Pre-fix: A guide for people with Hep C or HIV who inject drugs

Making drug use safer

Safer drug use: taking care of yourself

There are many things you can do to take care of yourself when you’re using drugs.

Find a safe place to use

Find a place that is warm, has good lighting and where you won’t be rushed, so you won’t mess up your veins. Have a friend close by who can look after you if you need it.

Learn how to inject yourself

If you don’t know how to inject yourself, ask someone you trust (for example, a street nurse or a peer worker) to show you how. When you can’t inject yourself, you are dependent on someone else to get high. You might be forced to share equipment, which increases the chance of getting Hep C (hepatitis C) or HIV. You might also be last on the 
needle and you might not get as much of the drug as you would like. Needing someone else to help you get high can give them power over you, and you may end up doing something you don’t want to do in order to get their help. Check out Safer Injection for more information on how to inject safely.

“I was lucky when I started injecting. This guy injected me first but he made me watch everything, and he said ‘You gotta know how to do this; this is the first and only time I will do this for you.’” — Jennifer

Buy your own drugs

If someone buys your drugs for you, consider making your own connection with the dealer. This way you won’t be dependent on someone else to buy you drugs if you are going into withdrawal, which may be a situation where you are more likely to share a needle or other drugs use equipment. If you are buying drugs from a new dealer, test a little bit of the drug before injecting your usual amount to make sure it feels OK in your body.

Start slow

If you haven’t used in a while or are starting Hep C or HIV treatment, it’s a good idea to start out with a small dose or a small tester shot. If you haven’t used a drug in a while because you were in jail, treatment, the hospital or for another reason, you will be more sensitive to it. Taking more than your body can handle could lead to overdose.

Stick to one drug

Sometimes people use more than one drug at a time or they use street drugs while drinking alcohol. Depending on what you are taking, this can be dangerous because different drugs and alcohol can mix in ways that are hard on your body and can lead to overdose. It is safer to take more of your favourite drug than to mix drugs.

Taking more than one downer or depressant (like alcohol, benzodiazepines, heroin and other opiates) at a time increases the risk of overdose because they slow down your breathing and heartbeat. Mixing a downer and an upper or stimulant (like crack, cocaine or crystal meth) can cause your liver to fail.

For more information on what different kinds of drugs do to your body and how to avoid an overdose, check out Information on Street Drugs.

Don’t judge yourself for using

Try not to judge yourself or get down on yourself for using drugs, even if others judge you. Some people find that they are able to use drugs more safely when they accept themselves and their drug use.

Safer drug use: taking care of others

Sharing, lending or borrowing equipment for using drugs can spread Hep C and HIV. This is because used equipment can have blood on it, and even invisible amounts of blood carrying Hep C or HIV can spread these viruses when they enter another person’s bloodstream. There are things you can do to lower the chance of passing on Hep C and HIV when using drugs:

  • Consider using drugs that you can swallow, eat or snort instead of inject because they are less risky for passing on Hep C and HIV if you share your injection equipment.
  • If you inject drugs, you can lower the risk by using new needles, syringes, cookers, filters, water, swabs and ties (tourniquets) as often as you can. You can also have your own equipment and try not to share it.
  • After you shoot, recap the needle and put it in a sealed container like a pop bottle, so nobody can use it again. Bring it to a harm reduction program or give it to an outreach worker. Do not dump it where someone could find it and get hurt.
  • If you smoke drugs, you can lower the risk by using your own pipe or stem, mouthpiece and screens and trying not to share with other people. Pyrex pipes are safest because they don’t break as easily or get as hot as other materials. Use a mouthpiece, like a piece of tubing or a rubber band. This keeps the stem cool.
  • If you snort drugs, you can decrease the risk by using your own equipment and trying not to share with anyone. Consider using items you can throw away, such as rolled up post-it notes or a straw.
  • It is not clear whether sniffing glue, gas or other solvents is linked to passing Hep C or HIV, but you can use solvents more safely. If you sniff or huff glue, gas or other solvents, use paper bags instead of plastic bags. Plastic bags can melt and be inhaled. Use your own bag. Avoid sharing it. Use a rag instead of the sleeve of your coat or shirt. Use a new rag as often as you can. Carry a sandwich bag for your rag. When you go inside a building put your rag in the bag. This will keep it moist and decrease the solvent smell. Don’t smoke cigarettes while you are huffing.
  • Learn about the signs of overdosing and how to take care of someone who is overdosing. Check out Information on Street Drugs.
“Make sure that your equipment is all yours and no one else’s. You want to share your dope? Divide it up beforehand. Don’t divide on your spoon, because even on your spoon you can catch [stuff].” — Rose

Injecting hormones? How to do it safely

Sometimes people need needles for reasons other than injecting street drugs, such as, trans people who inject estrogen or testosterone. Hep C and HIV can be passed through sharing needles used for these hormones, so try to use only your own needles. Some harm reduction programs or pharmacies carry the right size of needles for hormone injections. If you have to share a needle, check out the section What about when you can’t get new needles or injection equipment?

Dealing with pressure to share needles and other injection equipment

People who use injection drugs have come up with lots of strategies to deal with the pressure to share needles and other injection equipment. Here are some of their ideas, but you also probably have some of your own:

  • Inject drugs with a person who won’t pressure you to share needles or other injection drug use equipment.
  • Avoid situations where people will want you to share your drugs.
  • Bring extra new needles or injection equipment for other people if you are using in a group.
  • Teach the people you use with how to inject safely.
  • Encourage partners and friends to bring a “wake-up bag” of drugs so they don’t ask to share your drugs when they wake up in the morning.
  • Consider coming up with a budget for your rent, food and drugs, so you know how much money you have to spend on drugs. This will help you avoid going into withdrawal, which can lead to sharing needles because you are desperate for a fix.
“I used to be a smoker. I have my personal [pipe] and I always have a couple of spares, so if someone don’t have one or whatever I give’em one.” Nancy

What about when you can’t get new needles or other injection equipment?

Living in a rural area or any place without a harm reduction program can make it hard to get new needles and other injection equipment and not to share, but there are things you can do to be safer if you can’t get a new needle or other injection equipment:

  • Change up how you take your drugs, or try switching to drugs you can swallow (parachute), eat, smoke or snort until you can get new injection equipment. Stock up on needles, cookers, filters, water, swabs and ties when you can get to a harm reduction program. Stock up on pipes or stems, mouthpieces and screens if you inhale drugs.
  • Keep your own needle or syringe to re-use and don’t let anyone else use it. Mark it with tape, a marker or nail polish so you know it is yours. Rinse the needle with cold water after you use it so blood does not dry in the syringe and clog it. (This will not kill Hep C or HIV.) Try not to share cookers, cottons, ties, water, pipes or stems or any other equipment because blood on these items can also transmit infections.
  • If you re-use a needle, sharpening it will reduce barbs that can cause vein tears and scars. To sharpen a needle, get some clean water and a matchbook. Draw some water into the syringe. Run the bevel side (the angled edge) of the needle along the striking strip two or three times. Flip over the needle and run the tip once along the strip. Push the water out through the needle. Clean it with an alcohol swab. Before injecting, wet the needle with sterilized water to lubricate it.