A guide to avoiding infections when injecting
Re-using a filter? Touching your spike with your fingers? Sipping the water out of the cup you’re going to use to draw up from? Licking the end of your spike before a hit?
What occurs between you picking up that gear and then putting the spike in your vein, is a lot of idiosyncratic practices and habits picked up over an injecting career. A closer look usually tells us there’s a few ingrained habits that could prove to be dodgy, to down right dangerous!
We all know how important good hygiene is for injectors in the prevention of blood-borne viruses like HIV, hepatitis C or B – use your own or sterile syringes for each and every hit, and the more recent, but just as important, message of never sharing any spoons, filters, water or tourniquets. All these continue to play a critical part in a hygienic injecting regimen and will, if ritually adhered to, offer you protection against blood-borne viruses (but don’t forget the condoms). So what about other infections and bacteria? How susceptible are injectors to these?
BUT BEFORE WE START...
The answers seem to lie in your injecting routine and, to some extent, how hygienic your dealers are when they’re fiddling around with the powder that is soon to be in your spoon. What occurs between you picking up that gear and then putting the spike in your vein, is a lot of idiosyncratic practices – habits picked up over an injecting career.
Like, for example: licking the end of your spike before a hit, re-using a filter, sipping the water out of the cup you’re going to use draw up from, touching your spike with your fingers – all these seemingly small details carry risks of some pretty unpleasant bacteria entering your bloodstream or skin tissue. Long ingrained habits can be hard to break, but they are just that – habits and so they can be broken. If you can replace just one unhygienic practice with a safer one, you will be reducing your chances of experiencing future infections or complications – complications that can end up life-threatening, and that’s gotta be worth a change.
It may sound a bit cliché: but taking a bit of extra care whenever you can, will be protecting your health now and for the future. And since newer injectors pick up injecting practices from other injectors, it’s up to all of us to try and pass on safer injecting techniques (but don’t ever encourage anyone to start injecting!).
How do bacteria affect injectors?
It seems that you carry slightly more risk of getting certain infections if you inject street drugs IM (intramuscularly) or under the skin (subcutaneously). Bacteria entering your body this way can cause skin or soft tissue abscesses, for example, from bugs like staphylococcus that normally live happily on the skin’s surface; streptycoccus - within in your mouth and throat, to the sorts that can be picked up from your drugs such as Clostridium.
Clostridium is a bacterium that some readers may of heard of already through the terrible infections and deaths that occurred over the last couple of years to a small number of injectors [in the UK - ed.].
Bacteria, when given the chance to enter your bloodstream through your veins, can travel to your heart (causing endocarditis) joints and bones (septic arthritis) and osteomyelitis (a bacteria infection of the bone and bone marrow), or induce other infections like septic thrombophlebitis, septicemia blood poisoning), meningitis, cellulitis (when bacteria infect deeper levels of the skin), brain abscesses and less commonly, tetanus and even malaria!
While the boiling up of a hit of heroin does appear to reduce or kill certain bacteria, those who hit up cocaine, speed, ketamine, pills etc. and use no heat at all when mixing up, are often at greater risk. The practice of repeated injections during a long coke session for example, can often mean that water, filters and spoons are all left out on the table for hours at a time – increasing the chances of bacteria entering your mix, your skin, and your bloodstream.
But from our experience and research, all injectors are vulnerable, and all must take extra care when using their drugs IV. While it’s not a good idea to keep any hit mixed up for later, the reality is we all do it sometimes.
If you’ve got to keep a hit for later, it’s much safer to keep it in its powder form rather than mixed up with liquid. If you must, then keep any saved hits, filters, dex wash-outs, etc in the fridge. And not for more than 8 to 12 hours at an absolute maximum.
Anyone who has any sort of infected sore on the skin i.e. abscesses, cellulitis, wounds, even infected pimples etc, must be EXTREMELY CAREFUL AND HYGIENIC when shooting up and should absolutely avoid injecting anywhere near the infected area. It doesn’t take much for the bacteria involved to get on your fingers (especially if your a `picker or squeezer’) and travel to your injecting site, particularly when one must feel for a vein.
Never lick, or cough over, your injecting site/equipment either as a spray of bacteria is really bad news! Powder dealers - take note!
There are three main ways to pick up infections associated from injecting drugs. They are the air, skin and blood.
The skin is a common source of bacteria and viruses responsible for intravenous associated infection. Any bacteria found on the skin are usually referred to as resident or transient. Resident bacteria are those that are usually present on the skin, being relatively constant on each individual. They adhere tightly to the skin and as mentioned usually include Staphlococcus albus as well as diphtheroids and bacillus species. And since not all bacteria are removed by scrubbing, one must take par*ticular care not to touch any of your injecting equipment — sterile or otherwise — with grubby fingers.
Transient flora is loosely attached to the skin and is composed of bacteria which have been picked up by you from your environment, and it varies from day to day in its quantity and quality. There isn’t that much of it on clean protected skin, but there can be loads of it on greasy, dirty exposed areas of the body. It is here that handwashing before a hit becomes essential to avoid transferring germs to your injection site or to your equipment.
While the actual number of ‘microbes’ per foot on skin varies whenever an infection is present, bacteria also escape in body discharges, contaminating clothing, bed*ding, dressings etc. If you have an infec*tion on your body, any sort of activity such as throwing off your shirt, bed making etc, sends bacteria flying into the air – particles of lint and pus and dried skin! These contaminants can then find easy access to unprotected intravenous fluids. For example, a water filled glass that you use to draw water from for injecting is left open to the air – and any bacteria that has just flown off someone’s bandages can find it’s way in.
This also goes for spoons and filters. In order to avoid contamination, dispose of all the equip*ment you use after your hit. And if you have another one soon after? Well, get yourself clean equipment! The alternative of course, is to have a pack of sterile syringes, water ampoules and a regularly cleaned spoon etc. (Note - never use a silver spoon because Of silver tarnish). Try and cover your water container with a clean lid, but only if you have no other way to get more fresh water.
As we know all too well, blood can harbour potentially dangerous viruses. The hepatitis virus, as well HIV, is a testament to that. As such, it is crucial to wash your hands before and after each hit to ensure you don’t transmit or pick up often minute blood particles unseen to the eye that have been left behind, to be picked up by another person.
lt doesn’t matter what you inject, it is essential for injectors to keep themselves healthy. Groin injectors need to pay particular attention to keeping their site clean, and always take care to wash regularly if you inject here as any infec*tion has the potential to be extremely serious. Those who use in their feet or legs, must also take particular care to keep their sites clean as all are areas that regularly get exposed to a variety of germs that can easily gain access to your bloodstream after being pushed in on the end of a spike.