEP, it is a course of antiretrovirals, however it is only taken for the month adhering to the expocertain.




Track marks are the scars that appear alengthy the veins of someone who injects typically and also continuously provides the exact 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. Damage to the veins, including tracking and bruising, can be reduced or prevented altogether by practicing the adhering to safer injection guidelines. (These are particularly essential for those people that are worried about family members, friends, an employer, or someone else finding out about their drug usage. Track marks are among the most visible indicators that you usage.)

Use a new, sterile needle for eexceptionally injection. Re-making use of needles, also as soon as will certainly reason them to dull. Dull needles will certainly cause trauma to the veins and bordering tworry, reason a a lot larger puncture wound, and increase bleeding at the site.Use the highest gauge (thinnest) needle you have the right to discover to make the smallest puncture wound feasible.Alternate and also turn your injection sites. Always attempt to inject at least one inch “up” from your previous injection site (for your arms, this indicates moving ameans from the hand also and also toward the shoulder, and for the legs, this would expect amethod from your feet and toward the hips). Give your veins a possibility to remainder in between injections. Stay ameans from veins that are red or tender till they heal.Almeans inject in the direction of the body’s blood circulation (towards the heart).Use a soft, functional, easy-to-open tourniquet and rerelocate it after you’ve registered yet before you inject to assist prevent bruising.Use emollient-wealthy or antibiotic creams on injection sites once they’ve closed or scabbed over. Aloe vera gel and vitamin E oil are commonly-easily accessible and have the right to aid mitigate the appearance of track marks.


Vein collapse occurs once veins cshed up because of repeated injections right into the very same site, recurring local infections, or trauma to the veins and also surrounding tissues. Using barbed or dull needles can precipitate vein collapse. You know you have a fell down vein when you can’t draw blood from it or once the vein “disappears.” Thrombosis is the formation of an obstruction of a blood vessel bya blood clot. Don’t use veins that carry out not bend once puburned as they may have actually blood clots that can break off and also lodge in the lungs or other parts of the body and also reason serious damages.You deserve to stop vein collapse by always rotating and also alternating your injection sites and also by injecting in the direction of the body’s blood circulation (towards the heart). Using the exact same injection site over and also over without letting the vein heal is one of the suremainder methods to cause vein collapse. Also, insert your needle at a 15 to 45 degree angle through the bevel of the needle dealing with upwards. Taking oral vitamin C may assist your veins repair themselves and alleviate bleeding and bruising. NEVER inject vitamin C, just swpermit it.



Abscesses start via redness, swelling, and tenderness at an injection site and construct into an infection via a difficult, pus-filled core. Abscesses outcome from missed hits (injecting right into the tproblem surrounding the vein), injecting a solution through most pshort articles in it, not cleaning the injection site prior to injecting, re-making use of injection devices, or skin-popping drugs choose coke or rate that reason damage to muscle tissue and also skin.If you’ve simply missed your swarm and are worried around obtaining an abscess, ice the area automatically thereafter and also raise the injection site for at least 30 minutes, if you have the right to. This will certainly not proccasion an abscess if one is arising, but will certainly aid to ease the swelling. If any abscess does construct, switch from icing the area to warm.If you notification a hard, warm lump developing at an injection website, apply heat compresses at leastern 3 times a day to either make the abscess that is forming go ameans or involved a head (sfrequently and fill through pus). If it concerns a head, you deserve to obtain the abscess opened and also drained at a hospital or clinic. If you suffer fever before, chills, extreme exhaustion, pain linked via an abscess, or a thin dark line moving from the abscess, look for medical attention automatically because you could have actually a blood infection. Pain in the groin or armpits (wbelow your lymph nodes are)additionally implies you most likely have actually an infection for which you should look for medical therapy.




If you’re unable or unwilling to seek clinical treatment for an abscess, take the adhering to steps:

Clean the location with soap and also water and dry it well e sure to store it as clean and dry as feasible at all times.If the abscess is draining on its own (pus is coming out of it), let it proceed to carry out so. Do not touch the abscess (other than to clean it), squeeze it to extract the pus, stick your syringe into it, or inject above or listed below it.Keep the area extended via sterile gauze you deserve to buy in a pharmacy, and also change the dressing twice a day till the pus stops draining and at leastern when a day till the abscess is totally healed. Dressings that straight touch the wound need to be dampened with sterile saline (which you have the right to also purchase at a drug store) and then covered through dry gauze and also tape. Properly dressing an abscess will certainly aid keep it cost-free from even more infection and speed healing.When removing the dressing, dampen the gauze that’s poignant the wound so you don’t pull off recently created tissue.Warm compresses and salt soaks will certainly encourage the abscess to drain and promote healing. Do not soak or use a compush as soon as the wound is open up or draining. After the abscess has actually drained and also scabbed over, antibiotic creams and preparations like aloe vera gel have the right to be useful.Let the location heal totally. If the abscess refprovides to drain completely or pain and swelling persist, look for medical attention.

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 If you do look for clinical care to have actually your abscess drained, try to discover a wound clinic wright here you have the right to get your dressing adjusted on a constant basis and also make sure the abscess is healing properly. If tright here isn’t a wound clinic available close to you and also you need your abscess drained, try a community clinic or emergency room.. If you execute look for care for your abscess at the emergency room or a community clinic, understand in advancement that the doctor may reduced into your abscess and also scoop the pus out via their (gloved) fingers, and also that they must provide you through lidocaine to numb the area. If they perform not offer lidocaine, you are well within your rights to ask for it! Depending on what the infection is favor, you may additionally be prescribed antibiotics. Try to take the full course of medication. And remember, although tright here are definitely no assures when it concerns people’s views around injection drug use, you deserve compassionate treatment and are allowed to advocate for yourself. 



An embolism is something such as air, fat, impurities, dirt, or other pwrite-ups that deserve to obstruct a blood vessel which results in the blockage of blood circulation. Pwrite-ups from injected pills that were not completely pulverized and also clumps of bacteria are two examples of points that deserve to reason emboli. Emboli have the right to be very severe, especially if they take a trip through the blood vessels to the heart or lungs or lodge in the small capillaries of the fingers, eyes, or toes wright here significant circulation damage deserve to happen. The hazard of emboli have the right to be diminished by filtering out any type of pshort articles in your shot 



We’ve gained some tips for people that use drugs to access healthcare and advocate for yourself through healthcare service providers – inspect out Quality Healthcare Is Your Right reresource.