Drug injection
Encyclopedia
In substance dependence
and recreational drug use
, drug injection is a method of introducing a drug
into the body with a hollow needle and a syringe
which is pierced through the skin into the body (usually intravenous, but also intramuscular or subcutaneous). This act is often colloquially referred to as "Slamming", "Shooting", "Banging", "Digging", "Rigging", "Smashing", "Pinning", or "Jacking-up"
Although there are various methods of taking drugs, injection is favoured by some users as the full effects of the drug are experienced very quickly, typically in five to ten seconds. It also bypasses first-pass metabolism
in the liver, resulting in a higher bioavailability
for many drugs than oral ingestion would (so users get a stronger effect from the same amount of the drug). This shorter, more intense high can lead to a dependency, both physical and psychological, developing more quickly than with other methods of taking drugs.
As of 2004 there were 13.2 million people worldwide who used injection drugs of which 22% are from developed countries.
The drug, usually in a powder or crystal form (though not always), is dissolved in water, normally in a spoon, tin, bottoms of soda cans, or another metal container. Cylindrical metal containers sometimes called 'cookers' are provided by needle exchanges. Users draw the required amount of water into a syringe and squirt this over the drugs. The solution is then mixed and heated from below if necessary. Heating is used mainly with heroin, (though not always, depending on the type of heroin) but is also often used when time-released pharmaceutical drugs such as MSContin
(morphine) or OxyContin (oxycodone) are injected to better separate the drug from the waxy filler; amphetamine
s should never be heated. Cocaine HCl (powdered cocaine) dissolves quite easily without heat. Heroin prepared for the European market is insoluble in water and usually requires the addition of an acid such as citric acid or ascorbic acid (Vitamin C) powder to dissolve the drug. Due to the dangers from using lemon juice or vinegar to acidify the solution, packets of citric acid and Vitamin C powder are available at needle exchanges
in Europe. In the U.S., vinegar and lemon juice are used to shoot crack cocaine
. The acids convert the water-insoluble cocaine base in crack to a cocaine salt (cocaine acetate or cocaine citrate here) which is water soluble (like cocaine hydrochloride). Once the drugs are dissolved, a small syringe, usually 0.5 or 1 cc, is used to draw the solution through a filter, usually cotton
from a cigarette filter
or cotton swab
(cotton bud). 'Tuberculin' syringes and types of syringes used to inject insulin are commonly used. Commonly used syringes usually have a built-in 28 gauge (or thereabouts) needle typically 1/2 or 5/8 inches long.
The preferred injection site is the crook of the elbow (i.e., the Median cubital vein
), on the user's non-writing hand. Other users opt to use the Basilic vein
; While it may be easier to "hit", caution must be exercised as two nerves run parallel to the vein increasing the chance of nerve damage, as well as the chance of an arterial "nick".
Harm reduction
is an approach to public health intended to be a progressive alternative to an approach requiring complete abstinence from drug use. While it does not condone the taking of illicit drugs, it does seek to reduce the harms arising from their use, both for the person taking illicit drugs and the wider community.
A prominent method for addressing the issue of disease transmission among intravenous drug users are needle exchange programs, in which facilities are available to exchange used injection equipment for safe sterile equipment, often without a prescription or fee. Such establishments also tend to offer free condom
s to promote safe sex and reduce disease transmission. The idea is to slow disease transmission and promote public health by reducing the practice of sharing used needles.
In countries where harm reduction programs are limited or non-existent, it is quite common for an IV user to use a single needle repeatedly or share with other users. It is also quite uncommon for a sterilizing agent to be used.
of harm reduction
promotes information and resources for IV drug users. General guidelines on safer injecting of various substances intravenously are typically based on the following steps:
The area for drug preparation should be cleaned with warm soapy water or an alcohol swab to minimize the risk of bacterial infection.
The equipment required involves new syringes and needles, swabs, sterile water, filter, tourniquet
and a clean spoon or stericup. In order to minimize the chance of bacteria or viruses entering the bloodstream, people are advised to wash their hands with soap and warm water. However, as people do not always have access to hot water and soap when they are injecting, the philosophy of harm reduction seeks to find the most realistic option that people can take. Alcohol swabs are commonly distributed with injecting equipment, and while they are less effective than hand washing, their use is more effective than nothing. Any sharing of injecting equipment, even tourniquets, is highly discouraged, due to the high danger of transmitting bacteria and viruses via the equipment.
Sterile water is also recommended to prevent infection. Many needle and syringe programs distribute vial
s or ampoule
s of USP
sterile water for this reason. Where sterile water is not obtainable, the harm reduction approach recommends tap water boiled for five minutes, and then allowed to cool.
Once the water and substance are combined in the mixing vessel, heat is sometimes applied to assist the mixing. Filtering is recommended by health services, as the mix can consist of wax or other non-soluble materials which are damaging to veins. Wheel filters are the most effective filters. 5.0 micron wheel filter (e.g. Apothicom Sterifilt), now shared in some Needle-exchange programmes instead of cotton, is intended to get rid of the talc from prescription tablets like benzos, dexamphetamines, physeptone and other recreational drugs like ecstasy. However cotton wool or tampons can be used, although to be more effective, several filtrations should be undertaken.
Once the mix is drawn into the syringe, air bubbles should be removed by flicking the barrel with the needle pointed upwards and pressing the plunger to expel the bubbles that pool at the top. This is done to prevent injection of air
into the bloodstream.
A tourniquet can be used to assist vein access. The tourniquet should not be on too tight, or left on for too long, as this causes the veins to swell and stretch. When injecting, the needle's bevel or 'hole' should face upward and be eased into the vein at a shallow angle between 10 and 35 degrees to minimize the risk of penetrating through the vein entirely. In order to prevent stress on the vein, the needle should be pointing towards the heart.
The plunger should be pulled back slightly (colloquially known as ‘jacking back' or 'flagging’) to ensure the needle is in the vein. Blood should appear in the barrel of the syringe if this is the case. This process is termed aspirating the needle or registering. When accessing a vein with unobstructed blood flow a "flashback," or sudden flash of red blood inside the needle tip, may occur spontaneously when the needle enters the vein. Because sudden appearance of blood in the needle/syringe alone does not guarantee proper needle placement (flashbacks can also occur when a needle passes through a vein completely, enters an artery inadvertently, or otherwise is extravasated), aspirating the plunger on the syringe is still considered a requisite step.
The tourniquet should then be taken off and the plunger gently pushed. After injection, a clean tissue or cotton wool should be pressed against the injection site to prevent bleeding. Although many people use an alcohol swab for this purpose it is discouraged by health services as the alcohol interferes with blood clotting.
Dispose of injecting gear using a 'sharps bin' if supplied. Other rigid-walled containers such as a bottle are recommended as a second best option.
positive. The main symptoms for any blood-borne infections will usually appear a few days after infection has occurred and usually consists of a blocked and/or runny nose, loss of taste, smell, other senses and an unpleasant sense of thickness in and around the central cravioun in the brain. A general feeling of malaise, aching and weakness will usually accompany these symptoms. If the onset of symptoms happens around 4–8 days after infection then it is more than likely hepatitis but could also be any strain of HIV. Sufferers tend to get these same symptoms regardless of what disease or virus they may have contracted due to the method of infection and half life of the bacterial membranes within the cells but there are still many distinct separate symptoms that can occur within different infections.
The most common symptoms of HIV or AIDS that has been contracted intravenously are again a runny and/or blocked nose, acute loss of taste and/or smell, a blocked or thick sensation within the head, general aching, malaise and weakness, hot and cold sweats and occasionally acute insomnia. These symptoms will most likely subside after 2–3 days and the individual will then regain their previous posture and well being. Any one individual could possibly live completely unaware of the presence of the virus for many years as the initial symptoms subside and may not appear again for a long time.
Of all the ways to ingest drugs, injection, by far, carries the most risks as it bypasses the body's natural filtering mechanisms against viruses, bacteria and foreign objects. There will always be much less risk of overdose, disease, infections and health problems with alternatives to injecting, such as smoking, insufflation
(snorting or nasal ingestion), or swallowing.
Viruses such as HIV
and hepatitis C
are prevalent among IV drug users in many countries, mostly due to small groups sharing injection equipment combined with a lack of proper sterilization. Other health problems arise from poor hygiene and injection technique (be it IV, IM, or SC), such as cotton fever
, phlebitis
, abscesses, vein collapse
, ulcers, malaria
, gas gangrene
, tetanus
, septicaemia, thrombosis
, embolism
and all results thereof. Drug injection is also commonly a component in HIV-related syndemic
s. Fragments from injection of pills are known to clog the small blood vessels of the lungs, brain and elsewhere. A small proportion of pulmonary embolism
(PE) is due to the embolization of air, fat, talc in drugs of intravenous drug abusers. Hitting arteries and nerves is dangerous, painful, and presents its own similar spectrum of problems.
An alternative to syringes in the 1970s was to use a glass medicine dropper
, supposedly easier to manipulate with one hand. A large hairpin was used to make a hole in the skin and the dropper containing the drug (usually heroin) was inserted and the bulb squeezed, releasing it into the tissues. This method was also reported, by William S Burroughs and other sources, for intravenous administration at least as far back as 1930.
Drugs can also be smoked (e.g., tobacco or marijuana alone or mixed with heroin) or 'chased' (originating from 'chasing the dragon' - inhaling the vapors of the heated drug, or perhaps from following the heroin as it slides down the foil). Smoking and chasing have negligible risk of bacterial or viral transmission and the risk of overdose is lessened compared to injecting, but they still retain much of the 'rush' of injecting as the effects of the drug occur very rapidly. Chasing is a far safer way to use heroin than injecting, with the best option being to use new aluminum foil, first passing a cigarette lighter flame over both sides to help sterilize it.
Swallowing tends to be the safest and slowest method of ingesting drugs. It is safer as the body has a much greater chance to filter out impurities. As the drug comes on slower, the effect tends to last longer as well, making it a favorite technique on the dance scene for speed and ecstasy. People rarely take heroin orally, as it is converted to morphine in the stomach and its potency is reduced by more than 65% in the process. However, it is well known that oral bioavailability
of opioids is heavily dependent on the substance, dose, and patient in ways that are not yet understood. Pills like benzodiazepines are best swallowed as they have talc or wax fillers in them. These fillers won't irritate the stomach, but pose serious health risk for veins or nasal membranes.
Shebanging involves spraying the dissolved drug into the nose to be absorbed by the nasal membrane.
Plugging, or rectal ingestion, relies on the many veins in the anal passage passing the drug into the blood stream quite rapidly. Some users find that trading off some of the 'rush' for fewer health risks is a good compromise. Shafting usually involves about 1.5 ml of fluid mixed with the drug.
Women have the added option of shelving, where drugs can be inserted in the vagina. This is similar to the rectum, in that there are many blood vessels behind a very thin wall of cells, so the drug passes into the bloodstream very quickly. Care should be taken with drugs such as amphetamine that may irritate the sensitive lining of the rectum and vagina.
Substances below a certain molecular weight can be absorbed through the skin and into the bloodstream when dissolved in the solvent dimethyl sulfoxide
(DMSO) which is available as liquid or gel; there therefore exists the possibility of creating a topical concoction with medical-grade DMSO and a given drug which will solve the first pass and GI tract destruction problems in addition to faster onset of effects.
s and the synthesis of chemically pure morphine
and cocaine
.
It was noted that administering drugs intravenously strengthened their effect and since such drugs as heroin and cocaine were already being used to treat a wide variety of ailments, many patients were given injections of "hard" drugs for such ailments as alcoholism and depression.
By the time of Aleister Crowley
intravenous drug culture already had a small, but loyal following. Sir Arthur Conan Doyle writes that Sherlock Holmes
used to inject cocaine to occupy his mind between cases.
& syringe in its current form was invented by the French scientist Pravaz in 1851 and became especially known during the wars of that and the subsequent decade, although the first well-known attempt to inject drugs into the body was a 1667 attempt to inject a solution of opium into a dog, and some had suspected that parenteral administration of drugs may work better based on the practise of rubbing opium and other drugs into sores or cuts on the skin for the purpose of causing systemic absorption and the beginnings of scientific understanding of the functioning of the lungs.
During most of the 1850s, the previously-held belief that opiate dependence and addiction, often called "the opium appetite," (or when relevant the "morphine appetite" or "codeine appetite") was due to the drug's action on the digestive system—just like any hunger or thirst—caused doctors to opt to inject morphine rather than administer it orally in the hope that addiction would not develop; certainly by c.a. 1870 or earlier it was manifest that this was not the case and the title of earliest morphine addict as the term is currently understood is often given to Dr Pravaz' wife although habituation through orally ingesting the drug was known before this time, including Sertürner
and associates, followers, and his wife and dog. To some extent, it was also believed early on that bypassing the lungs would prevent opium addiction as well as habituation to tobacco. Ethanol in its usual form generally is not injected and can be very damaging by most routes of injection; in modern times it is used as an alternative or potentiator of phenol
(carbolic acid) in procedures to ablate damaged nerves.
In or shortly after 1851 the drugs which had been discovered and extracted from their plants of origin and refined into pure crystalline salts soluble in water included morphine
(1804 or late 1803), codeine
(1832), narcotine/noscapine
(1803-1805?), papaverine
(1814), cocaine
(1855), caffeine
(1819), quinine
(1820), atropine
(1831), scopolamine
aka hyoscine aka laevo-duboisine (1833?), hyoscyamine
or laevo-atropine (1831), opium salts mixtures (c.a. 1840s) chloral derivatives (1831 et seq.), ephedrine
(1836?), nicotine
(1828) and many others of all types, psychoactive and not. Morphine in particular was used much more widely after the invention of the hypodermic syringe, and the practise of local anaesthesia by infiltration was another step forward in medicine resulting from the hypodermic needle, discovered at around the same time that it was determined that cocaine produced useful numbing of the mucous membranes and eye.
A wide variety of drugs are injected, among the most popular in many countries are morphine
, heroin, cocaine
, amphetamine
and methamphetamine
. Prescription drugs, including tablets, capsules, or even liquids or suppositories, are also occasionally injected, especially prescription opioid
s, since some opioid addicts already inject heroin. Injecting preparations not intended for this purpose is particularly dangerous because of the presence of excipient
s (fillers), which can cause blood clots. Injecting codeine
into the bloodstream directly is dangerous because it causes a rapid histamine
release, which can lead to potentially fatal anaphylaxis
and pulmonary edema
. Dihydrocodeine
, hydrocodone
, nicocodeine
, and other codeine-based products carry similar risks. To minimize the amount of undissolved material in fluids prepared for injection, a filter of cotton or synthetic fiber is typically used, such as a cotton-swab tip or a small piece of cigarette filter.
Some manufacturers add the narcotic antagonist
naloxone
or the anticholinergics atropine
and homatropine
(in lower than therapeutic doses) to their pills to prevent injection. Unlike naloxone
, atropine does indeed help morphine and other narcotics combat neuralgia
. The atropine may very well not present a problem, and there is the possibility of atropine content reduction of soluble tablets by placing them on an ink blotter with a drop of water on top, then preparing a shot from the remainder of the pill. Canada and many other countries prohibit manufacturers from including secondary active ingredients for the above reason; their Talwin PX
does not contain naloxone. However, as a narcotic agonist-antagonist
, pentazocine and its relatives can cause withdrawal in those physically dependent upon narcotics.
Substance dependence
The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...
and recreational drug use
Recreational drug use
Recreational drug use is the use of a drug, usually psychoactive, with the intention of creating or enhancing recreational experience. Such use is controversial, however, often being considered to be also drug abuse, and it is often illegal...
, drug injection is a method of introducing a drug
Drug
A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.In pharmacology, a...
into the body with a hollow needle and a syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
which is pierced through the skin into the body (usually intravenous, but also intramuscular or subcutaneous). This act is often colloquially referred to as "Slamming", "Shooting", "Banging", "Digging", "Rigging", "Smashing", "Pinning", or "Jacking-up"
Although there are various methods of taking drugs, injection is favoured by some users as the full effects of the drug are experienced very quickly, typically in five to ten seconds. It also bypasses first-pass metabolism
First pass effect
The first-pass effect is a phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation. It is the fraction of lost drug during the process of absorption which is generally related to the liver and gut wall...
in the liver, resulting in a higher bioavailability
Bioavailability
In pharmacology, bioavailability is a subcategory of absorption and is used to describe the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. By definition, when a medication is administered...
for many drugs than oral ingestion would (so users get a stronger effect from the same amount of the drug). This shorter, more intense high can lead to a dependency, both physical and psychological, developing more quickly than with other methods of taking drugs.
As of 2004 there were 13.2 million people worldwide who used injection drugs of which 22% are from developed countries.
Advantages
There are a variety of reasons why drugs would be injected rather than taken through other methods.- Increased effect — Injecting a drug intravenously means that more of the drug will reach the brain more quickly. This also means that the drug will have a very strong and rapid onset. With some drugs this can produce sensations not found with other routes of administration known as a rush.
- More efficient usage — Injection means that more of the drug will reach the brain than with other methods. This is because the body's defenses and detoxifying mechanisms (such as first-pass metabolism in the liver with oral use) are bypassed. Injection increases a drug's bioavailability. This means that it requires less drug (and less money) to achieve the same effect (excepting the effects of tolerance).
- Bypasses the digestive system — Some people with sensitive stomachs find it very unpleasant to swallow drugs because of persistent cramps or nausea.
- Does not harm the lungs or mucous membranes — The mucous membranes can be permanently damaged by habitual insufflationInsufflation (medicine)Insufflation is the practice of inhaling a substance. Insufflation has limited medical use, but is a common route of administration with many respiratory drugs used to treat conditions in the lungs and paranasal sinus .The technique is common for many recreational drugs and is also used for some...
(snorting), and the lungs can be damaged by smoking.
Disadvantages
In addition to general problems associated with any IV drug administration (see risks of IV therapy) there are some specific problems associated with the informal injection of drugs by non-professionals.- Increased chance of infection — This is generally a twofold problem.
- Needle sharingNeedle sharingNeedle sharing is the practice of intravenous drug-users by which a syringe is shared by multiple individuals to administer intravenous drugs, and is a primary vector for diseases which can be transmitted through blood ....
transmits blood-borne diseaseBlood-borne diseaseA blood-borne disease is one that can be spread through contamination by blood.The most common examples are HIV, hepatitis B, hepatitis C and viral hemorrhagic fevers....
s between users. - AbscessAbscessAn abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
ed infections of injection sites are caused by lack of hygiene and a lack of aseptic techniqueAseptic techniqueAseptic technique refers to a procedure that is performed under sterile conditions. This includes medical and laboratory techniques, such as with microbiological cultures. It includes techniques like flame sterilization...
.
- Needle sharing
- Increased chance of overdose — Because IV injection delivers a dose of drug straight into the bloodstream it is harder to gauge how much to use (as opposed to smoking or snorting where the dose can be increased incrementally until the desired effect is achieved). In addition, because of the rapid onset, overdose can occur very quickly, requiring immediate action.
- Scarring of the peripheral veins — This arises from the use of blunt injecting equipment. This is particularly common with users who have been injecting while in jail and re-use disposable syringes sometimes hundreds of times. IV drug use for an extended period may result in collapsed veins. Though rotating sites and allowing time to heal before reuse may decrease the likelihood of this occurring, collapse of peripheral veins may still occur with prolonged IV drug use. IV drug users are among the most difficult patient populations to obtain blood-specimens from because of peripheral venous scarring. The darkening of the veins due to scarring and toxin buildup produce tracks along the length of the veins and are known as track marks.
- Arterial damage — Arterial pseudoaneurysmPseudoaneurysmA pseudoaneurysm, also known as a false aneurysm, is a hematoma that forms as the result of a leaking hole in an artery. Note that the hematoma forms outside the arterial wall, so it is contained by the surrounding tissues. Also it must continue to communicate with the artery to be considered a...
s may form at injection sites, which can rupture, potentially resulting in hemorrhage, distal ischemiaIschemiaIn medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
, and gangreneGangreneGangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies . This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood...
. Inadvertent intra-arterial injection can also result in endarteritis and thrombosisThrombosisThrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss...
, with ultimately similar consequences. - Increased chance of addiction — The heightened effect of administering drugs intravenously can make the chances of addiction more likely.
- Social stigma — In many societies there is a social stigma attached to IV drug use, in addition to the more general stigma around illegal drug use and addiction. People who are happy taking drugs by other routes may not inject. This may be because of its perceived prevalence in inner citiesInner cityThe inner city is the central area of a major city or metropolis. In the United States, Canada, United Kingdom and Ireland, the term is often applied to the lower-income residential districts in the city centre and nearby areas...
and with lower-income people.
Procedure
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
(morphine) or OxyContin (oxycodone) are injected to better separate the drug from the waxy filler; amphetamine
Amphetamine
Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
s should never be heated. Cocaine HCl (powdered cocaine) dissolves quite easily without heat. Heroin prepared for the European market is insoluble in water and usually requires the addition of an acid such as citric acid or ascorbic acid (Vitamin C) powder to dissolve the drug. Due to the dangers from using lemon juice or vinegar to acidify the solution, packets of citric acid and Vitamin C powder are available at needle exchanges
Needle-exchange programme
A Needle & syringe programme or syringe-exchange programme is a social policy based on the philosophy of harm reduction where injecting drug users can obtain hypodermic needles and associated injection equipment at little or no cost. Many programmes are called "exchanges" because some require...
in Europe. In the U.S., vinegar and lemon juice are used to shoot crack cocaine
Crack cocaine
Crack cocaine is the freebase form of cocaine that can be smoked. It may also be termed rock, hard, iron, cavvy, base, or just crack; it is the most addictive form of cocaine. Crack rocks offer a short but intense high to smokers...
. The acids convert the water-insoluble cocaine base in crack to a cocaine salt (cocaine acetate or cocaine citrate here) which is water soluble (like cocaine hydrochloride). Once the drugs are dissolved, a small syringe, usually 0.5 or 1 cc, is used to draw the solution through a filter, usually cotton
Cotton
Cotton is a soft, fluffy staple fiber that grows in a boll, or protective capsule, around the seeds of cotton plants of the genus Gossypium. The fiber is almost pure cellulose. The botanical purpose of cotton fiber is to aid in seed dispersal....
from a cigarette filter
Cigarette filter
A cigarette filter has the purpose of reducing the amount of smoke, tar, and fine particles inhaled during the combustion of a cigarette. Filters also reduce the harshness of the smoke and keep tobacco flakes out of the smoker's mouth.-History:...
or cotton swab
Cotton swab
Cotton swabs or cotton buds or ear buds consist of a small wad of cotton wrapped around one or both ends of a short rod, usually made of either wood, rolled paper, or plastic...
(cotton bud). 'Tuberculin' syringes and types of syringes used to inject insulin are commonly used. Commonly used syringes usually have a built-in 28 gauge (or thereabouts) needle typically 1/2 or 5/8 inches long.
The preferred injection site is the crook of the elbow (i.e., the Median cubital vein
Median cubital vein
In human anatomy, the median cubital vein is a superficial vein of the upper limb. It connects the basilic and cephalic vein and is often used for venipuncture . It lies in the cubital fossa superficial to the bicipital aponeurosis.There exists a fair amount of variation of the median cubital vein...
), on the user's non-writing hand. Other users opt to use the Basilic vein
Basilic vein
In human anatomy, the basilic vein is a large superficial vein of the upper limb that helps drain parts of hand and forearm. It originates on the medial side of the dorsal venous network of the hand, and it travels up the base of the forearm and arm...
; While it may be easier to "hit", caution must be exercised as two nerves run parallel to the vein increasing the chance of nerve damage, as well as the chance of an arterial "nick".
Harm reduction
Harm reduction
Harm reduction refers to a range of public health policies designed to reduce the harmful consequences associated with recreational drug use and other high risk activities...
is an approach to public health intended to be a progressive alternative to an approach requiring complete abstinence from drug use. While it does not condone the taking of illicit drugs, it does seek to reduce the harms arising from their use, both for the person taking illicit drugs and the wider community.
A prominent method for addressing the issue of disease transmission among intravenous drug users are needle exchange programs, in which facilities are available to exchange used injection equipment for safe sterile equipment, often without a prescription or fee. Such establishments also tend to offer free condom
Condom
A condom is a barrier device most commonly used during sexual intercourse to reduce the probability of pregnancy and spreading sexually transmitted diseases . It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner...
s to promote safe sex and reduce disease transmission. The idea is to slow disease transmission and promote public health by reducing the practice of sharing used needles.
In countries where harm reduction programs are limited or non-existent, it is quite common for an IV user to use a single needle repeatedly or share with other users. It is also quite uncommon for a sterilizing agent to be used.
Safer injection
A philosophyPhilosophy
Philosophy is the study of general and fundamental problems, such as those connected with existence, knowledge, values, reason, mind, and language. Philosophy is distinguished from other ways of addressing such problems by its critical, generally systematic approach and its reliance on rational...
of harm reduction
Harm reduction
Harm reduction refers to a range of public health policies designed to reduce the harmful consequences associated with recreational drug use and other high risk activities...
promotes information and resources for IV drug users. General guidelines on safer injecting of various substances intravenously are typically based on the following steps:
The area for drug preparation should be cleaned with warm soapy water or an alcohol swab to minimize the risk of bacterial infection.
The equipment required involves new syringes and needles, swabs, sterile water, filter, tourniquet
Tourniquet
An emergency tourniquet is a tightly tied band applied around a body part sometimes used in an attempt to stop severe traumatic bleeding. Tourniquets are also used during venipuncture and other medical procedures. Severe bleeding means the loss of more than 1,000 ml of blood. This flow of blood...
and a clean spoon or stericup. In order to minimize the chance of bacteria or viruses entering the bloodstream, people are advised to wash their hands with soap and warm water. However, as people do not always have access to hot water and soap when they are injecting, the philosophy of harm reduction seeks to find the most realistic option that people can take. Alcohol swabs are commonly distributed with injecting equipment, and while they are less effective than hand washing, their use is more effective than nothing. Any sharing of injecting equipment, even tourniquets, is highly discouraged, due to the high danger of transmitting bacteria and viruses via the equipment.
Sterile water is also recommended to prevent infection. Many needle and syringe programs distribute vial
Vial
A vial is a relatively small glass vessel or bottle, especially used to store medication as liquids, powders or in other forms like capsules. They can also be sample vessels; e.g., for use in autosampler devices in analytical chromatography.The glass can be colourless or coloured, clear or amber...
s or ampoule
Ampoule
An ampoule is a small sealed vial which is used to contain and preserve a sample, usually a solid or liquid. Ampoules are commonly made of glass, although plastic ampoules do exist....
s of USP
United States Pharmacopeia
The United States Pharmacopeia is the official pharmacopeia of the United States, published dually with the National Formulary as the USP-NF. The United States Pharmacopeial Convention is the nonprofit organization that owns the trademark and copyright to the USP-NF and publishes it every year...
sterile water for this reason. Where sterile water is not obtainable, the harm reduction approach recommends tap water boiled for five minutes, and then allowed to cool.
Once the water and substance are combined in the mixing vessel, heat is sometimes applied to assist the mixing. Filtering is recommended by health services, as the mix can consist of wax or other non-soluble materials which are damaging to veins. Wheel filters are the most effective filters. 5.0 micron wheel filter (e.g. Apothicom Sterifilt), now shared in some Needle-exchange programmes instead of cotton, is intended to get rid of the talc from prescription tablets like benzos, dexamphetamines, physeptone and other recreational drugs like ecstasy. However cotton wool or tampons can be used, although to be more effective, several filtrations should be undertaken.
Once the mix is drawn into the syringe, air bubbles should be removed by flicking the barrel with the needle pointed upwards and pressing the plunger to expel the bubbles that pool at the top. This is done to prevent injection of air
Air embolism
An air embolism, or more generally gas embolism, is a pathological condition caused by gas bubbles in a vascular system. The most common context is a human body, in which case it refers to gas bubbles in the bloodstream...
into the bloodstream.
A tourniquet can be used to assist vein access. The tourniquet should not be on too tight, or left on for too long, as this causes the veins to swell and stretch. When injecting, the needle's bevel or 'hole' should face upward and be eased into the vein at a shallow angle between 10 and 35 degrees to minimize the risk of penetrating through the vein entirely. In order to prevent stress on the vein, the needle should be pointing towards the heart.
The plunger should be pulled back slightly (colloquially known as ‘jacking back' or 'flagging’) to ensure the needle is in the vein. Blood should appear in the barrel of the syringe if this is the case. This process is termed aspirating the needle or registering. When accessing a vein with unobstructed blood flow a "flashback," or sudden flash of red blood inside the needle tip, may occur spontaneously when the needle enters the vein. Because sudden appearance of blood in the needle/syringe alone does not guarantee proper needle placement (flashbacks can also occur when a needle passes through a vein completely, enters an artery inadvertently, or otherwise is extravasated), aspirating the plunger on the syringe is still considered a requisite step.
The tourniquet should then be taken off and the plunger gently pushed. After injection, a clean tissue or cotton wool should be pressed against the injection site to prevent bleeding. Although many people use an alcohol swab for this purpose it is discouraged by health services as the alcohol interferes with blood clotting.
Dispose of injecting gear using a 'sharps bin' if supplied. Other rigid-walled containers such as a bottle are recommended as a second best option.
Risks
An estimated 16 million people world wide use intravenous drugs, and approximately 3 million of these are believed to be HIVHIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
positive. The main symptoms for any blood-borne infections will usually appear a few days after infection has occurred and usually consists of a blocked and/or runny nose, loss of taste, smell, other senses and an unpleasant sense of thickness in and around the central cravioun in the brain. A general feeling of malaise, aching and weakness will usually accompany these symptoms. If the onset of symptoms happens around 4–8 days after infection then it is more than likely hepatitis but could also be any strain of HIV. Sufferers tend to get these same symptoms regardless of what disease or virus they may have contracted due to the method of infection and half life of the bacterial membranes within the cells but there are still many distinct separate symptoms that can occur within different infections.
The most common symptoms of HIV or AIDS that has been contracted intravenously are again a runny and/or blocked nose, acute loss of taste and/or smell, a blocked or thick sensation within the head, general aching, malaise and weakness, hot and cold sweats and occasionally acute insomnia. These symptoms will most likely subside after 2–3 days and the individual will then regain their previous posture and well being. Any one individual could possibly live completely unaware of the presence of the virus for many years as the initial symptoms subside and may not appear again for a long time.
Of all the ways to ingest drugs, injection, by far, carries the most risks as it bypasses the body's natural filtering mechanisms against viruses, bacteria and foreign objects. There will always be much less risk of overdose, disease, infections and health problems with alternatives to injecting, such as smoking, insufflation
Insufflation
In religious and magical practice, insufflation and exsufflation are ritual acts of blowing, breathing, hissing, or puffing that signify variously expulsion or renunciation of evil or of the devil , or infilling or blessing with good .In historical Christian practice, such blowing appears most...
(snorting or nasal ingestion), or swallowing.
Viruses such as HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
and hepatitis C
Hepatitis C
Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
are prevalent among IV drug users in many countries, mostly due to small groups sharing injection equipment combined with a lack of proper sterilization. Other health problems arise from poor hygiene and injection technique (be it IV, IM, or SC), such as cotton fever
Cotton fever
Cotton fever is a syndrome that is often associated with intravenous drug use, specifically the use of cotton to filter drugs like heroin. The cause of the condition has been established to be the endotoxin shed by the bacteria Enterobacter agglomerans which colonizes cotton plants. A condition...
, phlebitis
Phlebitis
Phlebitis is an inflammation of a vein, usually in the legs.When phlebitis is associated with the formation of blood clots , usually in the deep veins of the legs, the condition is called thrombophlebitis...
, abscesses, vein collapse
Collapsed vein
Collapsed veins are a common result of chronic use of intravenous injections. They are particularly common where injecting conditions are less than ideal, such as in the context of drug abuse....
, ulcers, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, gas gangrene
Gas gangrene
Gas gangrene is a bacterial infection that produces gas tissues in gangrene. It is a deadly form of gangrene usually caused by Clostridium perfringens bacteria. It is a medical emergency....
, tetanus
Tetanus
Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani...
, septicaemia, thrombosis
Thrombosis
Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss...
, embolism
Embolism
In medicine, an embolism is the event of lodging of an embolus into a narrow capillary vessel of an arterial bed which causes a blockage in a distant part of the body.Embolization is...
and all results thereof. Drug injection is also commonly a component in HIV-related syndemic
Syndemic
Syndemic refers to the aggregation of two or more diseases in a population in which there is some level of positive biological interaction that exacerbates the negative health effects of any or all of the diseases...
s. Fragments from injection of pills are known to clog the small blood vessels of the lungs, brain and elsewhere. A small proportion of pulmonary embolism
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
(PE) is due to the embolization of air, fat, talc in drugs of intravenous drug abusers. Hitting arteries and nerves is dangerous, painful, and presents its own similar spectrum of problems.
Modifications
Particularly for intravenous administration, self-injection in the arm can be awkward, and some people modify a syringe for single-handed operation by removing the plunger and affixing a bulb such as from a large dropper or baby pacifier to the end of the barrel to in effect make it a large dropper with a needle affixed. This is therefore a variant of the common method of injection with a dropper with the hypodermic needle affixed, using a "collar" made of paper or other material to create a seal between the needle and dropper. Removing part of the plunger assembly by cutting off most of the shaft and thumb rest and affixing the bulb to the end of the barrel, thereby allowing the bulb to operate the plunger by suction, also does work in many cases.An alternative to syringes in the 1970s was to use a glass medicine dropper
Pasteur pipette
Pasteur pipettes, also known as droppers or eye droppers, are used to transfer small quantities of liquids. They are usually glass tubes tapered to a narrow point, and fitted with a rubber bulb at the top. The combination of the Pasteur pipette and rubber bulb has also been referred to as a teat...
, supposedly easier to manipulate with one hand. A large hairpin was used to make a hole in the skin and the dropper containing the drug (usually heroin) was inserted and the bulb squeezed, releasing it into the tissues. This method was also reported, by William S Burroughs and other sources, for intravenous administration at least as far back as 1930.
Alternatives
Snorting or sniffing (insufflation or nasal ingestion) is usually safer than injection in terms of the relative danger of transmission of blood-borne viruses. However, the membranes in the nose are very delicate and can rupture when snorting so users should have their own snorting equipment not shared with anyone else, to prevent viral transmission. As with injection, a clean preparation surface is required to prepare a drug for snorting. Nasal membranes can be seriously damaged from regular snorting.Drugs can also be smoked (e.g., tobacco or marijuana alone or mixed with heroin) or 'chased' (originating from 'chasing the dragon' - inhaling the vapors of the heated drug, or perhaps from following the heroin as it slides down the foil). Smoking and chasing have negligible risk of bacterial or viral transmission and the risk of overdose is lessened compared to injecting, but they still retain much of the 'rush' of injecting as the effects of the drug occur very rapidly. Chasing is a far safer way to use heroin than injecting, with the best option being to use new aluminum foil, first passing a cigarette lighter flame over both sides to help sterilize it.
Swallowing tends to be the safest and slowest method of ingesting drugs. It is safer as the body has a much greater chance to filter out impurities. As the drug comes on slower, the effect tends to last longer as well, making it a favorite technique on the dance scene for speed and ecstasy. People rarely take heroin orally, as it is converted to morphine in the stomach and its potency is reduced by more than 65% in the process. However, it is well known that oral bioavailability
Bioavailability
In pharmacology, bioavailability is a subcategory of absorption and is used to describe the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. By definition, when a medication is administered...
of opioids is heavily dependent on the substance, dose, and patient in ways that are not yet understood. Pills like benzodiazepines are best swallowed as they have talc or wax fillers in them. These fillers won't irritate the stomach, but pose serious health risk for veins or nasal membranes.
Shebanging involves spraying the dissolved drug into the nose to be absorbed by the nasal membrane.
Plugging, or rectal ingestion, relies on the many veins in the anal passage passing the drug into the blood stream quite rapidly. Some users find that trading off some of the 'rush' for fewer health risks is a good compromise. Shafting usually involves about 1.5 ml of fluid mixed with the drug.
Women have the added option of shelving, where drugs can be inserted in the vagina. This is similar to the rectum, in that there are many blood vessels behind a very thin wall of cells, so the drug passes into the bloodstream very quickly. Care should be taken with drugs such as amphetamine that may irritate the sensitive lining of the rectum and vagina.
Substances below a certain molecular weight can be absorbed through the skin and into the bloodstream when dissolved in the solvent dimethyl sulfoxide
Dimethyl sulfoxide
Dimethyl sulfoxide is an organosulfur compound with the formula 2SO. This colorless liquid is an important polar aprotic solvent that dissolves both polar and nonpolar compounds and is miscible in a wide range of organic solvents as well as water...
(DMSO) which is available as liquid or gel; there therefore exists the possibility of creating a topical concoction with medical-grade DMSO and a given drug which will solve the first pass and GI tract destruction problems in addition to faster onset of effects.
History
IV drug use is a relatively recent phenomenon arising from the invention of re-usable syringeSyringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
s and the synthesis of chemically pure morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
and cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
.
It was noted that administering drugs intravenously strengthened their effect and since such drugs as heroin and cocaine were already being used to treat a wide variety of ailments, many patients were given injections of "hard" drugs for such ailments as alcoholism and depression.
By the time of Aleister Crowley
Aleister Crowley
Aleister Crowley , born Edward Alexander Crowley, and also known as both Frater Perdurabo and The Great Beast, was an influential English occultist, astrologer, mystic and ceremonial magician, responsible for founding the religious philosophy of Thelema. He was also successful in various other...
intravenous drug culture already had a small, but loyal following. Sir Arthur Conan Doyle writes that Sherlock Holmes
Sherlock Holmes
Sherlock Holmes is a fictional detective created by Scottish author and physician Sir Arthur Conan Doyle. The fantastic London-based "consulting detective", Holmes is famous for his astute logical reasoning, his ability to take almost any disguise, and his use of forensic science skills to solve...
used to inject cocaine to occupy his mind between cases.
Origin and early use
The hypodermic needleHypodermic needle
A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...
& syringe in its current form was invented by the French scientist Pravaz in 1851 and became especially known during the wars of that and the subsequent decade, although the first well-known attempt to inject drugs into the body was a 1667 attempt to inject a solution of opium into a dog, and some had suspected that parenteral administration of drugs may work better based on the practise of rubbing opium and other drugs into sores or cuts on the skin for the purpose of causing systemic absorption and the beginnings of scientific understanding of the functioning of the lungs.
During most of the 1850s, the previously-held belief that opiate dependence and addiction, often called "the opium appetite," (or when relevant the "morphine appetite" or "codeine appetite") was due to the drug's action on the digestive system—just like any hunger or thirst—caused doctors to opt to inject morphine rather than administer it orally in the hope that addiction would not develop; certainly by c.a. 1870 or earlier it was manifest that this was not the case and the title of earliest morphine addict as the term is currently understood is often given to Dr Pravaz' wife although habituation through orally ingesting the drug was known before this time, including Sertürner
Friedrich Sertürner
Friedrich Wilhelm Adam Sertürner was a German pharmacist, who discovered morphine in 1804.-Biography:He was born on 19 June 1783 in Neuhaus ....
and associates, followers, and his wife and dog. To some extent, it was also believed early on that bypassing the lungs would prevent opium addiction as well as habituation to tobacco. Ethanol in its usual form generally is not injected and can be very damaging by most routes of injection; in modern times it is used as an alternative or potentiator of phenol
Phenol
Phenol, also known as carbolic acid, phenic acid, is an organic compound with the chemical formula C6H5OH. It is a white crystalline solid. The molecule consists of a phenyl , bonded to a hydroxyl group. It is produced on a large scale as a precursor to many materials and useful compounds...
(carbolic acid) in procedures to ablate damaged nerves.
In or shortly after 1851 the drugs which had been discovered and extracted from their plants of origin and refined into pure crystalline salts soluble in water included morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
(1804 or late 1803), codeine
Codeine
Codeine or 3-methylmorphine is an opiate used for its analgesic, antitussive, and antidiarrheal properties...
(1832), narcotine/noscapine
Noscapine
Noscapine is a benzylisoquinoline alkaloid from plants of the Papaveraceae family, without significant painkilling properties. This agent is primarily used for its antitussive effects. It has also been shown to have anticancer activity...
(1803-1805?), papaverine
Papaverine
Papaverine is an opium alkaloid antispasmodic drug, used primarily in the treatment of visceral spasm, vasospasm , and occasionally in the treatment of erectile dysfunction...
(1814), cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
(1855), caffeine
Caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
(1819), quinine
Quinine
Quinine is a natural white crystalline alkaloid having antipyretic , antimalarial, analgesic , anti-inflammatory properties and a bitter taste. It is a stereoisomer of quinidine which, unlike quinine, is an anti-arrhythmic...
(1820), atropine
Atropine
Atropine is a naturally occurring tropane alkaloid extracted from deadly nightshade , Jimson weed , mandrake and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects...
(1831), scopolamine
Scopolamine
Scopolamine, also known as levo-duboisine, and hyoscine, is a tropane alkaloid drug with muscarinic antagonist effects. It is among the secondary metabolites of plants from Solanaceae family of plants, such as henbane, jimson weed and Angel's Trumpets , and corkwood...
aka hyoscine aka laevo-duboisine (1833?), hyoscyamine
Hyoscyamine
Hyoscyamine is a tropane alkaloid. It is a secondary metabolite found in certain plants of the Solanaceae family, including henbane , mandrake , jimsonweed , tomato and deadly nightshade...
or laevo-atropine (1831), opium salts mixtures (c.a. 1840s) chloral derivatives (1831 et seq.), ephedrine
Ephedrine
Ephedrine is a sympathomimetic amine commonly used as a stimulant, appetite suppressant, concentration aid, decongestant, and to treat hypotension associated with anaesthesia....
(1836?), nicotine
Nicotine
Nicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves...
(1828) and many others of all types, psychoactive and not. Morphine in particular was used much more widely after the invention of the hypodermic syringe, and the practise of local anaesthesia by infiltration was another step forward in medicine resulting from the hypodermic needle, discovered at around the same time that it was determined that cocaine produced useful numbing of the mucous membranes and eye.
A wide variety of drugs are injected, among the most popular in many countries are morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
, heroin, cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, amphetamine
Amphetamine
Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
and methamphetamine
Methamphetamine
Methamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...
. Prescription drugs, including tablets, capsules, or even liquids or suppositories, are also occasionally injected, especially prescription opioid
Opioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...
s, since some opioid addicts already inject heroin. Injecting preparations not intended for this purpose is particularly dangerous because of the presence of excipient
Excipient
An excipient is generally a pharmacologically inactive substance used as a carrier for the active ingredients of a medication. In many cases, an "active" substance may not be easily administered and absorbed by the human body; in such cases the substance in question may be dissolved into or...
s (fillers), which can cause blood clots. Injecting codeine
Codeine
Codeine or 3-methylmorphine is an opiate used for its analgesic, antitussive, and antidiarrheal properties...
into the bloodstream directly is dangerous because it causes a rapid histamine
Histamine
Histamine is an organic nitrogen compound involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. Histamine triggers the inflammatory response. As part of an immune response to foreign pathogens, histamine is produced by...
release, which can lead to potentially fatal anaphylaxis
Anaphylaxis
Anaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure...
and pulmonary edema
Pulmonary edema
Pulmonary edema , or oedema , is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure...
. Dihydrocodeine
Dihydrocodeine
Dihydrocodeine, also called DHC, Drocode, Paracodeine and Parzone and known by the brand names of Synalgos DC, Panlor DC, Panlor SS, Contugesic, New Bron Solution-ACE, Huscode, Drocode, Paracodin, Codidol, Didor Continus, Dicogesic, Codhydrine, Dekacodin, DH-Codeine,...
, hydrocodone
Hydrocodone
Hydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is an orally active narcotic analgesic and antitussive...
, nicocodeine
Nicocodeine
Nicocodeine is an opiate derivative, closely related to dihydrocodeine and the codeine analogue of nicomorphine developed as a cough suppressant and analgesic. It is not commonly used in most countries, but has activity similar to other opiates. Nicocodeine and nicomorphine were introduced in the...
, and other codeine-based products carry similar risks. To minimize the amount of undissolved material in fluids prepared for injection, a filter of cotton or synthetic fiber is typically used, such as a cotton-swab tip or a small piece of cigarette filter.
Some manufacturers add the narcotic antagonist
Opioid antagonist
An opioid antagonist is a receptor antagonist that acts on opioid receptors.Naloxone and naltrexone are commonly used opioid antagonist drugs which are competitive antagonists that bind to the opioid receptors with higher affinity than agonists but do not activate the receptors...
naloxone
Naloxone
Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory...
or the anticholinergics atropine
Atropine
Atropine is a naturally occurring tropane alkaloid extracted from deadly nightshade , Jimson weed , mandrake and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects...
and homatropine
Homatropine
Homatropine is an anticholinergic medication that inhibits muscarinic acetylcholine receptors and thus the parasympathetic nervous system...
(in lower than therapeutic doses) to their pills to prevent injection. Unlike naloxone
Naloxone
Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory...
, atropine does indeed help morphine and other narcotics combat neuralgia
Neuralgia
Neuralgia is pain in one or more nerves that occurs without stimulation of pain receptor cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central...
. The atropine may very well not present a problem, and there is the possibility of atropine content reduction of soluble tablets by placing them on an ink blotter with a drop of water on top, then preparing a shot from the remainder of the pill. Canada and many other countries prohibit manufacturers from including secondary active ingredients for the above reason; their Talwin PX
Pentazocine
Pentazocine is a synthetically prepared prototypical mixed agonist-antagonist narcotic drug of the benzomorphan class of opioids used to treat moderate to moderately severe pain...
does not contain naloxone. However, as a narcotic agonist-antagonist
Agonist-Antagonist
In pharmacology the term agonist-antagonist is used to refer to a drug which exhibits some properties of an agonist and some properties of an antagonist In pharmacology the term agonist-antagonist is used to refer to a drug which exhibits some properties of an agonist (a substance that fully...
, pentazocine and its relatives can cause withdrawal in those physically dependent upon narcotics.
External links
- Fact sheets on illicit drugs including harm reduction strategies, detox and information for people affected by another's illicit drug use
- Safer injection and vein care Chicago Recovery Alliance's extremely comprehensive and well designed informational series
- United Nations Office on Drugs & Crime