The bottom of this page has information on how to find out if it's legal to purchase needles in your area, if they are considered drug paraphernalia, as well as locating needle exchanges near you. If you use needles (or plan to use needles any time soon), I highly recommend you read this page in its entirety. Whether you're a seasoned IV user or just starting out, there is likely information here that will save you from potential suffering - be it mild or severe.
Choosing a Needle
Ideally, each needle you use should pierce your skin only once. Reusing needles greatly increases your risk of damaged or collapsed veins. Every time a needle goes under your skin, it is being damaged - even if you were unable to inject the substance. If it hurts more than usual as the needle moves deeper, or if the needle takes a notable amount of pressure to pierce the skin, you should switch needles.
Never use a needle that has been used by someone else, even if they do not believe they have any diseases. Never use a needle that has been bent, or potentially damaged in any way. Never try to resharpen needles with any method. There is no reliable way to sharpen needles, and attempts can create tiny spurs on the needle which can get caught under your skin or in your vein, and can cause serious damage.
Most IV users use 29-31 gauge needles that are between 5/16"-1/2". In areas where you can buy insulin syringes over the counter, the pharmacist always asks what size you prefer. Smaller needles are better for hitting smaller surface veins, while larger ones are better for sightly deeper veins. If you are planning on injecting for the first time and have easy access to needles, getting needles in two different lengths will probably be helpful.
Ideally, each needle you use should pierce your skin only once. Reusing needles greatly increases your risk of damaged or collapsed veins. Every time a needle goes under your skin, it is being damaged - even if you were unable to inject the substance. If it hurts more than usual as the needle moves deeper, or if the needle takes a notable amount of pressure to pierce the skin, you should switch needles.
Never use a needle that has been used by someone else, even if they do not believe they have any diseases. Never use a needle that has been bent, or potentially damaged in any way. Never try to resharpen needles with any method. There is no reliable way to sharpen needles, and attempts can create tiny spurs on the needle which can get caught under your skin or in your vein, and can cause serious damage.
Most IV users use 29-31 gauge needles that are between 5/16"-1/2". In areas where you can buy insulin syringes over the counter, the pharmacist always asks what size you prefer. Smaller needles are better for hitting smaller surface veins, while larger ones are better for sightly deeper veins. If you are planning on injecting for the first time and have easy access to needles, getting needles in two different lengths will probably be helpful.
Choosing an Injection Site
You will want to choose a vein which you can see and feel pushing against the skin a bit, that also has a clear direction. You should be able to discern the direction in which the vein travels for at least an inch. Never inject into an artery, or into your neck. Injecting into arteries may seem easier due to their notable size, but that doesn't make it safe. Injecting into arteries carries a much higher risk of serious damage, and is less effective for achieving a high. Due to its proximity to your brain, injecting into your neck can cause seizures, or halt blood flow to your brain. There is advice on how to tell if your needle has entered a vein in the injection instructions below.
The step of actually accurately finding and hitting your veins varies in difficulty for different people. Females, as well as males with lower muscle mass, tend to have more trouble with finding veins. If you look at your arm, and can clearly see your veins, you probably won't have too much trouble. If the veins appear buried under the skin, or you can't see them at all, then it may be more difficult. Slapping your arm where the veins are is a common thing done in media, but doesn't actually work. Laying down with your arm hanging below the rest of your body, or very brief exercise (anything aerobic) with a tourniquet on, will cause blood to pool in the veins, raising them.
Generally, the easiest veins for beginners are in the crook of the elbow, though you should attempt to vary your injection sites if you're injecting frequently. Easily visible veins which aren't very far under the skin can move around fairly easily, so it is helpful to have someone who can hold it in place by lightly touching it an inch or two above the injection site while the needle enters the vein.
The step of actually accurately finding and hitting your veins varies in difficulty for different people. Females, as well as males with lower muscle mass, tend to have more trouble with finding veins. If you look at your arm, and can clearly see your veins, you probably won't have too much trouble. If the veins appear buried under the skin, or you can't see them at all, then it may be more difficult. Slapping your arm where the veins are is a common thing done in media, but doesn't actually work. Laying down with your arm hanging below the rest of your body, or very brief exercise (anything aerobic) with a tourniquet on, will cause blood to pool in the veins, raising them.
Generally, the easiest veins for beginners are in the crook of the elbow, though you should attempt to vary your injection sites if you're injecting frequently. Easily visible veins which aren't very far under the skin can move around fairly easily, so it is helpful to have someone who can hold it in place by lightly touching it an inch or two above the injection site while the needle enters the vein.
Considering the Substance and Dose You Plan To Inject
Remember that using a substance intravenously has, by definition, 100% bio-availability than any other ROA. If you have been smoking or snorting a substance and have decided to try intravenous administration, you should research the approximate bio-availability of the ROA you have been using, for the substance you've been using. Using this information, you can decide upon a safe intravenous dose. For example, heroin is about 44–61% bio-available when smoked, so if you want to inject it instead (which is 100% bio-available), a safe intravenous dose will be around one third of how much you would usually smoke.
Remember the golden rule of substance use: You can always take more, but you can never take less.
Remember the golden rule of substance use: You can always take more, but you can never take less.
Also, the following injection procedure works very well for heroin, meth, cocaine, and other street drugs. What this procedure is not meant for is any kind of pill. Pills tend to have fillers that are insoluble in water, and can clog veins. This can lead to clots or necrosis, both of which are very serious and often require surgery. Though removing fillers from opiate pills with a cold water extraction makes them safer to take in recreational doses orally, it doesn't necessarily make them safe to inject. If you do want to inject powdered pills, please use a wheel filter.
----------- What Do I Need? -----------
- Clean hands.
- A clean, unused, undamaged needle.
- A second needle - this one doesn't need to be new, as long as it isn't clogged.
- Alcohol swabs for wiping down the injection site before and after each attempt.
- Something form of tourniquet you can use to tie off the limb you will be injecting into. Rubber tourniquets, which are available at most needle exchanges, are ideal.
- A clean filter. You should use a new one for each injection. The ideal filter would be dental microfiber, but cotton will also work. Cigarette filters are not sterile, and though they are a commonly used last resort filter, they should never be used if the cigarette has been smoked.
- Clean water. A container of sterile water would be ideal - these are given out at needle exchange programs, as well as being available online and in some drug stores.
- A clean place where you can mix your substance with water, and heat if necessary (also known as a "cooker"). Many people use spoons for this purpose, and most needle exchanges have other forms of cookers available.
- A safe place to put used needles. Sharps containers are available at most needle exchanges,
- Ideal: A friend who can help you, or do the whole injection procedure for you.
- Ideal for Heroin Use: Some form of nalaxone (Narcan).
----------- Preparing the Shot -----------
- Put a small amount of water and your substance into the cooker, mix, and heat if necessary. For intravenous heroin use: Heroin itself is completely water soluble, so anything that doesn't dissolve without heat, likely isn't something you want to be injecting. So though using heat may kill some bacteria present in the substance and speed up the dissolving process, it can also introduce other potentially dangerous contents into your body. Always keep in mind that intravenous use is 100% bio-available, and you can rarely be sure exactly how potent a substance is.
- Put a pea-sized filter into the solution.
- Use your secondary needle (often called a "draw-up needle"), the one that won't be going under anyone's skin, to draw the liquid out of the cooker. Make sure that the tip of the needle is pushed into the filter such that the liquid would have to pass through the filter in order to go into the needle. It is important to use separate needles for drawing up and for injecting because it is very easy to scrape the bottom of the cooker as you draw up the substance, which damages the needle.
- Check the syringe to make sure there are no chunks of anything whatsoever.
- Transfer the solution from the draw-up needle to the fresh needle by removing the plunger of the fresh needle, and squirting the solution though the draw-up needle into the back of the fresh one. you can then replace the plunger of the fresh needle - pushing it in only enough to make a seal - turning the new needle sharp side up, waiting for the solution to fall down, and slowly pushing out the large air pocket. Make sure that this needle is able to draw up and push out air.
- Despite what you may have heard from myths and movies, a tiny bubble of air injected into a vein won't actually kill you. Though you obviously should do your best to avoid injecting any air, you also shouldn't be too worried if a small amount is left in the syringe.
----------- Injection Procedure -----------
1. Tie Off
Make yourself a very simple tourniquet that can be released quickly, since you will need to remove the tie while the needle is still in your vein. A simple way to do this is to put a loop at one end of a piece of chord, and thread the other end through this loop with the chord around your limb. If you have a rubber tourniquet - which are available at most needle exchanges - you can simply tie half a knot such that pulling one end removes the tourniquet. When tying off, you want the tourniquet to be 4-6 inches above your injection site, in order to maximize swelling of the veins. The tourniquet should be tight enough to feel, but shouldn't make the limb go numb.
2. Sterilize
Wipe down the injection site with an alcohol swab.
3. Insert the Needle
Push the needle into your chosen site with the hole (bevel) pointing up, and with the needle pointing in the direction of blood flow (towards the heart). A 25° degree angle is usually recommended, but deeper veins can require a slightly steeper angle. There is never a reason to go in at more than 45° angle. Never change the angle of the needle, or the position of your limb, once the needle is under your skin. This is called "digging", and this greatly increases the risk of vein damage.
Push the needle into your chosen site with the hole (bevel) pointing up, and with the needle pointing in the direction of blood flow (towards the heart). A 25° degree angle is usually recommended, but deeper veins can require a slightly steeper angle. There is never a reason to go in at more than 45° angle. Never change the angle of the needle, or the position of your limb, once the needle is under your skin. This is called "digging", and this greatly increases the risk of vein damage.
4. Attempt to Register
Once the needle has been pushed into the area, pull the plunger back about 10 units (1/10ml); more that double this and the suction may cause damage to the vein - especially if it's a smaller vein. The two plastic pieces on the back of the syringe are good to use for support between your middle and pointer finger, while pulling back with your thumb. If blood enters the syringe as you do this, you have successfully hit a vein. Drawing blood is absolutely necessary, because it lets you know that you have actually hit a vein and aren't just injecting into surrounding tissue, which will leave a bump that can easily cause an infection. If the blood that enters that syringe is bright red or foamy (or if you feel pressure pushing the needle out), you have most likely entered an artery, and should remove the needle. If you attempt to register the needle and nothing happens, pull the needle out very slowly (without changing the angle at all, of course). If you weren't in a vein when you initially pulled the plunger back, but the needle enters a vein as you're in the process of slowly pulling the needle out out, the vacuum you created from pulling (and holding) the plunger back in your initial attempt to register the needle will cause blood to enter the syringe, and you'll be able to tell. If you pull in blood but the tip of the needle is very close to the surface, you may not be in a vein, as there is a large amount of blood in the tissue close to the surface.
If you fail to register at any depth, remove the needle and get a new one to try again. If blood enters the syringe but you accidentally remove the needle - or something else happens that leaves you with a syringe with blood mixed into the water-dissolved substance - the blood will clot in the syringe in just a few minutes. Once the blood has clotted, the substance will no longer be able to pass through the needle, and the substance in the needle will no longer be able to be injected. If the liquid in the syringe no longer moves easily around an air bubble, it's not safe to inject.
5. Inject
Once you've registered the needle, release your tie/tourniquet, and inject slowly. If you do not release your tourniquet before pushing down the plunger, the pressure from the pooled blood can damage your vein. This is why an easily releasable tie is important.
6. Remove the Needle
Slowly pull the needle out of the vein while maintaining the angle it entered at.
7. Sterilize Again
Wipe down the injection site and apply pressure to prevent bruising.
8. Clean Up
Dispose of the needle safely. Make absolutely sure you have a method you use to tell which needles you have used and which ones you haven't.
Other Important Notes
Read about how to identify and treat abscesses, a common injury resulting from intravenous substance use.
If ascorbic acid is required to dissolve the drug before injection, use vitamin C packs instead of lemon juice or vinegar. Use as little as is possible to allow the substance to dissolve.
Learn about what to do if someone is overdosing HERE. There is a drug that is available in many areas called Nalaxone (brand name Narcan), which can give a person overdosing on opiates significantly more time to gets medical attention. Read more about the availability and use of Nalaxone HERE
Needle Legality
If you are 18+ in the USA (and not in California, Nevada, New York, or New Jersey), large packages of clean needles can be obtained at pharmacies for under $15 dollars. WalMart specifically sells needles for very reasonable prices. If you are in the US, you can check the legality of needle possession in your state HERE.When looking for needle exchange programs, research all the ones in your area, and find one that specializes in harm reduction over use prevention. If you are in the US, you can find a needle exchange program near you HERE.
If you are unable to find an exchange program near you, or the program in your area doesn't have all the resources you need, check out THIS site, which carries everything a needle exchange does, and lots more!
