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Safer slamming (injecting)

Wash your hands and clean the injection site

Choose a quiet, safe place to inject

Ensure the surfaces you prepare on are clean

Whenever possible, use a sterile spoon and dry, clean filter available from needle exchange services and PIP PAC

Avoid torn filters or exposed fibres as they can end up being injected and cause problems

Never share your injecting equipment

If you have to re-use equipment make sure it's yours

Use a sharps bin whenever possible. If not available improvise; eg: use a plastic drinks bottle with cap

Only recap needles if a sharps bin or alternative is not available

It's always best to only recap your own needle to avoid risk of infection

Take your sharps bin to a needle exchange for safe disposal

Safer injecting crystal meth

Safer injecting crystal meth | Three Flying Piglets for MEN R US | 2014 | 3m 24s
Precautions D'injection: Crystal Meth | Français | Three Flying Piglets for MEN R US | 2014 | 3m 24s
Safer injecting mephedrone
Safer injecting mephedrone | Three Flying Piglets for MEN R US | 2014 | 3m 25s
Precautions D'injection: Mephedrone | Français | Three Flying Piglets for MEN R US | 2014 | 3m 25s
Needle and syringe supplies
You may find the simplest option is to buy supplies online. We mention Exchange Supplies because they have collaborated with us on PIP PAC (our safer chemsex packs) for several years. While gay men have usually given mainstream drug services a wide berth you can drop by your local service who should provide you with FREE needles, syringes, swabs and condoms etc without a load of hassle or questions.

PIP PAC 3.0 safer chemsex pack for gay men | PIP PAC
Injecting Supplies | Exchange Supplies
Drug and Alcohol Services: Search by Post Code | NHS
More
Further safer injecting tips and advice can be found here but bear in mind these are mainstream resources and don't address safer clamming and/ or chemsex specifically:

Injecting Advice | Injecting Advice
Safer injecting | drugs.ie
The Safer Injecting Handbook | Exchange Supplies

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Safer slamming (injecting) Wash your hands and clean the injection site Choose a quiet, safe place to inject Ensure the surfaces you prepare on are clean Whenever possible, use a sterile spoon and dry, clean filter available from needle exchange services and PIP PAC Avoid torn filters or exposed fibres as they can end up being injected and cause problems Never share your injecting equipment If you have to re-use equipment make sure it's yours Use a sharps bin whenever possible.

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New posters, a booklet and an animation, co-designed by service users from Bristol Drugs Project, are being launched on 24 January to promote the benefits of low dead space injecting equipment for people who inject drugs, alongside broader harm reduction messages.

Low dead space equipment has less space between the needle and the plunger after injecting. Blood and drug remain in this space, so if equipment is shared the risk of spreading blood borne viruses such as HIV and Hepatitis C is higher when there's more space for blood to be left in the equipment.

The materials will be launched at a special event on 24 January at the Kitchen, the Station, Silver Street, Bristol BS1 2AG. At the event the animation will have its premier, there will be an opportunity to hear from those involved in the project, including the service users themselves, alongside an exhibition of the materials. The posters will be on public display from 8-31 January in the gallery at the Station.

The materials build on research by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) and the NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions at the University of Bristol. Their research found that people who inject drugs would be willing to switch to this safer equipment, if the benefits of less wasted drugs and lower risk of passing infections were explained and they were introduced gradually. The research also informed some of the messages in the materials.

Funded by the Economic and Social Research Council (ESRC), Deborah Hussey, Assertive Engagement Worker from Bristol Drugs Project, joined the CLAHRC West team as Knowledge Mobilisation Fellow for the project. Deborah visited needle and syringe programmes around the UK, from Glasgow to London, to understand barriers to the uptake of low dead space equipment, and how different programmes operate and share harm reduction messages.

Deborah and the rest of the team then worked with Michael Linnell of Linnell Communications, a designer who specialises in information product design for drugs, alcohol and public health campaigns.

Through a series of workshops, the materials were co-designed by service users from Bristol Drugs Project who shaped the messages, language and look and feel of the materials. The final products are available to download from Exchange Supplies' website. Exchange Supplies is a social enterprise that has pioneered the use of detachable low dead space equipment among people who inject drugs.

The project was overseen by a steering group that included Bristol Drugs Project, Exchange Supplies, Public Health England, the Bristol Health Partners Drug and Alcohol Health Integration Team (HIT), CLAHRC West and HPRU in Evaluation of Interventions.

Deborah Hussey, Knowledge Mobilisation Fellow on the project, said:

"It has been a privilege to work on this project. It's given me the opportunity to find out how other needle and syringe programmes operate, through shadowing and talking to staff, and having tours of their facilities. It's been fascinating to compare how different places tackle things.

"I've valued the opportunity to help the service users on the project feel a real part of the team. We've had wonderful feedback from them about how empowered the process has made them feel, and how they felt their views were not only listened to, but were integral to the design process. It was an honour to enable this positive experience for them. I'm very proud of what we've produced together."

Jo Kesten, Principle Investigator on the project, said:

"Increasing the use of low dead space injecting equipment has the potential to reduce the spread of blood borne viruses. Although detachable low dead space injecting equipment is available, it isn't widely distributed through needle and syringe programmes.

"This project is an important step towards encouraging needle and syringe programmes to introduce this equipment and helping service users get used it. It has great potential to reduce the harms of injecting drugs.

"It's been incredibly valuable to work with Deborah on this project. Her knowledge and expertise have been key to its success."

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New materials designed with people who inject drugs to promote the benefits of low dead space equipment - CLAHRC West

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New posters, a booklet and an animation, co-designed by service users from Bristol Drugs Project, are being launched on 24 January to promote the benefits of low dead space injecting equipment for people who inject drugs, alongside broader harm reduction messages. Low dead space equipment has less space between the needle and the plunger after ...

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Information for GPs about the NHS England and Public Health England initiative to support finding and treating diagnosed patients.

Documents

Details

Untreated hepatitis C infection causes cirrhosis and liver cancer. Very effective, well tolerated oral therapies are now available on the NHS.

To enable people previously diagnosed with hepatitis C to be treated for their infection, NHSE and Public Health England ( PHE) have organised a national 'patient re-engagement exercise' to help find and treat people with hepatitis C virus ( HCV) infection.

These documents provide further information about this important initiative.

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Hepatitis C: patient re-engagement exercise

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Information for GPs about the NHS England and Public Health England initiative to support finding and treating diagnosed patients. Untreated hepatitis C infection causes cirrhosis and liver cancer. Very effective, well tolerated oral therapies are now available on the NHS.

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Reports by Public Health England about testing, diagnosis and care HIV in the UK.

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Understanding femoral injecting -- part 1 of 2

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This website supports the harm reduction works campaign materials. The campaign was developed by Exchange Supplies for the National Treatment Agency as part of the implementation of the Department of Health publication Reducing Drug Related Harm: An Action Plan.

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After the arms the hand would be the next. You should swap to a finer gauge needle for your hands as the veins are smaller and more fragile compared to your arms. You should also use a fine wheel filter such as a 0.20 micron (while we are on the subject...

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Injection is the process of dissolving a compound in a liquid and drawing the resulting solution into a needle-tipped syringe for self-administration. Substances are typically either injected directly into the bloodstream via the veins (a practice known as intravenous or I.V. injection) or into the muscle tissue (known as intramuscular or I.M. injection).

More rarely, substances are injected in the flesh right under one's outer layer of skin and into the dermis itself: this is known as intradermal injection or "skin popping". Injecting into the subcutaneous tissue that surrounds the veins and arteries and lies under the skin is called "subcutaneous injection" or S.C. injection. Various classes of substances, like opiates, stimulants, dissociatives, benzodiazepines and psychedelics can be injected.

Injecting substances removes any bodily filtering mechanism and I.V. injection results in 100% bioavailability of a substance. If the substance being injected is impure, there is a massive increase in harm potential of said substance. Even medical quality substances meant for injection carry inherent risks of infection and death.

Risks and hazards

Risks of infection - The simple act of penetrating the skin with anything is a way to introduce bacterium and viruses directly into the body. One should be as sterile as humanly possible when injecting, making sure to use alcohol swabs to wipe the injection area before and after injection. There is also the risk of infection if the substance being injected is impure, adulterated, or unfiltered, which is extremely common. These substances do not pass any membrane for filtration, and any impurity in the substance will therefore be directly introduced into the body.

Blood-borne diseases - Sharing needles with other users is the most obvious way to transmit a blood-borne disease or infection, but there are other less commonly thought of ways too. Using multiple needles in the same water supply can easily spread illness and disease. Sharing the same spoons and other equipment used to prepare the injection solution is also a way to contract a blood-borne illness such as HIV/AIDS or Hepatitis B & C. The sharing injection materials page provides more in-depth information about the sharing of injection materials and the inherent risks of infection and disease that accompany it.

Re-using needles - Reusing needles is not advised for a number of medically relevant reasons. If upon injection the needle does not hit a vein or muscle tissue, only retry with that same needle one more time if needed. It is always best to use fresh needles every time one decides to inject because a needle is only meant to penetrate the surface of the skin once. After the first time penetrating the skin, the needle is dulled. Each additional time the needle is used it contributes to the dullness and harmful nature of the needle. Reusing the same needle can lead to greater risk of bodily injury and abscessed infections. Fresh needles can be found using needle exchange programs in the local area.

Abscessed infections - An abscessed infection is a collection of pus (usually caused by a bacterial infection) that has built up within the tissue of the body at or underneath an administration site. If one notices an abscess forming following an injection, it is important that they seek professional medical help immediately because abscessed infections can lead to severe health complications and, not uncommonly, death. Abscessed infections are especially common when I.V. injecting into the feet, as the blood circulation in the extremities is poor and decreases the foot's ability to heal.

Injecting into the wrong tissue - Some substances need to be injected into certain types of tissue in order to be effective. For example, heroin has been shown to be most potent when IV'd and can be extremely harmful when injected into the subcutaneous tissue, while ketamine is typically IM'd. This is why it is so important that one makes sure their needle is correctly inserted into the vein before proceeding with an I.V injection.

Development of scar tissue - This is especially present with I.V. injection, but can occur with I.M. and S.C. injections as well. If the site of injection is not varied, scar tissue can develop and can impede further injections.

Increased risk of overdose - This is especially present with opiates, such as heroin. If one is injecting opiates, it is important to have naloxone available, if possible, as this can reverse the effects of an opiate drug overdose if administered quickly. The risk of fatal overdoses rise sharply after a period of cessation and relapse, largely because of reduced tolerance. To account for this lack of tolerance, it is safer to only dose a small fraction of one's usual dosage if relapsing after an extended break. It has also been found that the environment one is in can play a role fatal overdosing. In one scientific study, rats were significantly more likely to die after receiving their dose in an environment not associated with the drug in contrast to a familiar environment.

Stroke Risk - Injecting into an artery and not a vein can be a potential cause of strokes and blood embolisms. This risk is especially present with I.V. drug use, when one misses a vein and injects into the artery instead. This is why it is important to make sure one is in a vein before I.V. injection. This risk increases with the use of uncommon injection sites such as the neck: the chemicals being injected might enter an artery and go straight to the brain, causing neurological problems and strokes.

Nerve damage - Injecting into the muscle tissue during an I.M. injection, missing a vein during I.V. injection, and S.C. injecting can all present the risk of nerve damage. The needle may puncture a nerve and cause serious, painful, and possibly fatal bodily harm. This risk is especially present if injecting into the groin, as the femoral nerve located there controls leg and muscle movement - damaging this nerve can result in serious problems with mobility or even paralysis.

Deep Vein Thrombosis - Deep vein thrombosis is a blood clot occurring in the deep arms of the legs and extremities, especially the legs. This is a risk that is especially present with I.V. drug use into the groin are and the deep veins in the arm. Signs of deep vein thrombosis include; pain, swelling, redness, or tenderness of the leg or arm around the injection site. I.V. drug use leads to a higher rate of DVT in younger patients, with most DVT issues occurring in the groin area and the thigh.

Hitting an Artery - One should always inject into a vein and never inject into an artery. One can differ between a vein and an artery by the following signs: Upon injection, when the plunger is pulled down the pressure of the blood in the artery will push it back up. The blood in the syringe is bright red, frothing and gushing versus the dark red and slow moving blood found within veins. You can avoid hitting an artery by never injecting where you feel a pulse and never trying to I.V. inject into deeper veins than those at the surface.

Materials and equipment

Milligram scale - It is vitally important to weigh out the substance one is going to inject to help mitigate the risk of overdose.

Insulin syringe with I.V. needle - Used for I.V. injection, this type of syringe has a short needle meant to penetrate surface veins.

Syringe with I.M. needle - This type of syringe is used for the less common intramuscular (IM) injection. These needles are longer than the traditional insulin needles seen for IV use because it is designed to penetrate deep into the muscular tissue and deposit the solution there instead of in a vein.

Alcohol swabs - This is for sterilization before and after injection. Hydrogren peroxide or other disinfectants can also be used.

Sterile water - It is important to use deionized water or distilled water when injecting substances as tap water may contain harmful impurities. It is also important to change the water at a regular interval to prevent bacteria growth within the water. Placing a small amount (10ml max) in a shot glass and using this for IV/IM purposes is a good way to ensure a fresh water supply. Be mindful that using multiple needles in the same water supply can easily spread illness and disease. No other liquid substance should be added to the injection, even if it is supposed to increase the solubility of the drug in the water solution. Heat can be used to aid dissolution, but fruit juice or vinegar can lead to infections.

Micron filters or cotton filters - These are used to filter out solid impurities in the substance solution. A cotton filter is better than nothing, but a micron filter is considered to be the best. If one is using a cotton filter it is important to never re-use this cotton filter as it can harbor bacteria and cause severe health consequences known as "cotton fever." This is due to the bacteria that grow in the moist conditions of the cotton filter - one should always dispose of their filters after a single use.

Vitamin C (ascorbic acid) - This can be added to heroin, crack and cocaine solutions to dissolve the substance. It is important that one does not use fruit juice or vinegar as these lead to greater risks of infection. Vitamin C powder can be found in packets online. Too much vitamin C will make the solution too acidic and can cause vein problems.

A friend - If possible, do your best not to I.V./I.M. alone due to its high risk. The risk of overdose is significantly increased when injecting and having someone there to call the emergency services or give you medical aid, such as naloxone, can literally be the difference between life and death.

Soap - One should always wash their hands with soap and water before injecting. If soap and water are not available, alcohol-based hand sanitizer may be used, however, washing one's hands with soap and water is always preferable.

Elastic tourniquets or stockings - These can be used to "tie off", or make the veins more visible and accessible, during I.V. injection. These materials are better for skin than leather belts or other similar objects used to "tie off". Neckties, lubricated condoms, and socks can also be used. One should always use a slip knot when tying off so the tourniquet can be removed quickly if needed. The tourniquet should be removed immediately if there is a loss of sensation in the limbs or the limb discolors or turns blue.

- If injecting an opioid, it is highly recommended that you have naloxone if it is available. Naloxone is a substance used to reverse the effects of opioids in an overdose. Many jurisdictions have programs to distribute naloxone for free or at discount prices to people who are in need of it. Naloxone may be available as a nasal spray under the brand name "Narcan" or as an autoinjector with voice instructions.

In the interest of harm reduction, the use of any substance via I.V./I.M./S.C administration is not advisable from a health and safety point of view. It should be noted that I.M. administration is more commonly found when using substances like ketamine, while opiates (like heroin) and stimulants are typically administered intravenously.

It is extremely important to vary the administration sites of injections. The overuse of one particular injection site can lead to degradation of the tissue of the site. With I.V. use, this can lead to collapsed veins. Once a vein has collapsed, it cannot be used again. In regard to I.M. injection use, there have been animal studies that show there is risk of permanent scarring and damage to the muscle tissue if the site is overused.

It is extremely important to never inject pills as they contain pill binders that may congregate and cause blood clots and other serious bodily harm. This risk may be mitigated by the use of micron filters and extraction of the active pill ingredient, but it is not advised to inject pills of any kind. This issue is most often seen with pills that contain oxycodone. When crushed these pills may look safe to inject, but they may harbor pill binders and other materials that can clog up the veins and cause blockages in the bloodstream, resulting in circulation issues and kidney complications.

I.V. injection

Administration sites - The most common administration site for an I.V. injection is in the body-facing side of the elbow, into the veins in the arm. The practice of injecting into extremities such as the hands, the feet, the legs, or even the pelvic area can lead to serious complications and bodily harm. The most dangerous places to inject are into the groin, the hands & feet, and the jugular veins in the neck. Injecting into the groin area is especially risky due to the femoral vein's location next to the femoral nerve and artery. The neck is the riskiest area to inject into because the jugular veins lie very close to the carotid artery, which can be fatal if injected into. Damaging the jugular veins can interfere with blood circulation to the brain. Also, veins in the legs are more likely than those in the arm to develop clots that can obstruct circulation and eventually break off and lodge in the lungs or heart, causing fatal bodily harm.

Collapsed veins - After prolonged injection, thrombosis in the veins can occur. Thrombosis occurs when a vein's blood flow is increasingly disrupted, creating blood clots in the lining of the vein. Eventually, the vein can become completely blocked by these clots, transforming the veins into scar tissue. This is commonly referred to as a collapsed vein. To avoid this issue, the injection site should be rotated.

Direction of injection - One should always inject the substance towards the heart, not away from it. By injecting with the flow of blood you may avoid problems caused by creating scar tissue or clots which occur when injecting against the flow of blood in the veins . If the substance flows towards against the heart, instead of away from it, it may lead to increased scar tissue and risk of infection.

1. Wash the hands with soap and water.

2. Dissolve the chosen substance in water, being careful not to exceed the amount of water that the syringe can hold.

3. Heat the solution up, sucking the solution into the syringe through the filter. Making sure that no air bubbles are present in the syringe barrel before the plunger is released is also of dire importance as air bubbles in the bloodstream can easily result in fatal injury.

4. Using a fresh needle, prepare the injection site with an alcohol swab.

5. If using the traditional crook of the elbow injection site, one may need to apply pressure above the vein to make the vein stick out more. This is typically achieved through "tying off," which refers to the practice of wrapping a solid band or tourniquet around the upper forearm so that blood constricts and the veins become more visible.

6. The needle will most likely have a bevel. It is important to angle the beveled edge away from the skin, so the point of the needle penetrates the vein and injects.

7. Penetrate the skin at a 15 to 35-degree angle and always inject toward the heart.

8. Once you have penetrated the skin with the needle, pull back on the plunger of the syringe. If there is blood present in the syringe, the needle has hit a vein and it is good to inject. If there is no blood in the syringe barrel or one feels a suck back, the needle is not in a vein; it is in subcutaneous tissue so do NOT inject! Repeat steps 1-5 until the needle hits a vein.

9. Once the needle is in the vein, push the plunger down SLOWLY. It is highly advised not to rush the injection, especially if one is IVing a strong opiate, such as heroin.

10. Once all of the solutions have been injected, slowly remove the needle and use a new alcohol swab to clean the injection site. There may be a little blood.

IM injections are generally safe in the arm areas and in the muscular tissue of the legs and buttocks.

The muscles flanking the hip and the gluteus medius and maximus muscles can be used as IM injection sites.

The gluteal muscles are a common spot for IM injections due to the abundance of muscle tissue.

Needle length - It is important that one uses a needle that is longer than the I.V. needle in order to reach the muscle tissue.

1. Wash the hands with soap and water.

2. Wipe the injection site with an alcohol swab.

3. To prepare the needle, hold the syringe with the dominant hand and pull the cover off with the other hand. Place the syringe between the thumb and first finger.

4. Hold the skin around where the injection will be administered. With the free hand, gently press on and pull the skin so that it is slightly tight.

5. Hold the syringe barrel tightly and use the wrist to inject the needle through the skin and into the muscle at a 90-degree angle.

6. Let go of the skin with the other hand. Hold the syringe, so it stays pointed straight in. Pull back on the plunger a little to make sure the needle did not hit a blood vessel. The point of intramuscular injection is to inject within the muscle itself. If blood comes back into the syringe barrel, remove the needle immediately and do not inject. If possible, dispose of the needle and syringe and get a new one. When giving the second injection, use a different injection site than the first.

7. Push down on the plunger to inject the solution. Do not push the plunger down hard and fast; some substance solutions may burn. Injecting at a slower rate reduces the pain.

8. Once the solution is injected, remove the needle at the same angle as it went in. Re-swab the area of injection with an alcohol swab.

Warning: This method of injection is uncommon and is strongly discouraged as the needle may break off in the skin, hit a nerve, or cause scarring, lumps, and other skin problems. Additionally, the risks of infection are greatly increased when using this method of administration.

Needle type - An I.V. or insulin needle length is suitable for this type of injection. Do not use a longer needle length as it can penetrate other types of tissue and cause medical problems.

1. Wash the hands with soap and water.

2. Wipe the area where the injection will be administered with an alcohol swab.

3. Hold the syringe in the dominant hand and grasp and pinch the skin where one will administer the S.C. injection.

4. Inject the needle into the skin and slightly pull the plunger back. No blood should enter the syringe barrel to ensure that you are in subcutaneous tissue.

5. Slowly inject the substance into the subcutaneous (skin) tissue.

6. Remove the needle at the same angle that it entered and re-wipe the injection site with an alcohol wipe.

Cleaning up after injection

In order to prevent the spread of blood-borne diseases and bacterial infections, it is extremely important that one cleans up and disposes of used needles and syringe barrels properly. The needle and barrel of the syringe can hold old blood that can harbor viruses for days or even weeks.

One should always re-cap their own old needle after injection to ensure that other people are not exposed to the old blood that still resides in the needle. The needle can and will cause accidental skin pricks that transmit disease. Do not let others re-cap someone's own used needle!

After the needle has been re-capped, it should be disposed of properly. Take the used needle and syringe to a medical waste/sharps disposal facility near you. Do not simply leave the needles lying around as this makes them available for re-use by others and is a possible vector for disease. Leaving needles lying around, especially if they are uncapped, also leads to an increased risk of accidental skin pricking which can cause injury, infection, or disease.

The injection administration site should be monitored for swelling, redness, or any other signs of infection. Seek medical attention from a doctor if you think the injection site may be infected or an abscess forms. An abscess may appear red, filled with puss, and hard and it may be a sign of a potentially serious infection. It is important to seek medical care immediately if persisting discomfort is experienced.

Proper Vein Care - One should avoid using veins that are tender, hardened, or inflamed until these veins have healed. It is important to take care of past injection sites, monitor them for signs of infection, and vary current injection sites.

Shooting Into the Wrong Tissue - If one misses an I.V. injection, it is important that the area is treated with a warm water soak or compress to reduce the likelihood of irritation and abscess formation. Warmth will open the capillaries and bring disease-fighting white blood cells to the affected area.

The injection of illegal drugs may lead to a higher risk of legal consequences. These consequences differ by country, state, and county. One should research the laws in their region before choosing to inject.

Overdoses - If someone overdoses, the person who stays with them and calls emergency medical services will not be prosecuted. Do not simply leave a person who has overdosed to die out of fear of legal repercussions. The legal repercussions of staying with someone that has experienced drug overdose and calling emergency medical services vary by location.
In the United States, the states that have "good samaritan" laws (in varying degrees) protecting those that call EMS as of January 2016 are: Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, Washington State, West Virginia, and Wisconsin.

- This life-saving drug is illegal to possess in some states, counties, or countries. Throughout the world, naloxone is not considered a controlled substance. In most countries, it is a prescription drug.

Australia: In Australia, naloxone is considered an over the counter drug and is available at most pharmacies.

Canada: In Canada, naloxone kits are distributed in many emergency rooms and clinics.

United States: At a federal level in the USA, naloxone is a prescription drug. Many states have programs that make naloxone over the counter and available at request at most pharmacies. In the United States, most jurisdictions have programs to deploy naloxone to law enforcement and fire and rescue services. The states that have a naloxone access laws (in varying degrees) as of January 2016 are: Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Michigan, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington State, West Virginia, and Wisconsin.

United Kingdom: In the United Kingdom, naloxone is considered a Prescription Only Medicine.

External links

References

Embey, D. J., & Ho, K. (2006). Air embolus revisited-a diagnostic and interventional radiological perspective (bubble trouble and the dynamic Mercedes Benz sign). SA Journal of Radiology, 10(1), 3-7.

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Injection is the process of dissolving a compound in a liquid and drawing the resulting solution into a needle-tipped syringe for self-administration. Substances are typically either injected directly into the bloodstream via the veins (a practice known as intravenous or I.V. injection) or into the muscle tissue (known as intramuscular or I.M.

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Injecting drugs is by far the most dangerous way to take them. All of the blood borne virus campaigns are aimed at injecting drug users. In addition there are safer injecting campaign resources designed to target specific causes of injecting related harm including poor injecting technique, poor hand hygiene and poor injecting site hygiene.

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The bulk of injectors coming into NSP are either using tourniquets, or have got to the stage where they're groin injecting because they say they 'have no veins left'. But from my experience most people lack basic knowledge on how to correctly use a tourniquet.

Information about what makes a good tourniquet and how to use it can give really effective fast results for injectors and help prevent the progression to higher risk sites like the groin.

Why use a tourniquet

If you use one correctly a tourniquet will increase the size of a vein considerably, this of course makes it easier to hit and so reduces the risk missed hits (that lead to abscess). But that's only if you use a tourniquet in the right way. Used incorrectly you can increase the risks of damage to the vein, totally fail to get a vein at all or even put the entire arm at risk. That's why it's important to let injectors know how to use tourniquets.

How tight?

The whole point is to increase the amount of blood in the arm by letting blood in, but stopping it leave. My normal approach is to ask people to tourniquet the arm just with their hand so I can get a look for veins. Nine times out of ten I end up with some bloke looking like he's trying to rip his arm off he'll put so much pressure on. Too much pressure and no extra blood can get into the arm; the basic idea is to increase blood pressure by letting blood in, then stopping it getting out.

You only really need a small amount of pressure. The way I normally explain this is:

... use as much pressure as you'd use holding your child's arm as you try to get them out of a toyshop.

I then show on my own arm how putting extra pressure stops the vein coming up (which to be frank, bloody hurts). The most important thing in my opinion though is to suggest people practice this when they DON'T need to use, that way they will take more time to see the results.

What to use?

Bootlace, nice thin, dirty one with a bit of blood on..... well that's what everyone coming in to see me seems to use anyway.

Of course that's not what you should use. The ideal tourniquet should be:

Non-absorbent

Wide enough to not cut into the skin

Long enough to tie in a way that you can loosen with your mouth (see below)

Have some give in it

The ideal tourniquet

The Chicago Recovery Alliance have been giving out great tourniquets for years now. They involve getting a bicycle inner tube (costs about £5) and cutting it in half, then cut the two halves into half lengthwise, this should give you 4 long strips of 1 inch rubber. A great, cleanable, tourniquet that can be released with the mouth (stopping the need to take your hand off the pin when you've found the vein).

You can tie these by looping around the arm and tucking it under itself, then put the rubber leading from the tuck into your mouth so it can be released BEFORE you take the shot.

Why not use a medical tourniquet?

As I've already mentioned you need to be able to release the tourniquet without removing a hand from the needle once it's sited. Medical tourniquets are designed to be used by another person and not the person being injected.

The Law

Here though we have a problem (at least in the UK); Section 9a of the Misuse of Drugs act specifically stops us being able to legally supply tourniquets of any kind to injecting drug users. It should be noted however that in the history of the act there hasn't been a single prosecution of a drug service giving out ANY form of harm reduction equipment.

Conclusion

Tourniquet advice is seldom given in UK NSPs, but giving this advice can get quick, effective results and help prevent injectors progressing to higher risk sites. However, tourniquets must be correctly used and released before injecting.

Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.

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The bulk of injectors coming into NSP are either using tourniquets, or have got to the stage where they're groin injecting because they say they 'have no veins left'. But from my experience most people lack basic knowledge on how to correctly use a tourniquet.

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Public Health England ( PHE) is urging people to get free testing for hepatitis C virus ( HCV) after new data shows a lack of awareness of the disease and the factors that can put people at risk of infection.

A study commissioned by The Hepatitis C Trust showed 80% of people were aware of HCV, however, less than 40% knew it infects the liver, and less than 30% knew the virus is curable.

Revolutionary treatments can now cure HCV in the vast majority of cases.

Around 200,000 people in the UK are thought to be living with chronic HCV, yet challenges in awareness remain a barrier to timely diagnosis and treatment.

HCV can cause severe liver damage and can lead to death if left untreated. It is spread through blood-to-blood contact.

It often doesn't have any specific symptoms until significant liver damage is caused. Some people with HCV may experience flu-like symptoms, tiredness and abdominal pain, which can easily be ignored or mistaken for other conditions.

In England, around one-third of those with a long-term infection with HCV are believed to be over the age of 50 and many will have acquired the infection years, or even decades, earlier.

As World Hepatitis Day approaches, PHE is partnering with The Hepatitis C Trust to increase efforts to ensure people living with HCV unknowingly are diagnosed and treated. This will contribute to achieving the World Health Organization's ambition of eliminating hepatitis C as a major public health threat by 2030 at the latest.

Dr Helen Harris, Clinical Scientist, Public Health England, said:

The results of this survey highlight the very low levels of awareness of hepatitis C and the factors that can put people at risk of infection. We strongly encourage anyone who may have been at risk of hepatitis C infection to get tested, whether or not they have any symptoms.

It is crucial that people are tested and diagnosed in order that they can access treatment early to clear the virus. Increased levels of testing and diagnosis are essential if we are to reach our goal of eliminating hepatitis C as a major public health threat in the UK by 2030, at the latest.

You should get tested if you:

received a blood transfusion before September 1991, or a blood product before 1986 in the UK

shared needles or other equipment to inject drugs, even if it was just once or many years ago

had medical or dental treatment abroad in unsterile conditions

had a tattoo, piercing, acupuncture, electrolysis, or semi-permanent make up using equipment that may have been unsterilised

had unprotected sex with someone who has or might have hepatitis C

shared a razor or toothbrush with someone who has, or might have hepatitis C

PHE strongly encourages anyone who may have been at risk of HCV to get tested, whether or not they have any symptoms. Free and simple testing is available from local GPs, sexual health clinics, genitourinary medicine ( GUM) clinics or drug treatment services.

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Around 80% of people don't realise hepatitis C can lead to cancer

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Public Health England ( PHE) is urging people to get free testing for hepatitis C virus ( HCV) after new data shows a lack of awareness of the disease and the factors that can put people at risk of infection.

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Pragmatics & pleasure in effective harm reduction

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Dr Magdalena Harris speaking at the HIT Hot Topics conference in Liverpool. She talks about measures to make harm reduction interventions effective & the essential need to acknowledge the pragmatics & the pleasures of drug use, and not to focus only on risks & harms.

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The Hepatitis C Trust is the national UK charity for hepatitis C with offices in London and Falkirk. It has been operating since 2001. It is a patient-led and patient-run organisation: most of our board, staff, and volunteers either have hepatitis C or have had it and have cleared it after treatment.

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Visit our downloads page to download any of the above publications and more.

Viral hepatitis affects over 700,000 people in the UK

There are several viruses that cause hepatitis. The common ones are hepatitis A, B and C. Most people recover from hepatitis A with no lasting liver damage, but hepatitis B and C can cause long term liver disease and even liver cancer.

How Hepatitis A hurts your liver

Hepatitis A is passed out in the bowel motions of an infected person, and is passed from person to person by eating food or drinking water contaminated with the virus due to poor hygiene standards . Most people feel better within a few weeks. The illness can be more severe in those who are old or who have other underlying conditions.

How to look after your liver. There are vaccines available to protect against hepatitis A. Vaccination is recommended if you are travelling abroad outside Europe and the US, but you should also speak to your GP if you think you might be at risk because of your job or your lifestyle.

Learn more about Hepatitis A

How Hepatitis B and Hepatitis C hurt your liver

Hepatitis B virus is found in blood and body fluids and causes liver damage. It is 50-100 times more infectious than HIV.
Hepatitis C is a virus carried in the blood which infects and damages the liver.

Both hepatitis B and C are easy to catch through blood to blood contact and very hard to get rid of. Even a tiny amount of dried blood - too small to be visible to the naked eye - is enough to pass on the infection if it gets into your blood stream.

This could be from sharing contaminated:

equipment for injecting drugs (including steroids)

tattoo, accupuncture or body piercing equipment

medical or dental equipment

razors, clippers, or toothbrushes

or through an open cut or wound.

Sex and passing the virus from mother to baby at birth, are also high risk factors for hepatitis B.

There are few symptoms of hepatitis B and C and people can be infected for many years without knowing, during which time liver damage can occur. An estimated five out of every six people with chronic hepatitis C are unaware of their infection.

How to look after your liver

There is a simple test to find out whether you have the virus and an effective vaccine to protect you from hepatitis B. There is no vaccine for hepatitis C.

Speak to your GP about testing and hepatitis B vaccination if you think you might be at risk because:

your job or your lifestyle puts you in contact with blood or body fluids

you are traveling to, or you or your family have spent time in, areas of the world where hepatitis B is common, including South-East Asia, China and Africa (eg see map)

you need regular medical treatment, such as dialysis or blood products

you received blood or blood products in the UK before 1991 (when screening for hepatitis B and C was introduced)

you have received medical or dental treatment in countries where equipment may have been inadequately sterilized.

Treatment is most effective if viral hepatitis is detected early.

Never share razors, nail scissors or toothbrushes

Cover wounds, especially when you play sport

Only use licensed tattoo and piercing studios and make sure all equipment used has been sterilised

Use a condom during sex

Never share drug equipment, and don't use rolled up bank notes for cocaine

If you need medical treatment abroad make sure only sterile equipment is used.

Hear Radio One's News Beat coverage of drug use and hepatitis C

What is it like to live with hepatitis C?

"...there is so much need to warn people about this silent killer. Make sure they get tested and get the right treatment at the right time.""The best way to survive Hep C is to know that you have got it."

Find out more about hepatitis B

Hepatitis B in other languages

The Canadian Liver Foundation have also released a short information film entitled "You could be living with hepatitis C and not even know it" . Click here to view their film.

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Visit our downloads page to download any of the above publications and more. There are several viruses that cause hepatitis. The common ones are hepatitis A, B and C. Most people recover from hepatitis A with no lasting liver damage, but hepatitis B and C can cause long term liver disease and even liver cancer.

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Hepatitis - general information | Terrence Higgins Trust

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Hepatitis is an inflammation of the liver. There are three main types: A, B and C. Find out more about their symptoms and the available treatment.

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Hepatitis is a disease characterized by inflammation of the liver. There are several types of viral hepatitis, known as A, B, C, D and E. Hepatitis D is linked to hepatitis B and is not considered as a separate type of its own any longer.

Hepatitis A and E are spread by faecal contamination and are rarely considered blood borne pathogens.

The other hepatitis viruses are blood borne, and both hepatitis B virus (HBV) and hepatitis C virus (HCV) present the greatest risk for drug users.

An effective vaccine exists to prevent hepatitis B infections.

In most cases, hepatitis C causes no noticeable symptoms until the liver has been significantly damaged. This can take many years and consequently, as most drug dependent people are not overly concerned with the long-term future, can remain undiscovered for long periods.
History
Hepatitis C was first discovered in the 1980s when it became apparent that there was a new virus ('non A, non B') causing liver damage. Before being properly identified in 1989 it was originally known as non-A non-B hepatitis. In 1991 a screening process was developed making it possible to detect HCV in blood samples.
Hepatitis C
In hepatitis C there are 6 major variations of the virus, labelled 1 to 6. These are known as 'genotypes'. Different genotypes predominate in different parts of the world. It is possible, although rare, to be infected with more than one genotype at the same time.

A hepatitis C infection can be categorised into two stages. The first stage is acute infection (following initial infection). The second stage is chronic infection. The acute stage refers to the first 6 months of infection and does not necessarily result in any noticeable symptoms. For the majority a chronic (long-term) infection will develop. The severity of symptoms varies from individual to individual.
Hepatitis C: Signs and Symptoms
When symptoms occur they are usually flu-like and include fatigue, mild fever, muscle and joint aches, inability to tolerate food, nausea, vomiting, abdominal pain, diarrhoea, and jaundice. Chronic carriers of HBV may develop a chronic hepatitis that may progress to fibrosis, bridging fibrosis and cirrhosis or liver cancer and may be fatal. Carriers remain infectious to others, so cross contamination remains a risk.
Hepatitis C: Treatment
There are different treatments available but the rates of success and the rates of treatment compliance paint a complex picture. For example, it is strongly evidenced that while visiting a nurse specialist at a treatment centre actually adds nothing to the medical treatment, protocols that include personal contact and medication do much better than unsupervised medication. Medications where there are some negative side effects appear to show better compliance and results to more easily tolerated medication. Hep C sometimes comes under different hospital specialisms, so depending on where you live you may be looking for the sign to Hepatology, Virology or perhaps, Gastroenterology.

The Hep C Trust's suggested length of treatment:

Treatment regimens for patients with genotype 1 and 4 are generally 48 weeks; Treatment regimens for patients with genotype 2 and 3 are generally 24 weeks, but this is variable

At the beginning of 2012, NICE approved of two new drugs for the treatment of hepatitis C - Telaprevir (Invico) and Boceprevir (Victrelis). Another drug, Sofosbuvir, is being clinically trialled. It is important to remember that these new drugs are taken both with and separate from the older drugs - Interferon and Ribavirin. They are also only presently for those with Genotype 1. However, as of early 2014 in the UK, this is changing.

There are trials for Interferon, Ribavirin (RBV) and Sofosbuvir for HCV genotypes 2 and 3, Sofosbuvir in combination with RBV for oral dual therapy of HCV genotypes 2 and 3. There are also trials for triple therapy with (weekly) injected PEGylated interferon (pegIFN) and RBV for treatment-naive patients with HCV genotypes 1 and 4.

Sofosbuvir treatment regimens last 12 weeks for genotypes 1, 2 and 4, and 24 weeks for treatment of genotype 3. This is typically half the time as with prior treatments. The side effects appear to be better tolerated (anecdotally) and the results are very promising. In April 2014 it was announced that a Phase 3 clinical trial in Japan produced a positive decrease in the virus after 12 weeks in 97% of patients with genotype 2. In August 2014, NICE issued draft guidance that Sofosbuvir should be considered as a treatment option for some people with hepatitis C. It is hoped that this will be upheld in the final recommendations to the NHS.

If NICE recommends any treatment it means they are now available on the NHS. If your clinician decides they are appropriate and you want this treatment, it should be available to you.

These newer treatments are currently taken in conjunction with pegIFN and RBV. This is known as triple or combination therapy. These treatment regimens are usually 24-48 weeks but may be shortened in a significant number of patients who have a very rapid response. Future therapy courses are likely to eliminate the need for combination with the older interferon and ribavirin treatments.

The majority - but not all - patients undergoing hepatitis C treatments experience serious side effects. These may include weight loss, headaches, joint pains, and sleeplessness, loss of mental clarity, irritability, depression and fatigue. Before you begin treatment a specialist nurse or clinician should explain all the possible side effects in detail and provide advice as to how to minimise their effect.

Treatment has also been shown to reduce both inflammation and fibrosis, this even happens in patients who do not have a 'Sustained Viral Response' (SVR), although only in about half the number of cases. It is quite possible to get previously erratic liver function tests to return to normal limits without clearing the virus entirely. Groups of patients are 'non-responders', 'responders/relapsers' and 'responders'. The terms are largely self-explanatory. As the treatment progresses the amount of virus in your system is reduced (it can now be tracked to minute amounts). For example with HCV, it is not unusual for a person to go from 1,000,000 units of virus (virions) per µL/ blood to less than 10. Even in cases of cirrhosis (considered as one of the end-stages of liver damage), which until recently was believed to be irreversible, there is evidence that it can sometimes be reversed with the right treatment.

Advances in measuring small amounts of virus can now detect less than 10 (virions) per µL, so whereas once <10 virions was 'undetectable', implying clearance, it can now be classified as unquantifiable but present. This brings up the issue that a small number of 'responder/relapsers' may not have been complete responders and may not have cleared the virus, only for it to return later, but may have retained very small amounts in the blood. The question is now, if it is cleared from the blood but returns (without re-infection) where it does abide? In bone marrow? In brain tissue? At the moment we do not know.

Co-infection, where someone has another infection like HIV or hepatitis B alongside hepatitis C, can cause complications such as one infection masking the effects of the other, but should not be a barrier to receiving treatment for hepatitis C. EASL (European Association for the Study of the Liver) 2014 guidelines say 'Patients [with HIV and hep B co-infection] should be treated with the same regimens, following the same rules as HCV mono-infected patients'. However, patients with co-infection will need extra specialist care to monitor the stages of both infections, as long-term illnesses can progress more rapidly than with one.
Harm Reduction
Never share any injecting equipment -this includes 'front-loading' and 'back loading', squirting/decanting liquid from one syringe to another either via the plunger end or the needle end of the barrel. Virus can be spread from spoons, cottons, shared water and even from dividing drugs up on a grimy congested surface. Clean the preparation surface with an alcohol swab. As soon as you are finished with the syringe put it in a 'cin bin', you do not want to get 'stoned' and leave it around. Coloured 'nevershare' syringes help prevent confusion. Return your sharp bin to the pharmacy or exchange. Always make sure you get enough needles and barrels, if you use or are planning to use a short-acting drug (e.g. cocaine) you need to consider how many sets you require. If you really decide you have to re-use remember: rinse through with cold water, then weak bleach, then repeat with a final cold water rinse. Also for vein preservation, use the smallest needle that you can with a low capacity barrel, a 1ml or 2 ml is sufficient.

Remember that the risk is blood to blood, so if your sexual preferences include activities where this is possible you will require extra prophylaxis. Don't pass a straw or note around if you are snorting drugs. Also remember that alcohol damages your liver particularly as the product coca-ethylene (formed from a combination of alcohol and cocaine in the stomach). Theoretically HCV can be contracted through sex, although the incidence is actually rare, unless the act encompasses 'rough' sex, involving an increased risk of blood to blood contact. Be aware of keeping your toothbrush separate if you have Hep C and always clear up any blood spillages with bleach and wipe clean disposing of tissues and wipes appropriately. The virus has been known to survive under optimal circumstances for months in laboratory conditions and while it will perish rapidly elsewhere, there is a slim chance of 'environmental' contamination.
Other BBVs
Diseases that are not usually transmitted directly by blood contact, but rather by insect or other vectors, are more usefully classified as vector-borne disease, even though the causative agent can be found in blood. Vector-borne diseases include West Nile virus and malaria. Although more commonly recognized as a Sexually Transmitted Disease/Infection (STD/STI), Syphilis is also a BBV.

Viral Haemorrhagic Fever (VHF) refers to a group of illnesses that affect multiple organ systems. Bleeding, or haemorrhaging, can be a major symptom of these diseases. Insects and rodents are known hosts of VHFs but the hosts of some VHFs are unknown. Ebola and Creutzfeldt-Jakob are two of the most well-known and dangerous VHFs.

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Hepatitis is a disease characterized by inflammation of the liver. There are several types of viral hepatitis, known as A, B, C, D and E. Hepatitis D is linked to hepatitis B and is not considered as a separate type of its own any longer.

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myHIV - Support for people living with HIV | Terrence Higgins Trust

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myHIV is the place to get the help and support you need, whether you are newly diagnosed with HIV or have been managing your condition for many years

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Be part of the generation that stops HIV. Your body, your sexual health, your wellbeing - looking after them starts with you.

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Research and analysis

Data tables and commentary for the unlinked anonymous monitoring surveys of infections and risk among people who inject drugs (PWID).

Documents

Details

The unlinked anonymous monitoring ( UAM) surveys of people who inject drugs ( PWID) aim to measure the level of HIV, hepatitis B and hepatitis C in this population. They also monitor the levels of risk and protective behaviours in this population. The surveys provide data on people who inject psychoactive drugs (such as heroin) and also on people who inject image and performance enhancing drugs ( IPEDs).

People who inject drugs that are in contact with a sample of specialist drug services (such as needle and syringe programmes and addiction treatment centres) throughout England, Wales and Northern Ireland, are recruited in to the surveys. The data are used to assess, develop and evaluate public health interventions.

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People who inject drugs: HIV and viral hepatitis monitoring

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Research and analysis Data tables and commentary for the unlinked anonymous monitoring surveys of infections and risk among people who inject drugs (PWID). The unlinked anonymous monitoring ( UAM) surveys of people who inject drugs ( PWID) aim to measure the level of HIV, hepatitis B and hepatitis C in this population.

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Slamming drugs can be more dangerous in comparison to other methods of taking chems. We're here to reduce the harm injecting could potentially have. Keep yourself informed and come in and speak to us for a judgement-free consultation. We can offer you clean needles and guidance on how to take drugs safely.

Important:

Never inject below your waist

Avoid injecting into your hands or feet

Never inject deeper than 5mm or you may hit an artery or a nerve. Arteries are deeper and harder to pierce than veins, the blood is brighter and it will spurt rather than ooze

Never inject into a site that is sore, swollen or tender

Don't inject into the same spot two times in a row. Vary your injecting sites to give the vein a break and to recover

Don't bend your elbow to stop the bleeding - apply pressure and hold the bleeding site

Safer injecting practices

If you are injecting it is safer to do it yourself if you can, you then have power over of the situation. You can practice safer injecting practices like being hygiene aware and can stop if you feel something is wrong.

Never use alone. Having someone else there is important if your body reacts in a way you did not expect

Wash your hands with warm soapy water before and after injecting

Never let a used fit come into contact with a group mix. No matter how well it has been cleaned everyone must have their own fit, water, spoon and filter

Stock up on equipment so you don't run out, always get more than you think you will need

Always mix up on a clean space (wipe with a clean cloth and soapy water or use new swabs)

Clean your spoon before mixing up (wipe once with a new swab)

If you can't wash your hands use single wipes with new swabs. Remember - rubbing swabs backwards and forwards spreads the dirt and bacteria around

Stop the flow of blood after injecting with clean cotton wool, tissues or clean toilet paper

Have your own tourniquet and don't share it, wash it regularly to remove blood

Rinse your fit with clean, cold tap water straight after your hit to help remove traces of blood

If you keep your own fit, mark it and keep it somewhere safe

Always dispose of injecting equipment in a disposal container or a puncture-proof container with a child-proof lid. If possible return the container to your local needle and syringe exchange programme

Don't re-use swabs, filters or open water ampoules as they can become contaminated once opened. Dispose of them with your fits or inside two plastic bags

Be aware of blood on sleeves and clothes - if you get blood on your clothes, tourniquet or other washable items wash them immediately

If someone is helping you inject, make sure they wash their hands before and after

Injecting over a long period of time can result in:

Blocked blood vessels (caused by things mixed or cut with the drugs)

Inflamed blood vessels and abscesses

Damage to vital organs such as the liver, heart or lungs

Injecting may also increase the risk of becoming dependent on the drug thereby exposing you to serious mental health problems

Crystal meth is a strong, highly addictive amphetamine stimulant which is usually snorted, smoked, mixed with water and injected (slamming), or injected inside the anus (booty bumping). It releases the brain's stress hormone norepinephrine and 'feel good' chemicals dopamine and serotonin which makes people feel high, full of energy, confident, invincible, impulsive, less likely to feel pain and very horny with fewer inhibitions. It also increases the appetite and energy levels, so people taking Crystal can go for days without eating or sleeping. It is often used during non-stop sex sessions and on the clubbing scene.

Sex on Crystal Meth
Crystal can make people feel extremely sexually aroused for long periods. People using this drug may do things they wouldn't normally do, including risking picking up or passing on HIV. It often makes it difficult for men to get an erection or ejaculate (known as 'crystal dick'). It can become hard to think of having sex without being on meth and - like G and mephedrone - it can have a big impact on your ability to have sex sober.

Health risks of Crystal Meth

Long or rougher crystal-fuelled sex sessions can cause the genitals, mouth or anus to become irritated, sore or bleed. This may not be noticed at the time, but it can increase the risk of HIV, Hepatitis C and other sexually transmitted infections being passed on.

Due to increasing the body temperature, heart beat and blood pressure, it can increase the risk of heart attack, stroke, coma or death

Comedowns can leave a person exhausted, aggressive and paranoid, in some cases even suicidal.

People can develop stomach problems such as acid reflux or gastritis due to not eating for a long period of time.

With long-term use, crystal meth can damage the lungs, nose and mouth and lead to lasting mental health problems, even after quitting the drug. It can also interact dangerously with other recreational and prescription drugs

People may find quitting crystal very difficult and its effects on the brain can last long after giving the drug up.

Useful to know

Injecting is best avoided. It's the quickest way to getting addicted and runs the risk of serious health problems (skin abscesses, collapsed veins, blood poisoning and heart infections).

Sharing injecting equipment puts you at high risk of getting or passing on HIV, Hepatitis C and other infections.

Using hot pipes might injure your mouth and if you share them it risks passing on infections like hepatitis C and HIV.

Condoms are more likely to break after about half an hour of use. So during long sex sessions it makes sense to check condoms regularly and put a fresh one on after 30 minutes.

Although Mephedrone (Meph) is now illegal, it developed popularity in 2009 along with other so called "Legal Highs". It is a stimulant that causes speediness and euphoric effects.

Psychological dependance is common with Mephedrone. If you're worried this applies to you come and see us.

Mephedrone is most often a powder and can be snorted, mixed with a drink, "bombed" (wrapped in paper or put in a capsule and swallowed), booty-bumped (syringed up the anus) or injected.

Meph is very irritant and commonly causes inflammation.

Snorting the drugs can cause nose bleeds. Swallowing it mixed with a drink can cause a sore throat.. It is particularly damaging to your veins. The best harm reduction advice (besides not doing it at all) would be to "bomb" it in a paper wrap or capsule, to avoid the aggravation to nostrils, veins and throat.

Side effects include heart palpitations, anxiety, sleeplessness, temperature fluctuations and in some cases hallucinations and fainting.

GHB/GBL causes a feeling of euphoria and reduced inhibitions, but when used carelessly it can also be very dangerous.

There are many common dangers with GHB/GBL including accidental overdose, "going under" on a dance-floor, date-rapes in saunas, or visits to A&E. People using the drug frequently can physically dependent (addicted) to the drug. They may find themselves forced to dose hourly to avoid difficult and dangerous withdrawal symptoms.

Dependent use means that stopping GHB/GBL without medical supervision poses dangerous health risks, to clear your system you will require an in-patient detox.

If you are using GHB or GBL dependently (multiple times daily, for more than 2 weeks), then it is advisable that you are assessed for a medically supervised detox. A GHB/GBL detox is not a service that 56 Dean Street can provide; you would need to contact your local borough drug & alcohol service. Below is a list of the London services that provide GHB/GBL detoxes; if your own borough is not there, or if you have no formal connections to a London borough (eg, residence, GP, hostel) then come to see us at 56 Dean Street Chemsex support and we will explore options for you.
TRI BOROUGH (WESTMINSTER - KENSINGTON&CHELSEA - HAMMERSMITH & FULHAM)
CLUB DRUG CLINIC
http://clubdrugclinic.cnwl.nhs.uk/ BARKING & DAGENHAM
RED LION SERVICE
https://www.changegrowlive.org/content/red-lion-service-barking-dagenham BARNET
WPD - BARNET RECOVERY CENTRE
http://www.wdp.org.uk/find-us/london/barnet-0 BEXLEY
THE PIER ROAD PROJECT
https://www.bexley.gov.uk/services/public-health/drug-and-alcohol-services BRENT
WPD - BRENT RECOVERY & WELLBEING SERVICE
http://www.wdp.org.uk/find-us/brent BROMLEY
BDAS - BROMLEY DRUG AND ALCOHOL SERVICE
https://www.changegrowlive.org/content/bromley-drug-alcohol-service-bdas CAMDEN AND ISLINGTON
GRIP CLUB DRUGS SERVICE
https://www.candi.nhs.uk/services/grip-club-drugs-service CITY OF LONDON
WDP
http://www.wdp.org.uk/get-help/club-drugs CROYDON
CROYDON RECOVERY NETWORK
http://www.turning-point.co.uk/croydon-recovery-network.aspx EALING
CGL - EALING RISE
http://www.ealingrise.org.uk/ ENFIELD
ENABLE - ENFIELD DRUG AND ALCOHOL SERVICE
http://www.beh-mht.nhs.uk/mental-health-service/mh-services/enable-enfield-alcohol-and-drug-service.htm GREENWICH
CGL - ASPIRE GREENWICH
https://www.changegrowlive.org/content/greenwich-aspire HACKNEY
HACKNEY RECOVERY SERVICE
http://hackneyrecoveryservices.org.uk/ HARINGEY
THE GROVE
http://www.beh-mht.nhs.uk/mental-health-service/mh-services/the_grove_drug_treatment_service_haringey.htm HARROW
WPD - HARROW RECOVERY SERVICE
http://www.wdp.org.uk/find-us/london/harrow-0 HAVERING
WPD - HAVERING
http://www.wdp.org.uk/find-us/london/havering HILLINGDON
WPD - ARCH
http://www.wdp.org.uk/find-us/london/hillingdon HONSLOW
iHEAR PARTNERSHIP
http://www.ihearpartnership.org/ KINGSTON
KINGSTON WELLBEING SERVICE
https://www.kingstonwellbeingservice.org/ LAMBETH
CHEMCLINIC
http://www.slam.nhs.uk/our-services/service-finder-details?CODE=SU0995 LEWISHAM
CGL - LEWISHAM
https://www.changegrowlive.org/content/new-direction-lewisham MERTON
WDP - MERTON
http://www.wdp.org.uk/find-us/london/merton NEWHAM
CGL - NEWHAM RISE
https://www.changegrowlive.org/content/cgl-newham-rise REDBRIDGE
WDP - REDBRIDGE
http://www.wdp.org.uk/find-us/london/redbridge RICHMOND
RICHMOND INTEGRATED RECOVERY SERVICE
https://www.changegrowlive.org/content/richmond-integrated-recovery-service SOUTHWARK
CGL
https://www.changegrowlive.org/content/cgl-southwark TOWER HAMLETS
RESET
https://www.elft.nhs.uk/service/362/Reset-Tower-Hamlets-Drug-and-Alcohol-Service WALTHAM FOREST
CGL - WALTHAM FOREST

https://wwWER HAMLETS w.changegrowlive.org/content/cgl-waltham-forest-chingford
WANDSWORTH
WANDSWORTH COMMUNITY DRUG AND ALCOHOL SERVICE
https://www.addaction.org.uk/services/wandsworth-community-drug-and-alcohol-service

Recreational Use

Always be responsible for your own dosing. Always.

Avoid mixing GHB/GBL with alcohol and ketamine as this increases your chance of 'going under' or having fits and coma

Take appropriate doses at appropriate time intervals. A commonly used dose would be between 0.5ml and 1ml. Never dose again within the same 3 hour period

Stick to your own doses and times. Don't accept GHB/GBL from friends just because it's being offered

Use a measured dropper bottle or syringe to measure your doses. Never just pour it casually into a cup and never drink from the bottle or from someone else's drink

Dependence

If you use GHB/GBL regularly for a long weekend you might find yourself feeling anxious, sweaty and shaky the week after or unable to sleep. These are the first signs of dependence (addiction). Even though a shot of GHB/GBL would alleviate these symptoms, resist the urge to take GHB/GBL and try to ride out these early signs with rest and stress free activities.

If you have become dependent on GHB/GBL, your withdrawals will be shakes, sweats, sleeplessness and extreme anxiety. In this case, you should continue taking your GHB/GBL in regular amounts at regular time intervals. Then you can seek medical advice from a drugs advisor at 56 Dean Street, Antidote, your local borough drug service, or GP

Keep a record of your doses and times, to stabilise your use and reduce chaotic ups and downs.

If you're experiencing withdrawals and have no GHB/GBL you should go to A&E and be honest about your situation. This is the safest course of action as withdrawals can be dangerous.

Try not to panic, help is available

NOTE:

GHB and GBL are not the same thing; GHB is the chemical produced in the body when we drink GBL. (The liver converts the GBL to GHB after ingestion.) And sometimes, though less commonly, GHB is a different form of the drug that can come as a powder or liquid, different from GBL. In regard to the effects on the body, they are essentially the same; but when it comes to dosing, it is important to understand the difference.

GBL is the most commonly used form of the drug, and the one you are most likely to find available on the internet, often sold as a liquid cleaning solvent. Concentrations of GBL when bought on the internet rarely vary enough to cause concern in regard to dosing. Take appropriate doses at appropriate time intervals. A commonly used dose of GBL might be between 0.5ml and 1ml. Never dose again within the same 3 hour period. If unsure or inexperienced, always start with the lowest dose, and if it doesn't work after 45 minutes, you might increment up; in this case, make sure your second dose is never more than half of your first dose.

is less commonly available than G BL; sometimes sold as a powder to be mixed with water (never sniffed, never injected), and sometimes already mixed and in liquid form (liquid GHB). This would be more likely to have been sold to you by a dealer or on the dark web, than via traditional internet shopping. G HB in liquid form (not G BL) is perhaps the most dangerous way to ingest the drug, as the concentration can vary enormously. Some samples of liquid GHB in Holland measured between 350 and 550 mg/ml; but without testing your sample, there is really no way of knowing the concentration of your liquid GHB, so be extremely careful. Don't assume anything. Carefully check the concentration with your source before calculating your dosage. 2.5ml of liquid GHB might be a safe dose to start with - but again, there are no guarantees, and be sure that it is GHB and not GBL you are using, as a 2.5ml dose of GBL could be fatal.

Always start with a low dose to determine if it works for you, and if there is no effect after 45 minutes, increment up gently with a second dose; this second dose should never be more than half of your first dose.

Whether it is GHB or GBL you are using, appropriate dosing vary person to person, depending on body weight, how much sleep you've had, when you ate last, other drugs you might have taken, and other factors. Alcohol and Ketamine are especially dangerous in this regard, and should never be used with GHB/GBL.

Both GHB and GBL are drugs that can develop into a physical dependence, and if this kind of addiction develops, you should not consider stopping "cold turkey" without advice from a doctor or drugs worker, as these withdrawal symptoms can be dangerous, and sometimes fatal. Sexual assaults, poor choices around safer sex, and overdsoses (sometimes fatal) are commonly reported consequences of GHB and GBL.

More GHB/GBL harm reduction tips from our friends at Drugs.ie can be found here.

If a new pair of gloves is used with each sexual partner you can cut the risk of most infections, you can pick up gloves as well as lube and condoms from 56 Dean Street.

There is a risk of HIV transmission from fisting if the fister (the guy doing the fisting) has cuts or sores on his hand or wrist

It is easy to damage the lining of the rectum when fisting, so if fisting is followed by condomless anal sex the risk of transmission of HIV and Hepatitis C to either partner is much higher.

Using oil-based lube (such as Crisco) for fisting can cause problems if you have anal sex afterwards. This is because the oil damages the rubber that's used in most condoms. Either use a water-based lubricant or switch to non-latex condoms which are not affected.

If more than one person is being fisted, HIV or Hepatitis C could be passed from one fistee to another via anal mucus or blood carried on the fist

It's best to have your own pot of lube. Sharing lube can also lead to the transmission of HIV and other STIs, as the pot can become contaminated with others blood or anal mucus

Hepatitis A and gut infections like salmonella and shigella (causing fever, diarrhoea with blood and mucus) can get passed on if anything gets passed to the mouth

Urine carries no risk of HIV transmission. There is little risk of passing on any infections.

Shared dildos and butt plugs can pass on infections. Wash sex toys thoroughly after use, using warm soapy water or a sterilising fluid designed for baby bottles.

Alternatively use a condom on it and change it between partners.

Using sex toys may cause microscopic damage inside. You may not notice anything but it may increase the chance of HIV transmission if followed by condomless sex.

Shared penile toys such as Fleshlights can also pass on infections As with dildos, you should wash them thoroughly after use, using warm soapy water or a sterilising fluid designed for baby bottles.

Using other household objects can be very dangerous. If you do, avoid anything with sharp edges or anything that may break inside you. If it doesn't have a base, be careful not to let it go too deep inside you. If you lose anything inside go to A&E.

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Slamming drugs can be more dangerous in comparison to other methods of taking chems. We're here to reduce the harm injecting could potentially have. Keep yourself informed and come in and speak to us for a judgement-free consultation. We can offer you clean needles and guidance on how to take drugs safely.

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Scientific evidence against HIV criminalisation

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Scientific evidence against HIV criminalisation

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Preparation

Chose a safe place to inject: one that is private, clean and well lit with running water, if possible. Use soapy water to wipe down the surface where you'll prepare your hit or lay down the paper bag your equipment came in.

Make sure you have everything you need within reach: new sterile fits, new sterile water (or cooled boiled water in a clean glass), new swabs, a clean filter, clean spoon, and a clean tourniquet.

Wash your hands (and your injecting site) with warm soapy water. Hand washing is very important to remove viruses, bacteria, and plain old dirt from your injecting environment. If you can't wash your hands use swabs, wiping in one direction to clean them. Rubbing swabs backward and forward spreads the dirt and bacteria around.

Mixing up

Clean the spoon by wiping once with a new swab and let it dry. Put the drugs in the spoon. Use your new sterile needle/syringe to draw up water from the new ampule of sterile water (or cooled boiled water in a clean glass).

No matter how well it has been cleaned, never let your used equipment or anyone else's come into contact with a group mix. Unless new sterile equipment is used to mix and divide up, each person must have all their own equipment.

Add water to the spoon and mix. You can use the blunt end of your syringe for mixing.

Add the filter to the spoon. The best filters are a bit of a new swab, tampon or cotton bud.

Injecting pills is bad for your health you can damage your heart, your veins and cause other serious health issues. If you are injecting pills, use pill filters if you can get them; if you can't get them, filter at least three times. Draw the solution up through the filter to remove impurities.

Remove air bubbles by pointing the needle skywards and flicking it on the side. Push the plunger up slowly until the air bubbles escape through the eye of the needle. Injecting air bubbles can cause serious problems with your brain (stroke), heart and lungs that can be fatal.

Injecting

Wipe the injection site once with a new swab.

Place the tourniquet around your upper arm (or above the injection site). Don't leave it on too long. If you have trouble finding a vein, release the tourniquet and try again. Running warm water over the injection site will help raise a vein. So will opening and closing your hand in a pumping action.

Try not to touch anything that hasn't been cleaned until you have finished injecting. Put the needle into your arm at a 45-degree angle, with the hole facing up. Blood will sometimes appear in the barrel when the needle is inserted in the vein.

Pull back (jack back) slightly the plunger and blood should appear. If there is still no visible blood in the fit, remove the tourniquet and then the needle from your arm, apply pressure (using a cotton ball, tissue or toilet paper) to stop any bleeding, take a deep breath and start again.

When you are sure the needle is in the vein, loosen the tourniquet and slowly depress the plunger. If you feel any resistance or pain, you may have missed the vein and will need to start again.

After injecting, remove the needle, keep your arm straight, and apply pressure to the injection site for a couple of minutes (using a cotton ball, tissue or toilet paper). Don't use a swab to stop the bleeding, it may in fact stop the blood clotting.

Injecting over a long period of time can result in:

Blocked blood vessels (caused by things mixed or cut with the drugs)

Inflamed blood vessels and abscesses

Damage to vital organs such as the liver, heart or lungs

Periods of psychosis

Injecting may also increase the risk of becoming dependent on the drug and thereby expose you to serious mental health problems

Cleaning up and disposal

Even if you are disposing of your fit, rinse it with clean cold tap water, straight after your hit. This will remove most of the blood, prevent if from blocking and help reduce the likelihood of dirty hits if you have to use the fit again.

Dispose of the rinsing water immediately, so no one else can use it and contaminate their equipment with your blood. Dispose of your fit in a disposal container or a puncture proof, childproof container and return the container to your NSP. Don't recap other people's fits.

Wipe down the area where you have mixed up your fix with soapy (detergent) water. Where there is a possibility of skin contact, the area should be wiped with household bleach. Don't re-use swabs, filters, or open water ampules - they can become contaminated once opened.

When you have cleaned up, wash your hands and arms with warm soapy water. If this is impossible, use single wipes with new swabs instead. Store all your equipment in a clean, safe place.

Cleaning used equipment

The best way to avoid contracting Hep C and other blood-borne viruses such as HIV/AIDS and Hep B is not to inject. Injecting is the greatest risk factor for contracting Hep C. There is no way of completely eliminating the risk of viral transmission from used syringes.

If you choose to inject:

Use new injecting equipment every time you inject including new needles, sterile water, new swabs, a clean spoon, tourniquet, filter, a clean injecting space and clean hands.

If you can't get a new equipment:

Choose to wait until you can get new equipment.

Try using your drugs another way like smoking, snorting, swallowing or Booty Bumping (up ya bum).

Clean equipment that only you have used before.

As the very last resort - clean equipment that someone else has used. This is not recommended - no matter how well you know the person you could get Hep C.

If you inject with a needle/syringe used by someone else, you are taking the risk of becoming infected with Hep C, Hep B and/or HIV/AIDS. Even if you are already Hep C positive, cleaning is important, as you can be re-infected with a different or even the same strain of Hep C.

Follow these directions for cleaning used equipment (including your own).

Equipment:
You will need three separate containers.
1. One filled with clean, cold tap water for rinsing blood out of your own fit. Soapy (detergent) water is best. Use water from the cold tap. If the water is too hot or too cold it can cause any blood in the fit to congeal and stick inside the needle where it can shed microscopic particles into your mix;
2. One filled with full strength bleach (at least 5.25% sodium hypochlorite, and check the 'use by' date) for soaking/bleaching the used needles; and
3. One filled with clean, cold tap water for rinsing the bleach from your needle/syringe. You will also need a clean workspace and a safe area to get rid of fluids - like a sink, bin or drain or whatever.

Cleaning process
There are three steps to the cleaning process: rinsing, bleaching and flushing.

1. Rinsing

Draw up water from the first container

Squirt the water out

Repeat process until the needle/syringe is clear

Empty the container of contaminated water

2. Bleaching

Take the needle/syringe apart and put it in the second container

Make sure it is covered completely with bleach

Soak it for at least two minutes

If you can't soak it, draw the bleach up into the needle/syringe and shake it for at least 30 seconds

Count slowly to make sure that the bleach has enough time in contact with any virus present. Count "1 000, 2 000"... up to "30 000"

Squirt the bleach out into your sink, bin or drain

Repeat this process at least once

Draw up fresh water from the third container into the needle/syringe

Don't use water from the first container: this has been contaminated with blood

Squirt, flushing the water out

Repeat this process at least six times, until the bleach is removed

Flushing your equipment is very important. If you don't flush your needle/syringe at least six times you can risk having a 'dirty hit' from the leftover bleach in the syringe. The symptoms of a dirty hit include; severe headaches, the shakes, fever, pain, vomiting and sweating. Paracetamol can help with the fever and anti-nausea tablets can help with the vomiting. If you or someone with you has these symptoms the person should rest, drink plenty of fluid and seek medical advice if the symptoms cannot be relieved or worsen.

Safer injecting practices

If you are injecting, it is safer to do it yourself if you can. You then have power over of the situation. You can include safer injecting practices like being hygiene aware, and can stop if you feel something is wrong.

Remember - never use alone

Stock up on equipment so you don't run out. Always get more than you think you need

Always mix up on a clean space (wipe with a clean cloth and soapy water or use new swabs)

Clean your spoon before mixing up (wipe once with a new swab)

Wash your hands with warm soapy water before and after injecting

If you can't wash your hands, use single wipes with new swabs. Remember - rubbing swabs backwards and forwards spreads the dirt and bacteria around

Stop the flow of blood after injecting with clean cotton wool, tissues or clean toilet paper

Never let a used fit come into contact with a group mix - no matter how well it has been cleaned -. Everyone must have their own fit, water, spoon and filter

Have your own tourniquet and don't share it. Wash it regularly to remove blood

Rinse your fit with clean, cold tap water straight after your hit to help remove traces of blood

If you keep your own fit, mark it and keep it somewhere safe

Always dispose of injecting equipment in a disposal container or a puncture-proof container with a child-proof lid. If possible return the container to your local Needle and Syringe Program

Don't re-use swabs, filters or open water ampoules: they can become contaminated once opened. Dispose of them with your fits or inside two plastic bags

Be aware of blood on sleeves and clothes - if you get blood on your clothes, tourniquet or other washable items wash them immediately

If someone is helping you inject, make sure they wash their hands before and after

Unsafe injecting

The practice of unsafe injecting (such as sharing or reusing injecting equipment) increases the risk of transmitting a blood-borne virus (HIV/AIDS, Hep B and Hep C). People who inject, or who are injected by someone else with drugs, are especially at risk if sharing or re-using injecting equipment. Hep C is the most common of the possible infections among people who inject drugs, with an extremely high percentage of people who inject likely to be exposed to a new infection and at risk of chronic (long term) infection. Be blood aware and take care.

Safer using means understanding the risks associated with injecting drugs and making sure you protect yourself and others from these risks in any way you can.

Vein care

Stimulants such as tobacco, cocaine, chocolate, coffee and black tea send your body into action mode. They make your heart work harder by causing your veins to tighten and shrink, squeezing more blood towards the heart. When veins shrink, they are harder to find to inject. This could lead to misses, vein damage, and abscesses. Smaller veins also restrict blood flow and increase blood pressure.

Many stimulants are toxic chemicals that can burn and eat away at delicate vein tissue. With frequent injecting, vein tissue becomes inflamed and breaks down. This can cause scarring, abscesses and collapsed veins.

Some chemicals can also make abscesses worse if you skin pop or miss.

Tips for healthier veins

Give your veins extended breaks from toxic chemicals and frequent puncture damage. Your veins will be sure to last longer that way.
The best way to protect your veins is to stop injecting drugs - particularly crystal, or if that's not a real option then try cutting back on injecting, or use in different ways.

Water is your best friend when it comes to veins! Drink at least 8 glasses a day. Fruit juice (100% juice, not juice "drinks") and sports drinks like PowerAde or Gatorade are also good choices.

Drink less coffee, caffeinated soda and alcohol - these make your body lose more fluid than it takes in. Cut down on cigarettes, especially 1-2 hours before having a shot. Nicotine also shrinks veins.

Before you inject

Try to make your veins expand as much as possible. When veins expand, or dilate, they are more visible. Veins you can see are easier and safer to hit. Dilated veins also allow more blood to flow.

If you're already speeding, your veins will be smaller than when you first shot up. So getting a good vein is going to be more difficult than when you had your first shot. Take a hot shower. Or place a hot, wet washcloth on the injection area for 5-10 minutes. The temperature increase will help your veins expand and rise to the surface.

Rotate your injection sites

Each time you shoot up, move at least one inch from your previous hit. Better still - move to a different site altogether. Sticking to your favourite spot is a sure way to cause that vein to scar or collapse.

If possible, clean your injection area thoroughly with hot water and soap. Then wipe the site with a fresh alcohol swab. A good wash with soap followed by an alcohol swab will cut down on bacteria that can lead to abscesses, endocarditis and other infections.

Important:

Never inject below your waist.

Avoid injecting into veins in your hands or feet.

Never inject deeper than 5mm or you may hit an artery or a nerve. Arteries are deeper and harder to pierce than veins, the blood is brighter and it will spurt rather than ooze.

Never inject into a site that is sore, swollen or tender.

Don't inject into the same spot 2 times in a row. Vary your injecting sites to give the vein a break and a chance to recover.

Don't bend your elbow to stop the bleeding - apply pressure and hold the bleeding site.

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Chose a safe place to inject: one that is private, clean and well lit with running water, if possible. Use soapy water to wipe down the surface where you'll prepare your hit or lay down the paper bag your equipment came in.

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Find out about sexual health, sex and relationships, sexually transmitted diseases and where to get advice.

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Whether you belong to a group of people at high risk of HIV infection or simply want to know how it is transmitted and prevented, our downloadable fact sheets are here to help.

You may find these useful for your own personal knowledge, to share with friends or colleagues, or to use in the workplace or schools to educate others.

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Whether you belong to a group of people at high risk of HIV infection or simply want to know how it is transmitted and prevented, our downloadable fact sheets are here to help. You may find these useful for your own personal knowledge, to share with friends or colleagues, or to use in the workplace or schools to educate others.

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Sigma Research undertakes social research to inform policy and practice concerning HIV and sexual health.