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Injecting powder and crack cocaine: Steps to safer preparing and injecting

This resource provides harm reduction information on how to prepare and inject powder cocaine and crack cocaine. Powder cocaine and crack cocaine are stimulants. This means that they speed the body up, which can increase heart rate, energy and alertness.

Injecting drugs can lead to a range of health issues including vein damage, blood-borne infections such as hepatitis C and HIV, and other types of blood, skin and heart infections. Injecting drugs can also lead to overdose or drug poisoning.

Using new sterile equipment and other safer injecting practices helps to lower the chance of health issues for people who inject drugs. Providing education on safer injecting practices along with a range of free harm reduction supplies can support people to use their drugs as safely as possible.

Getting ready to inject powder or crack cocaine

New equipment should be used for every injection and should not be shared or reused. This will reduce the chance of vein damage, blood-borne infections such as hepatitis C and HIV, and other types of blood, skin and heart infections.

The following equipment is recommended for injecting powder or crack cocaine:

  • alcohol swabs
  • sterile needle and syringe
  • sterile cooker
  • sterile water
  • sterile filter
  • tourniquet
  • vitamin C (if injecting crack cocaine)
  • lighter
  • post-injection dry swab

Preparing powder or crack cocaine for injection

All drugs need to be turned into a liquid to be injected. Powder cocaine dissolves well in water alone. Crack cocaine needs to be mixed with an acidifier to turn it into a liquid that can be injected. Vitamin C (ascorbic acid) is the safest acidifier for dissolving crack cocaine. Other acidifiers such as lemon juice and vinegar can cause vein irritation and lead to bacterial or fungal infections.

Both powder and crack cocaine can be dissolved in water without heat. Using heat to cook the drugs can help them dissolve and reduce the chance of infection from certain viruses and bacteria that may be present.

Service providers can give education on how to prepare powder or crack cocaine for injection by sharing the following steps and information.

How to prepare powder or crack cocaine for injection:

  • Wash hands and preparation surface with soap and water before handling harm reduction supplies. This can prevent infections caused by viruses and bacteria. Hand sanitizer or alcohol swabs can be used if soap and water are not available.
  • Add powder or crack cocaine to a new sterile cooker. The back end of a new syringe can be used to crush larger chunks.
  • Add sterile water to the cooker from a new unopened package. Using sterile water will prevent infections caused by bacteria found in tap, bottled and boiled water.
  • [For crack cocaine only] Add a small amount of vitamin C powder (about half as much as the amount of drugs) to the cooker, to help the crack cocaine dissolve. Use as little as possible because too much vitamin C can cause vein irritation.
  • Use the back end of a new syringe to stir the mixture and help it dissolve.
  • Hold a lighter or other heat source under the cooker until the liquid bubbles, at least 10 seconds. This can kill certain viruses and bacteria that may be present. Allow the liquid to cool, to help prevent vein irritation.
  • Drop a new sterile filter into the cooker directly from the package to ensure it remains sterile. Touching the filter with fingers can transfer bacteria into the drug solution.
  • Insert a new sterile needle into the flat end of the filter with the needle hole facing down. Ensure that the needle is not pushed through the bottom or side of the filter, as this can damage the needle tip.
  • Draw the liquid up into the syringe by pulling the plunger. Remove air bubbles by tapping the sides of the syringe with the needle tip pointed up and slowly pressing the plunger.

Steps to safer injecting

The following steps describe safer injecting practices for injecting any drug into a vein. Service providers working with people who inject drugs should offer education on safer injecting by sharing these steps and information:

  • Find a vein to inject into. Injecting in some veins is safer than others. Veins in the lower arm are always the first choice. Avoid veins near the torso or lower legs if possible. Injecting near the face, neck, wrist, groin and thighs can be dangerous.
  • If using a tourniquet, place it about four to five finger widths above the injection site. A tourniquet can help make veins bigger and easier to find and can hold them in place.
  • Clean the injection site with an alcohol swab, then let the skin dry. This reduces the chance of bacteria getting inside the body and can help prevent skin, blood and heart infections.
  • Insert the needle slowly and smoothly into the vein. Point the needle in the direction of the blood flowing back toward the heart. To reduce vein damage, keep the needle at a shallow angle with the needle hole facing up.
  • Pull the plunger back until blood appears. This is called flagging and it ensures that the needle is inside the vein before injecting. If no blood can be seen, the needle may need to be advanced a bit further or withdrawn slowly and checked again.
    • NOTE: It is dangerous to inject into arteries. Arteries can be identified because they have a pulse and bright red blood. Veins have no pulse and have dark red blood. Injecting into arteries will hurt and can cause bleeding that is hard to stop. To stop the bleeding, remove the tourniquet and the needle and apply direct pressure to the area.
  • Once the needle is in a vein, it is best to untie the tourniquet before pressing the plunger. This reduces the risk of missed hits and vein damage.
  • Press the plunger and inject slowly. If there is burning, stinging or pain, remove the needle and try again.
  • After injecting, remove the needle slowly and carefully.
  • Hold a post-injection dry swab or dry tissue firmly on the injection site for at least 30 seconds to stop any bleeding. Rotate injection sites to allow them to heal.
  • Put all injecting equipment in a sharps container or other hard plastic bottle, and drop it off at a local harm reduction organization for disposal.

Important info about safer use of powder or crack cocaine

Mixing different substances

There are risks with mixing drugs. Mixing different drugs can cause stronger or different effects than either drug alone. Mixing stimulants like cocaine with opioids like fentanyl or heroin increases the risk of heart attack, stroke and overdose. Different drugs also stay in the body for different amounts of time. It is important to always start with a small amount, increase slowly and use caution when using multiple doses or mixing drugs.

Safer sex

Use of cocaine and crack cocaine is associated with sex that has a higher risk of passing HIV and other sexually transmitted and blood-borne infections (STBBIs). Safer sex supplies such as condoms, gloves, barriers and lube should be offered to help reduce the chance of passing these infections. People can be referred to a healthcare provider who can prescribe PrEP (or pre-exposure prophylaxis), which is a pill that is used to prevent getting HIV. PrEP does not prevent any other infections.

Stimulant overamping

Signs of overamping from stimulant use may include rapid heart rate or chest pain, rigid or jerking limbs, skin feeling hot or sweaty, anxiety, agitation and hallucinations. If someone is overamping, try to help the person calm down, cool down and rest. Emergency medical attention is required if someone has crushing chest pain or seizures, if they go unconscious or if they are not breathing. Naloxone only works on opioids and does not reverse stimulant overamping, but it is safe to use and may help if an opioid overdose is suspected.

Overdose/drug poisoning

When someone is using drugs purchased from the illegal or street supply, there is a higher chance of overdose or poisoning. People can try to prevent or prepare for an overdose by:

  • using with other people or at a supervised consumption site
  • starting with a small amount and increasing slowly
  • getting their drugs tested, if possible
  • carrying naloxone and knowing how to use it

Naloxone temporarily reverses an opioid overdose. A person may be having an opioid overdose if they are unresponsive or unconscious, have slow or no breathing, are snoring or making choking or gurgling sounds, have cold or clammy skin, and/or have blue or grey lips and nails.

Resources

Safer substance use video series – CATIE

Mapping the body: Choosing a vein for safer injection – CATIE

Sharp shooters: Harm reduction info for safer injection drug use – CATIE

Responding to an opioid overdose, responding to stimulant overuse and overdose – CATIE, Toward the Heart BCCDC Harm Reduction Services

Harm Reduction Fundamentals: A toolkit for service providers – CATIE

Connecting: A guide to using harm reduction supplies as engagement tools – Ontario Harm Reduction Distribution Program

Best Practice Recommendations for Canadian Harm Reduction Programs – Working group on best practice for harm reduction programs in Canada

Acknowledgement

This resource is adapted from CATIE’s Safer Substance Use Video Series and Connecting: A Guide to Using Harm Reduction Supplies as Engagement Tools by the Ontario Harm Reduction Distribution Program (OHRDP). CATIE thanks the reviewers who contributed their expertise to this resource.