Health - Comprehensive List: Heroin Safety Issues/Tips for New Heroin Users

[dyingtomorrow]

SWIM realized that almost all the heroin safety information in this forum is spread about piecemeal, and that someone very new to injecting heroin would not know whether they had all the information. Although we can hope they would have basic knowledge from their social group, there is still a risk that they could be missing something – and there isn’t room for risks with such high stakes.

The goal of this thread is to compile a list of all the safety knowledge pertaining to heroin use and death, disease or significant bodily harm (not necessarily superficial usage tips). The information added by SWIM, and any additional brought to light by other members, will be updated to this first post, so that those new to heroin won’t have to dig around anymore.


The following is a list of basic heroin safety knowledge that everyone should have to avoid death, disease or severe injury:

(1) Don’t mix heroin with other depressant / “downer” drugs. Especially not alcohol or benzodiazepines (e.g. Xanax, Valium). A major percent of heroin related deaths occur when heroin is mixed with alcohol and/or benzos. This is because they all depress breathing, causing the user to suffocate to death when combined. Mixing heroin with any other drug is dangerous, even “uppers” such as cocaine, because of the effects the mixture can have on the heart and lungs.

(2) Don’t share needles with anyone. Don’t share water, cookers, cottons, or any object involved in injecting heroin with another heroin user. They all are likely to be contaminated with some amount of blood, and this is how HIV, Hepatitis and all kinds of other diseases are spread. It is highly recommended that you find a needle exchange near you, if there is one, for access to detailed safety information and free, clean, heroin injecting kits.

(3) Always test a small amount first after a heroin purchase. It is impossible to know the quality or purity of street heroin without a testing kit, which is not a realistic part of heroin users’ lives. After purchasing a new batch, or if offered heroin from another users supply, always do a smaller than usual amount to make sure it is not of unusually high potency. The potency of street heroin can vary widely, and it is also occasionally cut with other powerful opiates such as fentanyl. Your “standard dose” could very well be of overdose potency one day, which is why doing a small amount first is so important.

(4) Avoid using heroin alone. There is always a risk of overdose when you use heroin, and countless lives have been saved by a friend noticing their heroin-using friend turning blue. Using alone increases the chance of a fatal overdose many times over.

(5) Don’t do a large amount at once, do small amounts, with a break in between, to reach the desired high. Doing a large amount at once greatly increases the risk of overdose, especially if the potency is unknown. Whether smoking or snorting or injecting, using in small increments is the safest way to go.

(6) If possible, obtain a heroin overdose kit. Some needle exchanges, methadone clinics, and other sources give away free kits to revive someone who is overdosing on heroin. If not, it is worth it to purchase one.

(7) If a friend is overdosing, which is apparent if they begin turning blue and are breathing shallow, and/or will not wake up - call an ambulance! Do not try and resuscitate them yourself. Cold water, loud music – none of these will reverse a heroin overdose. They need medical attention immediately or they will die.

(8) Clean the area of injection with an alcohol pad. This can prevent infections, which can become serious if untreated.

(9) If an injection site becomes red, warm and painful, or if the mark grows in area, or especially begins to darken or turn black, go to a doctor immediately! Heroin users do lose limbs from untreated infections at injection sites.

(10) Always use sterile water for injection. It is extremely important to use sterilized water for injecting, as other types can be filled with viruses and bacteria.

(11) Draw your cooked heroin through a filter. You can purchase wheel filters and other high grade types which will filter out the highest amount of harmful particles. Most heroin users use cottons of some type (e.g. cotton balls, Q-Tips). Do not use cigarette filters, they can cause health problems in the long run.

(12) Don’t reuse your old cottons as filters, and don’t re-cook old ones to try for another shot. This can cause anything from blood poisoning, to severe infections requiring hospitalization.

(13) Go to a methadone clinic or needle exchange and get tested for the common heroin user diseases. At many places these tests are free. Many of these diseases can be treated effectively if they are caught early, and cause significantly more harm the longer they go undetected.

(14) Re-cap and dispose of your needles safely. You don’t want to accidentally get stabbed with an old needle, or have someone else get stabbed.

(15) Use fresh needles each time if possible. Needles become dull quickly, and dull needles cause significant vein damage, essentially ripping through them rather than cleanly sliding in. Old needles can also contain bacteria which can cause infection and blood poisoning. If you must use a very old needle, run a couple cycles of bleach and fresh water through it, making sure to wash it out the last time very thoroughly with fresh water.

(16) Rotate injection sites. This not only helps preserve your veins and prevent vein collapse, but also helps prevent infection. When rotating, one should shoot downstream (more towards the heart) from the previous site. This prevents pushing a blood clot (from congealed blood at an older injection site) down the vein into the heart.

(17) Drink a lot of water while on heroin. Heroin causes constipation, which over the long term is unhealthy for your intestines. Drinking lots of water helps.

(18) Do not inject into a "vein" that has a pulse. This is not a vein, it is an artery. Injecting into an artery is not only painful, but extremely unhealthy. You will know very quickly that you are in an artery by the pressure of the blood going into the syringe, the pain, and the immediate redness and swelling if you inject even a tiny bit of heroin. The two arteries that are most at risk for accidental injection are the wrist artery that is commonly used to take one's pulse, and an artery that runs on the inside of the bend of one's elbow. For those who inject in their legs, there is also the femoral artery to avoid.

(19) Smoking or snorting heroin is far safer than injecting. Injecting heroin is many times more dangerous than the other methods in terms of overdose and health issues. Not only that, but it brings with it dozens of additional dangers and issues compared with smoking or snorting. It is also almost universally attested that the addictiveness and life-hampering psychological effects of heroin are greatly magnified by IV use. Many heroin users, including SWIM, found that the point where they switched to the needle was when everything spiraled out of control. If you are new to heroin, and/or if you can help it, it is best not to inject.

If you are new to using heroin and found your way to this site, it is highly recommended that you read over the sticky threads, as well as all the other health related threads for more specific information. Each of these was intended as a guideline to make you aware of the issue, and should be researched thoroughly before risking the dangers involved in heroin use.



DF Members, please add anything you think is missing, and also any updates or amendments to the list you think would be appropriate.

Thank you everyone!

Reputation Comments on this post:

	Great advice, very informative, thank you
	Brilliant harm prevention and a very informative post
	Very useful information!! Great post:)
	Awesome harm reduction post.
	Excellent information given and a great idea for a contributory collaborative thread.
	Excellent compilation. Good thinking.
	Great thread.. very informative.
	Lots of rep for a very valuable harm reduction contibution.
	Great for harm reduction. Great information
	Excellent thread and advice
	Amazing...lots of thoughts and considerations for a new user! Thanks!
	excellent work for OP on behalf of DF.extremely informative.thank-you

[Arthur Dent]

Amazing post, dyingtomorrow, very valuable.

Originally Posted by dyingtomorrow

(16) Rotate injection sites. This not only helps preserve your veins and prevent vein collapse, but also helps prevent infection.

Might also be worth mentioning that, when rotating, one should shoot downstream (more towards the heart) from the previous site. This prevents pushing a blood clot (from congealed blood at an older injection site) down the vein into the heart.

That's documented in the Harm Reduction PDF, called Rotate Your Spot. I can't post links yet, so maybe someone else could add the link. It's available on harmreduction . org under Home -> Harm Reduction -> Safer Use.

Here's a graphic from that PDF to demonstrate:

Reputation Comments on this post:

	helpful addition to the thread, thanks!
	Good point to make.

[Junkhead23]

Thought that I would add this picture just to show people not to reuse their needles if possible

Reputation Comments on this post:

	picture says alot about vein care
	awsome visual for why not to reuse needles
	Pics explain this so much better, no misunderstandings, in your face advice.
	Boy, thats scary. Pictures are worth a thousand words, thanks for postiong.
	Brilliant Images. Thanks for sharing.
	WOW! That is awesome! Who would ever thought this happens!

[EyesOfTheWorld]

If snorting, use your own straw. It's impossible to spread HIV through sharing straws, but not so with hepatitis and many other infections.

Reputation Comments on this post:

	Very good information to add to this. Many people don't think of Hep C and sharing straws, rolled bills, etc. It's a rea...
	Good harm-reduction advice.

[cra$h]

wow, awsome idea, DT, and I'm diggin the pics!

[Figaro]

The Harm Reduction Coalition put out a book that is also in the internet named:


"HOW TO GET OFF RIGHT" Got a lot of information, I still have the book I picked it up at one of their conference. I don't remember if it was the Drug Policy Foundation in New Orleans Dec. 2006 or the Harm Reduction Conference in Miami Nov 2008.

[missparkles]

Sparkles thinks adding the threads that have specific info on heroin prep and injecting would also be useful. Brilliant topic dying tomorrow, keeping others safe is all we can do, nice one love.
Sparkles.

[cnajob]

just straight up go to a random doc and tell em you want Naloxone, they will give it....and they can't tell b/c of breach of confidentiality. tell them the old man/lady has a problem (unless you happen to have pupils the size of pin holes, then be honest) this is an important thing to have around the house. swim found boyfriend dead in the bathroom in june 2006. swim doesn't know if anything could have been done in a timely manner---but wishes naloxone had been available at an arms reach.

Reputation Comments on this post:

This is a vital item to have, especially if using IV. These can be a lifesaver and help determine if one lives or dies ...

[dyingtomorrow]

Originally Posted by missparkles

Sparkles thinks adding the threads that have specific info on heroin prep and injecting would also be useful. Brilliant topic dying tomorrow, keeping others safe is all we can do, nice one love.
Sparkles.

SWIM is lazy, but will just copy and paste this well received writeup he did of it:

RE: Back of the hand vein

As MsMogadon said it is a very good vein. SWIM would highly recommend rotating it with at least 3-4 other veins though to preserve it. The veins on the back of the hands are generally the easiest to hit, very resilient, and have good "flow."

SWIM recommends, first of all, not filling the needle up totally to 1 CC. If you use an amount of water such that it fills up to .7 or .8 CC, that will give you a lot more leverage an maneuverability with the needle if that is a problem for you.

What SWIM does, is first lines the needle up with the vein. Then he sticks a small amount of the needle in, just enough to "seal" the tip. Then SWIM pulls back slightly on the plunger, that way it will register immediately when it hits. SWIM never understood people who dig the needle around first to their estimated spot, then pull it, typically get nothing, then move it around more, then pull, trying to find a vein. He's seen a lot of them. If you pull it gently when you first insert it, and then after that get your hand into the ideal injection position as you slide the needle further in, it will give you much better control.

Then, after it registers, SWIM is very careful to not move the needle any further. He always gently lowers the needle and presses the "top" or "base" part where the needle meets the barrel, to his skin with slight force, to keep the needle from sliding around and to give stability. SWIM always figured this might have the effect of pulling the vein up a bit, but it's never been a problem, and makes it so SWIM never has the problem of slipping, and having the needle either pull out or push through the vein, thus blowing the shot and ruining the vein.

SWIM always starts injecting very slowly. You will feel the sting immediately if you have missed and are making a bubble. Even if you register, sometimes you aren't always in a usable vein, and if you jam the plunger down this will blow your rush and waste some of the IV potential of however much you injected.

SWIM especially recommends hand veins for beginners. The ones that pop up can roll and be difficult to hit, but if you aim for places where your skin is flat (not pushed up from the vein), but you can see the blue down in there, those are the best spots. The vein is kind of held in place by your hand tissues, so you don't have to worry about rolling. Also, you can try injecting above or below the spot where your "popped up" veins appear. The "flat" blue veins you can see in the top of you hand are good because they are held in place, and also because if you are not in properly, and you started injecting slowly, you will immediately feel the sting and see the bubble, and can pull out before ruining the vein. With fleshy parts of you arm, like your forearm and legs and groin area, unfortunately sometimes the veins not only roll, but also you can be really injecting the heroin into your flesh and not bloodstream, and not feel it until half your shot is gone (because of the "extra space" in those fleshy tissues). Also, when you do miss a significant part of a shot in fleshy tissues, it typically becomes a very severe bruise at best, or more likely a disgusting abscess or ulcer-type skin condition which can take a long time to heal and be very prominent. So hand veins are best for beginnings in SWIM's opinion.

Back to the steps - after you get the register and have pressed a little in to make sure you don't feel the sting or see the bubbling, you are going to press the syringe in. You don't want to press too hard or too fast, but generally speedy, but not where you are feeling too much resistence. The speed which you push the shot in depends a lot on the vein type. Those large wrist veins (which SWIM didn't recommend for inexperienced IVers), have the highest "flow" since they are large veins, and you can push the shot in relatively fast. There is a debate, but many believe the faster the push the better the rush, and the general consensus was that it is true.

Your top of the hand veins are the next size down. They can handle relatively fast flow, but you want to be very sensitive and in-tune with the "back-pressure" which you are feeling as you inject. If it gets too high and you are trying to jam it in too fast, you can explode the vein, and it will generally become irreversibly destroyed, or at least out of commission for a long time, and your shot will be blown.

If you are injecting the tiny blue veins in your fingers and palms, you have to inject very slowly. Generally these are the hardest to hit and adjust to using, so save them for when you have some experience. These blow up very easily. Injection speed should almost be .10 CC every 2-3 seconds. Also these are best hit using 31 gauge needles. Larger gauge requires even more skill and may not even be possible where the needle is larger than the vein. Again, it is not recommended to shoot fingers and knuckles for the beginner. While it becomes immediately apparent if you are missing the shot (as it is generally more painful to shoot them until you adjust); if you miss too much heroin in your finger you are going to be fucked for probably half a year. Both SWIM and his brother in acts of desperation ended up injecting about .5 CC of heroin into their pinky and their middle finger respectively. It creates a large, disgusting ulcer that doesn't even close up and stop oozing for 2-3 months. It has been about 7 months now since SWIM blew a shot in his pinky. It is still bent like an L, and he can't straighten it without exercising it first. The knuckle is very swollen, and still has about a 1 cm scabbed hole in the center of the knuckle. So be VERY careful shooting these. Never blow them.

After injecting, SWIM slides the needle out slow. Then he holds his arm up and massages the injection site lightly. He is not sure if this does anything, but he has an idea that it could marginally help the rush. SWIM also squirts the last bit of heroin-blood in his mouth from the needle. With really good dope you can taste it in your mouth, and SWIM artifically causes this phenomenon to happen, possibly creating a sort of placebo effect to increase the rush. He also likes the taste. Finally SWIM licks the injection site - but that is not recommended because of the bacteria in the mouth (human mouths have more bacteria in them than dog mouths) - you should use a alcohol pad afterwards too or some sanitary wipe. SWIM just likes the blood taste again.

Voila!

Anything missing DF peoples? Any more questions?

P.S. MMMMMmmmm SWIM wants to shoot up now after talking about it!

[missparkles]

Naloxone has to be administered by injection, Sparkles can't see any doc (in the UK) giving it to anyone (whatever reason they use) to counter a possible OD.
There have been trials where addicts were trained to use it, Sparkles remembers reading about the Berlin Project in 1999, but it didn't get off the ground, apparently. Addicts were titrating doses to effect resuscitation without provoking W/D. Which puts lives at risk, doesn't save em.
Take care.
Sparkles.

[cnajob]

you may be able to get it at a methadone clinic. swim lives in the states and swim works in an ER...a doctor here will give an Rx for naloxone to a junkie. some docs are dickheads and won't. however, a lot of instruction must be given to the person who will administer the drug--as death is a major side effect.

[Spucky]

1.
Smoking Heroin is always safer than Injecting,
(even a CtD.-Syndrom is nothing compare to Hep. C and HIV.)
if swiny get a new unknown substances it`s better to check it out
via a Alu-Foil than injecting.

2.
Spend more Time and doing Research in this Forum if you are a "New User"!

3.
Injecting into the Palms is sooooo Pseudo, there is absolute no Reason to do that in the beginning.
Imo. it`s like People with a Kiss-mark (here look what i have done, i am soooo "in"!).

Reputation Comments on this post:

	Pointing out safety of smoking compared to IV use.
	Good advice.

[Dionne]

Thank you for posting. Swim is new to IV and does not have one single person to talk about these sort of things. Swim uses alone and it is a big secret of hers x

[EyesOfTheWorld]

Originally Posted by Dionne

Thank you for posting. Swim is new to IV and does not have one single person to talk about these sort of things. Swim uses alone and it is a big secret of hers x

If SWIY wishes to discuss any issues with heroin or IV drug use in general feel free to pm my Monkey. He cant talk sources or prices but harm reduction/safe use is his thing.

[dyingtomorrow]

Originally Posted by Spucky

1.
Smoking Heroin is always safer than Injecting,
(even a CtD.-Syndrom is nothing compare to Hep. C and HIV.)
if swiny get a new unknown substances it`s better to check it out
via a Alu-Foil than injecting.

2.
Spend more Time and doing Research in this Forum if you are a "New User"!

3.
Injecting into the Palms is sooooo Pseudo, there is absolute no Reason to do that in the beginning.
Imo. it`s like People with a Kiss-mark (here look what i have done, i am soooo "in"!).

Ugh, sorry it took me so long to notice this. I updated the list with your info.

Thanks Spucky!

Originally Posted by Dionne

Thank you for posting. Swim is new to IV and does not have one single person to talk about these sort of things. Swim uses alone and it is a big secret of hers x

Thank you in return ... it is very nice to know that this info is being used. There are lots of friendly people here all with the same issues who you can talk to if you ever need to, as EyesOfTheWorld was kind to offer, and myself included.

Be safe and have fun

[g666d]

So this backpacker i traveled with had a few tips i carry with me to this day...
Store in sterile place.
If possible, get someone else to inject (for new users)
Salt water instead of alcohol pad? maybe. Some guy he knew used to use mouthwash when nothing else available.
Boiled water is sterile, and should have slightly less contaminants (not much less though, just a bit of scale should drop out) dH2O is better (no-one he knew did this though...) Boil it just prior to use.
Get from good source. This backpacker said all his gear used to dissolve without heat, was a good sign.
Always ask source how much they use, ie if strong/weak. Then as you say test small amount first.
Double agreed about safe disposal. If fit pack not available, gatorade bottle makes good place to store before dropping off at exchange. If no exchange, then dunno, hospital? Don't leave on footpath...
Can remember someone saying something about asorbic acid/citric acid, can't remember what... don't use lemon juice though.
List doesn't say cook H, maybe it should? not sure, this guy i keep talking about generally just cooked the water...
Clean spoon beforehand, use boiling water or alcohol swab. Possibly can squeeze alcohol onto H to sterilize, if worried about heat destroying it (just guessing here)
Avoid scratching spoon with needle, sit it on top of cotton/filter.
...thats all he told me

[MsBrownstone]

Originally Posted by Dionne

Thank you for posting. Swim is new to IV and does not have one single person to talk about these sort of things. Swim uses alone and it is a big secret of hers x

Its tough when you're just starting out and don't have anyone to talk to.. If you ever have any questions, or just need someone to chat with, sway is always around, don't be hesitant to send a message or something. Sway has to hide her drug use from alot of her family and friends and she knows how hard it can be.

[bananaskin]

I found this on the 'net and thought it could be useful here.
It is interesting to see that there are arteries in the fingers and toes, which could explain why these areas can be so painful to inject into.

Principal arteries of the human body:

1 internal carotid artery,
2 external carotid artery,
3 common carotid artery,
4 arch of the aorta,
5 descending aorta,
6 pulmonary vein,
7 left coronary artery,
8 celiac artery,
9 splenic artery,
10 left gastric artery,
11 inferior mesenteric artery,
12 abdominal aorta,
13 common iliac artery,
14 internal iliac artery,
15 external iliac artery,
16 femoral artery,
17 deep femoral artery,
18 popliteal artery,
19 dorsalis pedis,
20 posterior tibial artery,
21 peroneal artery,
22 anterior tibial artery,
23 digital artery,
24 superficial palmar arch,
25 deep palmar arch,
26 ulnar artery,
27 radial artery,
28 common interosseous artery,
29 superior mesenteric artery,
30 right gastric artery,
31 hepatic artery,
32 right coronary artery,
33 brachial artery,
34 ascending aorta,
35 brachiocephalic artery,
36 axillary artery,
37 anterior humeral circumflex artery,
38 subclavian artery

Reputation Comments on this post:

	great addition to the thread
	Excellent post. Informative.
	good research!

[mickey_bee]

Swim posted this a fair few months ago in this forum, but feels it's actually a little too important to simply let slip into the archives. It's about what water to use for injections, and the dangers of certain sources of water....

So here it is:

Found this !interactive! poster on the exchange supplies website. I was pretty amazed to learn that cold kitchen tap water is actually safer to use for injections than bottled water....

http://www.exchangesupplies.org/drug...ks_poster.html

check it out, it's good info!