A Guide To Intravenous Use
It’s common for people who use drugs to inject their drugs intravenously. It has a fast onset and you don’t need to use as much to achieve the same high as other routes of administration, such as smoking or snorting. However, intravenous use also presents a unique risk for error and infection, especially when you’re shooting yourself up.
Depending on another person to shoot you up takes away your autonomy to choose how and when you get high. This also puts you at risk for being taken advantage of. Learning how to shoot up yourself allows you to be in control. What can be the most intimidating part of shooting is properly anchoring the needle into the vein and registering.
Registering refers to pulling the plunger up slightly to confirm whether the needle tip is fully in the vein, or anchored. If there is a small amount of darker red blood that comes into the syringe barrel when the plunger is pulled, the needle is properly anchored. This guide will discuss the environment you choose to use in, supplies (tourniquet, needle sizes, skin cleansing and after care needs), selecting a vein including rotating injection sites, and tips on safer injection drug use.
Preparing to Shoot
Choosing Where to Shoot
Both the environment where you are shooting up and the location on your body are important things to consider. If you need to use in an open area with lots of foot traffic, shooting in your hands may seem like the more discreet and convenient option. However, there are thinner veins in the hands and feet, so there is an increased risk of trauma if you are rushed and need to “slam” (inject very quickly) your shot due to lack of privacy. If you’re able to use in a bathroom or another private place, this is ideal as you may be more likely to shoot in the arms using a tourniquet. How you shoot up will depend on your situation at the moment. Knowing what veins are available to you and what risks come with them can help you prevent infection and scarring in your veins.
Shooting in the arms is the safest option as these veins are accessible and easier to plump up when shooting due to the arms being closer to the heart than legs. Shooting when veins are hydrated and plumped up is the safest way to shoot up. It’s also important to rotate which arm and
injection sites you use to keep those veins healthy and from collapsing. The hands and feet are riskier because the veins in the hands are thinner and more delicate. This makes hands more likely to bruise and increases the chances of track marks. Legs can be convenient for hiding track marks.
The groin area is a risky place to shoot. This is because of the large femoral vein that passes close to the femoral nerve and artery. These are structures that supply blood and feeling to the legs and feet. Damage to these structures with a missed shot could be devastating. It is very hard to see the femoral vein so if you plan on using in the groin, you should be somewhere you can take your time and properly shoot. This is a high risk area and shouldn’t be done in a rush.
It is riskiest to shoot in your neck veins. These veins are close to the carotid arteries which bring blood directly to the brain. Hitting these arteries can be fatal because damage to the jugular veins will affect blood circulation to the brain. Also, infections (cellulitis or abscesses) in this part of the body can compress your airway and cause you to suffocate. Track marks in the neck are also very difficult to hide.
Choosing where on your body to inject can be overwhelming. It’s beneficial to know what potential risks are associated with injecting in different areas of your body. In addition, proper preparation before injecting can help preserve vein health and lessen the risk of life threatening infections such as bacterial infections (sepsis, endocarditis, osteomyelitis, ect) which will be discussed later in this guide.
Vein Prep
As stated, even though intravenous use may be an efficient route of administration, it is the riskiest way to use drugs. Constantly piercing into veins and missing shots opens up the potential for infections, abscesses, and vein damage. There are precautionary steps you can take before shooting up to improve chances of getting successful shots and minimize health risks.
Assuming your drugs are prepped for use, the next steps will be to hydrate and get your blood pumping. You can try running warm water or using a hot compress on the injection site, any form of exercise that is possible to increase your heart rate and blood flow (jumping jacks,
push ups, bicep curls, etc.), and drinking lots of water. You know you are hydrated if your urine is clear and you are not thirsty. You can also work with gravity to bring blood to the limb by swinging or hanging it down, and then tying your tourniquet above the intended injection site. These methods can make your veins “pop out” or “plump up” because they’re filled up with blood, thus, helping with finding a vein and properly registering the needle into it.
Needle Sizes
The appropriate needle length, volume, and gauge you choose depends on what part of your body you plan to shoot in. The needle length needs to be long enough to reach the vein but not long enough to puncture all the way through the vein out the other side. Drugs injected outside or around a vein can lead to burning sensations, especially when shooting meth or coke, and can cause abscesses, infections, or a diluted high. The length of needles used intravenously will usually be 1/2” or 5/16”. 1/2” syringe tips are usually used to shoot into limbs and 5/16” syringe tips are usually used for more delicate veins on hands and feet. Gauge refers to the thickness of the needle- the higher the gauge the thinner the needle. Thinner needles are better suited for the delicate veins in the hands and feet. Lastly, 1/2cc vs 1cc refers to the barrel size which dictates how much liquid will enter the syringe. A larger barrel can help with diluting a shot and possibly saving half a shot for later. A smaller barrel is appropriate for less liquid being shot into your veins.
Tourniquets
Tourniquets are useful tools that can aid in finding veins all over your body by decreasing blood flow just enough to dilate veins. Shooting up when your veins are hydrated and dilated can preserve vein health, make anchoring easier, reduce the risk of infection, and reduce track marks– it’s the safest way to inject. Shooting when veins are dilated and plumped up also reduces the chance of a vein “rolling” or moving away as you’re inserting the needle. With the ledge of a table below the tourniquet and above the injection sight, you can hold a rolling vein still to anchor into it.
It’s important to only keep tourniquets on for the least amount of time possible to avoid cutting off blood flow for too long- ideally less than 60 seconds is recommended. Tourniquets shouldn’t be applied too tightly or too loosely. They need to provide a light squeeze to slow, not stop, the blood flow and allow veins to get bigger. However, you still need to be able to feel your pulse. Applying a tourniquet too tightly will cut off blood flow completely and applying
them too loosely is no help at all.
A common mistake is taking the tourniquet off at the wrong moment. Tourniquets need to be released AFTER you’ve confirmed you’re anchored in the vein. This is done by pulling the plunger back and having blood rush into the barrel. The tourniquet should be released BEFORE the plunger is fully pushed down because the blood carrying your drugs must be able to travel past the tourniquet. If it can’t, the vein can tear at the injection site causing a missed shot, your drugs to leak out, swelling, bruising, or resistance when trying to push the plunger down.
One common reason some people prefer not to use tourniquets is because they’re hard to take off yourself. There are ways to tie them on that make the release simple with one swift motion. This video is a good example of how to use a tourniquet on yourself: NUAA presents Tourniquet techniques for safer using
Tourniquets can get blood on them while being used, so try to avoid sharing tourniquets, or any other supplies, as this can spread bloodborne pathogens. Ideally they’re a single use item, but if tourniquets need to be reused, use alcohol, bleach, or soap and warm water to sanitize them. If tourniquets are not available, wrapping something, like a scarf, that can be easily removed right before you push the plunger can be a good substitute. Belts are not recommended as tourniquet substitutes as they can be difficult to remove at the appropriate time in one swift motion.
Being able to take the time to prepare your veins and properly use a tourniquet to locate an injection site can be difficult, especially, if you’re experiencing withdrawal. Sniffing a small amount of your drugs can settle you enough to concentrate and reduce shaking. Check the usability of your veins before you begin breaking skin with the needle. Preparation can bring veins closer to the surface and dilate them, which decreases the chances of wasting your shot.
Finding the Right Vein
Your injection site should be about two inches below your tourniquet. Once your tourniquet is properly placed, you should begin palpating to find a vein. Palpation means pressing against the skin to assess a vein’s depth, width, direction, and health. When choosing which vein to register into, you want to feel for elasticity and depth. The more “bounce back” the vein has, the more likely it’s a healthy and hydrated vein. Veins that are closer to the surface will be easier to properly anchor into. Wider veins can be easier to register into but they also have a greater chance of rolling.
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As an intravenous user, you may have your favorite veins to shoot in. These veins are often visible, plump, and easily located. Usually you’re able to successfully shoot up when using these veins. However, overusing the same veins is not a sustainable practice. Veins will collapse over time if used over and over again, which is why rotating the injection site is so important. Rotating injection sites also makes you practice finding new veins. It is not recommended to shoot in bruises, scabs, abscesses, or any open wounds.
The veins on one side of your body will usually mirror the veins on the other side. This means if you find a good vein on your left arm, you can likely find a vein in a similar spot on your right arm, giving you the opportunity to rest the initial injection site. If you find a good vein, you can inject in different areas along that vein to rest the initial injection wound as well, but ultimately the vein will still need to rest.
Cleaning the Injection Site
Once you’ve located your vein and have your tourniquet properly tied on, sanitize your hands with either soap and water or hand sanitizer. Right before the needle touches your skin, make sure to sanitize the injection area with an alcohol pad to avoid any bacteria on the skin being pushed into the bloodstream. This can cause potentially life threatening severe bacterial infections such as endocarditis or osteomyelitis (infections in your heart and bone, respectively). More commonly, bacteria entering the bloodstream may cause abscesses and cellulitis.
Sanitizing the injection site with alcohol wipes can remove bacteria, palpate for veins, and can make veins appear more present against the light. When using alcohol wipes, make sure to wipe in one direction and only once with one side of the wipe to avoid spreading bacteria back and forth. As you wipe, apply a small amount of pressure so while the injection sight is being cleaned, the vein is being palpated at the same time.
If possible, make sure you have extra syringes. Sometimes a syringe needs to be reinserted multiple times until you’re able to successfully register into a vein. Keep in mind that the needle will dull each time it pierces skin. A duller needle tip will cause more trauma to the skin and veins.
Syringes should be replaced regularly between each time the skin is pierced; a sharper needle will break the skin easier. Drugs can be transferred from one used syringe to a new syringe by backloading. Backloading is done by removing the plunger of the unused syringe, and transferring your drugs through the back of the barrel from the used syringe. Be careful when you are replacing the plunger on the new syringe. If your drug is by the end of the barrel, the contents of the barrel will be emptied out of the needle tip as you’re pushing the plunger in. Backloading can be confusing at first so practice this using saline or water to avoid accidentally spilling your drugs. Once you’re comfortable backloading, try doing it with your shot.
Shooting up
Breaking the skin
Before breaking the skin with the needle, it’s important to make sure the syringe is going in the direction of your heart with the bevel side of the needle facing up. The needle tip should enter your body at a 15-35 degree angle depending on the body part. Hands and feet require an angle that is more shallow because the veins here are smaller and closer to the surface. This angle should be shallow enough to keep from going through the vein and puncturing the vein wall twice, and deep enough to fully enter the vein and not result in accidental skin popping.
To register into the vein is to confirm the needle is properly anchored into the vein by drawing the plunger back slightly. If the needle IS in the vein, dark red blood will rush into the barrel of the syringe. If the needle IS NOT in the vein, very little blood or a small air pocket will appear at the end of the syringe and you will feel the plunger pull back. You will need to untie the tourniquet, remove the
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needle, and try again. If your shot has too much blood in it to be able to tell if you’re registering, dilute it with water and split the shot into a second syringe.
It is possible to accidentally inject into an artery. This is usually extremely painful and will likely cause the syringe to fill up with a bright red foam like substance that is oxygenated blood. If this happens, look for something you can use to apply pressure to slow the bleeding before removing the needle and elevate the limb.
Once you’ve confirmed that you’re anchored into the vein, remove the tourniquet and slowly push the plunger. Slamming the plunger down quickly will cause trauma to your vein walls and valves. If you aren’t properly anchored into a vein and you push your plunger, the substance will likely cause swelling, possible abscess formation, and your high will not come on as strongly or quickly.
Some people who inject, will “boot” the shot after they’ve fully pushed the plunger down. Booting is when the syringe is still anchored into the vein and the plunger is drawn up and pushed repeatedly filling and unfilling the barrel with blood. There are varying reasons people do this; either to use up whatever substance is possibly still in the barrel or to confirm that they were still anchored into the vein. Booting is not recommended because it can cause more trauma to the valves in the veins. Booting also involves lots of blood which can be more of a risk if you have no choice but to share supplies.
After Care
Clean up
Once your plunger is fully pressed, remove the needle at the same angle that it entered your body to prevent injury. It’s common practice to remove needle tips from syringes when disposing of them to avoid other people getting poked by the needle. Do not recap the needle, recapping syringes when disposing of them increases the chances that you’ll get poked by the needle tip. A safer disposal option would be to place the needle as is in a puncture resistant container like an empty water bottle or a bottle of detergent.
After your syringe or syringes are safely discarded, it’s time to clean the injection site again. Avoid using alcohol pads once an incision has been made. Alcohol will thin the blood and will cause the open wound to bleed more. Instead, stop the bleeding with pressure and a cotton ball or gauze. If available, wipe the injection site with antiseptic wipes and place a bandaid on it. Clean off any dried blood on arms, hands, or legs with warm water and soap. Hand
sanitizer can also work as a substitute if you don’t have access to running water, however it does contain alcohol. Try avoiding the puncture wound if you’re cleaning yourself off with hand sanitizer.
In the event of a missed shot, run the wound under warm water or use a warm compress on it. This will reduce the chance of an abscess or infection by encouraging blood flow to the wound. Wait until the wound closes to add any creams or salves to the injection site.
What Next?
Wait 10-15 minutes in between shots to monitor how the drugs are hitting you. Remember, you can always use more but once the drugs are in your body, they can’t be removed. If you’re planning on doing another shot, consider rotating your injection site from the vein you’ve just used. Avoid sharing syringes, tourniquets, cookers, and cottons if possible to lessen the chances of the spread of bloodborne pathogens. Do not inject in bruises, scabs, abscesses, any open wounds. Try to avoid using alone if possible and have naloxone on hand incase of accidental overdose.
Resources used:
1. https://www.usersnews.com.au/home/tourniquetrefresher-course-the-why-the-how-and-the-pitfalls
2. https://harmreduction.org/issues/safer-drug-use/ injection-safety-manual/safer-injection-basics/
3. NUAA presents Tourniquet techniques for safer using: youtube.com/watch?v=Qq63gcvWDko
4. Cleaning Works (2021)
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