A skin abscess is a build up of pus within and underneath the skin. They are common among people who use needles. Read about how to safely use needles HERE. An abscess can feel warm and painful to the touch and appear as a red raised bump. They form when bacteria is trapped under the skin. They do not always occur at the injection site, so don't pass something off because of its location. If an abscess is untreated, the bacteria can spread into the blood and deeper tissue, which can cause a large number of other health problems. Do not try to cut or squeeze the abscess.
What you can do on your own:
- Use a warm compress
- Keep the area clean
When you should go to a doctor:
- If the abscess is larger than one half inch across
- There are red streaks around the abscess
- The abscess recurs or won't heal with home treatment
Sunday, November 12, 2017
Addiction prevention
Before talking about addiction prevention, I would like to provide a concise and comprehensive explanation of addiction. Your perception, both of your emotions and of your body, is shaped by the balance of chemicals in your brain. When you use a substance which quickly changes your perception, you are altering this chemical balance. Physical addiction is when your body and brain become used to these altered chemical levels. You can become physically addicted to any substance that has the potential to cause physical dependence - even if you never used it to feel high.
Dopamine is one of the chemicals in your brain which helps motivate you to engage in healthy behaviors such as eating, socializing, and exercising. You take care of yourself, and your brain gets a bit of dopamine to encourage you to continue keeping yourself alive and well. If a person uses a dopamine-releasing drug every day, their brain will recognize that there is much more dopamine than usual, and produce less of it in an attempt to return to its normal chemical balance. But this means if they stop using this drug, their brain is no longer producing as much dopamine as it was before they started using regularly. Though it will return to that previously normal balance after a period of time (exactly how long varies by substance), the re-adjustment period is what we know as withdrawals, and it is an incredibly uncomfortable, painful, and - for some substances - dangerous process.
Psychological addiction is just as serious as physical addiction, and the two often come hand in hand. Even substances which are not physically addictive can be psychologically addictive. Psychological addiction is when a person has used a substance in order to cope for an amount of time which has lead them to lose any other coping strategies that may have previously had for dealing with stress. This could look like a person using a certain substance every time they are feeling sad. When it comes to psychological addiction, one might not even be the same substance every time, but they feel the need to use something every time they are struggling.
If you want to use recreationally without developing a dependence, there are a fair number of precautions you need to take.
1) Know the addiction potential of your drugs, and space out your use accordingly
In general, it is safe to use the same drug once every one or two weeks. This is true in terms of physical addiction and protection from bodily harm. The notable exceptions to this are MDMA and MDA, both of which are likely to cause brain damage - including but not limited to serotonin syndrome - if used more than one every 30-40 days. It is also generally inadvisable to use psychedelics this frequently, both because it often takes around two weeks for the experience to fully settle, and because of the risk of brain damage from research chemicals, or drug-induced psychosis. Make sure you feel as though you have full perspective on the impact your experience had on you before using again. Using different forms of any opioid, stimulant, or benzodiazapine, is essentially the same as using the same substance. So taking hydrocodone on Monday, and morphine on Thursday, is not adhering to the 1-2 week rule.
Of course, the 1-2 week rule can be broken while still maintaining perfect physical and emotional health - but don't forget that making exceptions to the rule should be an outlier. The moment it stops being abnormal to regularly use one substance more often than that, is when you should start to worry.
2) Keep yourself in a healthy routine
Eat 2-3 good meals every day, keep your space and body clean, exercise, sleep, and socialize. If you have work or school, prioritize punctuality and deadlines. If at any point you find your use of any drug impairing your ability to do any one of these things more than once every 1-2 weeks, it's time to cut back on your use.
3) Watch for psychological changes
Being physically well is a very helpful thing for maintaining your mental health, but there is always more you can do. Anyone who uses any substance (especially stimulants or psychedelics) on a semi-regular basis, should make sure that they consistently evaluate their mental state. Residual effects are not something that should be ignored, even if they aren't bothersome.
4) Stay away from people engaging in behaviors you do not want to take part in
Even if you feel like you have above average self-control, being around addicts is the easiest way to make yourself into one. Your environment shapes you more than you think. The other side of this, is to intentionally have people in your life who value harm reduction and safety as much as you do.
Dopamine is one of the chemicals in your brain which helps motivate you to engage in healthy behaviors such as eating, socializing, and exercising. You take care of yourself, and your brain gets a bit of dopamine to encourage you to continue keeping yourself alive and well. If a person uses a dopamine-releasing drug every day, their brain will recognize that there is much more dopamine than usual, and produce less of it in an attempt to return to its normal chemical balance. But this means if they stop using this drug, their brain is no longer producing as much dopamine as it was before they started using regularly. Though it will return to that previously normal balance after a period of time (exactly how long varies by substance), the re-adjustment period is what we know as withdrawals, and it is an incredibly uncomfortable, painful, and - for some substances - dangerous process.
Psychological addiction is just as serious as physical addiction, and the two often come hand in hand. Even substances which are not physically addictive can be psychologically addictive. Psychological addiction is when a person has used a substance in order to cope for an amount of time which has lead them to lose any other coping strategies that may have previously had for dealing with stress. This could look like a person using a certain substance every time they are feeling sad. When it comes to psychological addiction, one might not even be the same substance every time, but they feel the need to use something every time they are struggling.
If you want to use recreationally without developing a dependence, there are a fair number of precautions you need to take.
1) Know the addiction potential of your drugs, and space out your use accordingly
In general, it is safe to use the same drug once every one or two weeks. This is true in terms of physical addiction and protection from bodily harm. The notable exceptions to this are MDMA and MDA, both of which are likely to cause brain damage - including but not limited to serotonin syndrome - if used more than one every 30-40 days. It is also generally inadvisable to use psychedelics this frequently, both because it often takes around two weeks for the experience to fully settle, and because of the risk of brain damage from research chemicals, or drug-induced psychosis. Make sure you feel as though you have full perspective on the impact your experience had on you before using again. Using different forms of any opioid, stimulant, or benzodiazapine, is essentially the same as using the same substance. So taking hydrocodone on Monday, and morphine on Thursday, is not adhering to the 1-2 week rule.
Of course, the 1-2 week rule can be broken while still maintaining perfect physical and emotional health - but don't forget that making exceptions to the rule should be an outlier. The moment it stops being abnormal to regularly use one substance more often than that, is when you should start to worry.
2) Keep yourself in a healthy routine
Eat 2-3 good meals every day, keep your space and body clean, exercise, sleep, and socialize. If you have work or school, prioritize punctuality and deadlines. If at any point you find your use of any drug impairing your ability to do any one of these things more than once every 1-2 weeks, it's time to cut back on your use.
3) Watch for psychological changes
Being physically well is a very helpful thing for maintaining your mental health, but there is always more you can do. Anyone who uses any substance (especially stimulants or psychedelics) on a semi-regular basis, should make sure that they consistently evaluate their mental state. Residual effects are not something that should be ignored, even if they aren't bothersome.
4) Stay away from people engaging in behaviors you do not want to take part in
Even if you feel like you have above average self-control, being around addicts is the easiest way to make yourself into one. Your environment shapes you more than you think. The other side of this, is to intentionally have people in your life who value harm reduction and safety as much as you do.
Cold water extraction
What is a cold water extraction?
A cold water extraction is a very simple method of separating two substances by water solubility.
When should I use a cold water extraction?
You should use a cold water extraction any time that the amount of filler in a prescription opiate would lead to an overdose if you took the dose of the opiate you intend on taking. The most common fillers are acetaminophen and acetylsalicylic acid (asprin). 4,000mg of acetaminophen is considered toxic and puts you at risk of liver damage, but the overdose threshold is around 8,000mg. 150-300mg of acetylsalicylic acid is considered dangerous, and the lethal dose is around 500mg.
How does it work?
Opiates - including fentanyl - are much more water soluble than the common fillers in prescription opiates, so when you use this method you will have water with the active ingredient in the pill, and solid filler which you can filter out. Cold water extractions will work to filter non-opiate material out of pressed pills.
1- Get hot water.
Water from the tap is fine, as long as it's potable. If the water is too hot to touch, it may break down the opiates. You will want around 5-10ml of water per pill, depending on the quantity of filler. Never use more than 500ml of water for a single dose.
2- Crush the Pill(s).
Crush up the pill(s) the best that you can in a separate container.
3. Mix Into Water.
Mix the crushed pill(s) into the warm water. The powder should be as evenly distributed as you can get it to be.
4. Chill the Solution
Put the mixture in the freezer for at least 20 minutes, but don't wait long enough for it to freeze
5. Strain
The solid leftover is the filler you don't want, and the opiates are dissolved into the water. You can use a coffee filter or other similar object to strain out the filler material. Squeeze lightly to get all the liquid out of the filter.
A cold water extraction is a very simple method of separating two substances by water solubility.
When should I use a cold water extraction?
You should use a cold water extraction any time that the amount of filler in a prescription opiate would lead to an overdose if you took the dose of the opiate you intend on taking. The most common fillers are acetaminophen and acetylsalicylic acid (asprin). 4,000mg of acetaminophen is considered toxic and puts you at risk of liver damage, but the overdose threshold is around 8,000mg. 150-300mg of acetylsalicylic acid is considered dangerous, and the lethal dose is around 500mg.
How does it work?
Opiates - including fentanyl - are much more water soluble than the common fillers in prescription opiates, so when you use this method you will have water with the active ingredient in the pill, and solid filler which you can filter out. Cold water extractions will work to filter non-opiate material out of pressed pills.
Steps
1- Get hot water.
Water from the tap is fine, as long as it's potable. If the water is too hot to touch, it may break down the opiates. You will want around 5-10ml of water per pill, depending on the quantity of filler. Never use more than 500ml of water for a single dose.
2- Crush the Pill(s).
Crush up the pill(s) the best that you can in a separate container.
3. Mix Into Water.
Mix the crushed pill(s) into the warm water. The powder should be as evenly distributed as you can get it to be.
4. Chill the Solution
Put the mixture in the freezer for at least 20 minutes, but don't wait long enough for it to freeze
5. Strain
The solid leftover is the filler you don't want, and the opiates are dissolved into the water. You can use a coffee filter or other similar object to strain out the filler material. Squeeze lightly to get all the liquid out of the filter.
Drug-Induced Delusions and Paranoia
The information on how to help is something which applies to anyone experiencing a frightening delusion and or hallucination. But in a substance use context, there is one major difference - their distress will fade as the substance slowly exits their system. Unless of course they have done serious and permanent brain damage, which is incredibly unlikely and, for everyone's emotional well-being, shouldn't be considered a possibility until at least 4-5 days without the use of any psychoactive substance. In this section, when I talk about delusions and paranoia, I am assuming it will pass as the high passes. Read the section on drug-induced psychosis to learn more about the substances and circumstances which present higher risks of these kinds of symptoms persisting.
Before I get into how to help someone, I'm going to talk briefly about when to help someone. Delusions caused by drug experiences are not inherently dangerous, and just because someone doesn't entirely know what is real, doesn't always mean they need help. Attempting to assist someone when they aren't a danger to themselves or others in some way (including psychological harm), can end up doing them more harm than good. A harmful temporary delusion is one which does one of the following:
- Consistently causes or increases paranoia
- Makes one believe they should or need to harm themselves
- Makes one believe that someone believe they need to (or may need to) harm someone else
- Leads them to want to do something reckless and or illegal
- Appears to be resulting in traumatizing amounts psychological distress
Paranoia is the urgent certainty that is something is wrong, and someone or something is trying to hurt you, regardless of circumstance. When someone is experiencing paranoia about a specific thing, it is not because their belief makes them feel paranoid - it is because their paranoia has cultivated and reinforced the belief. This is important to remember, because Someone who is feeling paranoid is very likely to associate any stress they feel with their paranoia. So, when someone feels that this malicious intent is being expressed by some sort of authority figure - regardless of whether that authority figure actually exists or is present - it is very likely that asking about or suggesting the involvement of any authority figure (police, doctors, family members, etc.), may lead to the person believing that you are trying to harm them as well. For the most part, the things which help a person with delusions will help someone with paranoia, but it is important to understand it as a separate issue.
There are a few specific things you can try to remember if you catch yourself having a delusional thought, or know some substances sometimes lead you personally to experience delusions.
If you know more than you should, it probably isn't real.
Many hallucination accompanied delusions are ones in which you hallucinate, for example, footsteps on your back porch. When you hear those footsteps, you feel that you know it is a seven-foot tall man in a long black collared coat, and he is picking the lock. In fact, you can almost perfectly picture it. You might feel you know what someone is planning or thinking. Attempting to explain to yourself how it is that you know what you know, is one of the most effective ways to prevent yourself from forming a delusional belief. Just remember not to help yourself flesh out the delusion.
If it's all about you, it probably isn't real.
This applies to things like "the FBI is watching me", where you might think a person or group of people are putting a lot of effort into trying to harm or monitor you. That would really be a ton of focus on you, when you haven't done anything or ever been confronted by anyone.
If everything suddenly makes sense but you've never had this idea before, it probably isn't real.
That feeling of intense, horrifying realization, rarely if ever occurs in real life. The pieces of the puzzle that was why you felt uncomfortable or afraid, should not suddenly float together in front of your eyes.
Before I get into how to help someone, I'm going to talk briefly about when to help someone. Delusions caused by drug experiences are not inherently dangerous, and just because someone doesn't entirely know what is real, doesn't always mean they need help. Attempting to assist someone when they aren't a danger to themselves or others in some way (including psychological harm), can end up doing them more harm than good. A harmful temporary delusion is one which does one of the following:
- Consistently causes or increases paranoia
- Makes one believe they should or need to harm themselves
- Makes one believe that someone believe they need to (or may need to) harm someone else
- Leads them to want to do something reckless and or illegal
- Appears to be resulting in traumatizing amounts psychological distress
Helping With Intoxication-Induced Paranoia
Paranoia is the urgent certainty that is something is wrong, and someone or something is trying to hurt you, regardless of circumstance. When someone is experiencing paranoia about a specific thing, it is not because their belief makes them feel paranoid - it is because their paranoia has cultivated and reinforced the belief. This is important to remember, because Someone who is feeling paranoid is very likely to associate any stress they feel with their paranoia. So, when someone feels that this malicious intent is being expressed by some sort of authority figure - regardless of whether that authority figure actually exists or is present - it is very likely that asking about or suggesting the involvement of any authority figure (police, doctors, family members, etc.), may lead to the person believing that you are trying to harm them as well. For the most part, the things which help a person with delusions will help someone with paranoia, but it is important to understand it as a separate issue.
Helping With Intoxication-Induced Delusions
Know when they need more help than you can give
As much as we often want to help a friend who is distressed and detached, especially when you know about or are involved in the drug use which has lead to the issue, getting any outside help can feel like something you would never even consider. But when someone is a serious danger to themselves or others and you are unable to talk them down, or physically prevent them from violence, physical safety is more important than social safety. Also, in many US states, there is a law which protects you from having drug-related legal issues if you call 911 for a drug related emergency. I discuss this in the section about overdoses.
Address their feelings before their beliefs
This is the thing you should remember, if nothing else. When someone doesn't know what is real, our first inclination is often to correct them. But this is actually one of the lowest-impact things we can do. Obviously it's worth giving a shot when you are just beginning to notice their delusion, but it should be done in the least confrontational way possible. Remember that anyone having trouble staying in touch with reality, probably needs clear and concise communication.
Remember that it isn't generally a good idea to question someone on, or even let them talk in depth about, their delusion(s). This is because delusions are often created when someone accepts ideas they momentarily have about how things may be, usually while in a state of fear, as the truth. So allowing them to talk about it, can also mean helping them expand upon their delusion. Keeping them on other subjects, and focusing on addressing the feelings it causes is the best thing you can do.
For example, if someone says to you "I think there's someone in your house, I just heard a knife being taken out of the drawer in the kitchen.", but the kitchen is in plain view as you are in a studio apartment and the door is locked, you wouldn't want to ask more about what they heard or tell them they are being silly. A good thing to say in this situation might be "I'm pretty sure you're okay, you're safe at my house - I always lock the door".
In a situation where the delusion has been present for a longer period of time and/or you don't feel it would be a good idea to present an opposing point of view, you might want to say something like "It's never a good thing to not feel safe in your own house, would it be okay with you if I got up and checked the kitchen?" or "Is there somewhere else you'd like to go?". What's important is that you don't allow them to expand on their delusion, while helping them handle their fear, or other accompanying emotion.
Suggest safe alternative actions
People with delusions sometimes think something dangerous is the safest option because they are scared. Keep them calm the best you can and help them find a safer way to feel secure. Of course, you shouldn’t agree with their delusion, but that is different from helping them feel safe even though they have that belief.
Let's say someone believed that someone was watching them through the window with the intention of coming inside to hurt them, so they wanted to run out into the front yard with a knife and confront the person. Obviously this person doesn't need to be holding something potentially dangerous, and shouldn't go outside waving around a knife and drawing attention to themselves. So you might offer to go check all the locks, close the blinds, or put something in front of the door. Just make sure you're making them feel safer, and not reinforcing the idea that they should be afraid.
Keep an eye on them
If someone experiences brief or light delusions early on after taking a psychoactive substance, make sure to check in with them. If they acknowledge the delusion after it passes, still try to focus your attention on the feeling behind it rather than the specific belief, and help them ground themselves. Do what you can to keep their mind from returning to that thought, or similar thoughts.
Helping Yourself With Delusions
There are a few specific things you can try to remember if you catch yourself having a delusional thought, or know some substances sometimes lead you personally to experience delusions.
If you know more than you should, it probably isn't real.
Many hallucination accompanied delusions are ones in which you hallucinate, for example, footsteps on your back porch. When you hear those footsteps, you feel that you know it is a seven-foot tall man in a long black collared coat, and he is picking the lock. In fact, you can almost perfectly picture it. You might feel you know what someone is planning or thinking. Attempting to explain to yourself how it is that you know what you know, is one of the most effective ways to prevent yourself from forming a delusional belief. Just remember not to help yourself flesh out the delusion.
If it's all about you, it probably isn't real.
This applies to things like "the FBI is watching me", where you might think a person or group of people are putting a lot of effort into trying to harm or monitor you. That would really be a ton of focus on you, when you haven't done anything or ever been confronted by anyone.
If everything suddenly makes sense but you've never had this idea before, it probably isn't real.
That feeling of intense, horrifying realization, rarely if ever occurs in real life. The pieces of the puzzle that was why you felt uncomfortable or afraid, should not suddenly float together in front of your eyes.
Drug-Induced Psychosis
Psychosis is what we call the condition that causes one to experience hallucinations, delusions, and detachment from reality. This is separate from specific psychotic disorders such as schizophrenia. Psychosis is just a description of a set of symptoms, which include hallucinations or delusions. This is not always serious, and most people with the symptoms of psychosis are able to function just fine with some amount of treatment.
Substance-induced psychotic disorder is defined as any psychotic episode or condition developed after excessive or continuous use of a substance. Stimulants are the class of drug which most often cause this issue, followed by hallucinogens. It is nearly expected that a stimulant binge (especially with methamphetamine) will lead to temporary psychosis. Drug induced psychosis often includes persecutory delusions, which are delusions that you are being persecuted in some way (believing you are being spied on, followed, manipulated, or that someone intends to harm you). The following lists are loosely ordered in terms of risk, starting with the most risky behavior/substance.
Factors that can put you at higher risk for drug-induced psychosis:
- Family or personal history of any psychotic disorder
- Long term stimulant or hallucinogen use
- Heavy doses of stimulants or hallucinogens
- Research chemicals
- Mixing stimulants
Drugs which are most likely to lead to drug-induced psychosis:
- 25i
- Methamphetamine
- Cocaine/Crack
- LSD
- MDMA/MDA
Psychosis is one of the more notable and obvious mental issues that can arise from drug use, but it is far from the only one. Any time you put a recreational dose of a psychoactive drug in your body, you are putting yourself at risk. It is more common than you think, and it can happen to anyone. The best way to prevent serious mental health issues while still using psychoactive substances, is to keep track of your stability and mental health. Therapy, journaling, and staying in touch with friends, are all good ways to monitor yourself. It is incredibly difficult to accurately assess the mental state of someone who is using, or has very recently used, any psychoactive drug - especially illegal ones, due to lack of regulation. So if you notice something off about yourself, take a break for whatever amount of time you feel is reasonable and analyze your sober self. Are you as capable as you were before? If you aren't, take a longer break. If it isn't a temporary ailment, you need to address it, and continuing to use could worsen the issue. Read more about maintaining your mental health while using HERE.
Substance-induced psychotic disorder is defined as any psychotic episode or condition developed after excessive or continuous use of a substance. Stimulants are the class of drug which most often cause this issue, followed by hallucinogens. It is nearly expected that a stimulant binge (especially with methamphetamine) will lead to temporary psychosis. Drug induced psychosis often includes persecutory delusions, which are delusions that you are being persecuted in some way (believing you are being spied on, followed, manipulated, or that someone intends to harm you). The following lists are loosely ordered in terms of risk, starting with the most risky behavior/substance.
Factors that can put you at higher risk for drug-induced psychosis:
- Family or personal history of any psychotic disorder
- Long term stimulant or hallucinogen use
- Heavy doses of stimulants or hallucinogens
- Research chemicals
- Mixing stimulants
Drugs which are most likely to lead to drug-induced psychosis:
- 25i
- Methamphetamine
- Cocaine/Crack
- LSD
- MDMA/MDA
Psychosis is one of the more notable and obvious mental issues that can arise from drug use, but it is far from the only one. Any time you put a recreational dose of a psychoactive drug in your body, you are putting yourself at risk. It is more common than you think, and it can happen to anyone. The best way to prevent serious mental health issues while still using psychoactive substances, is to keep track of your stability and mental health. Therapy, journaling, and staying in touch with friends, are all good ways to monitor yourself. It is incredibly difficult to accurately assess the mental state of someone who is using, or has very recently used, any psychoactive drug - especially illegal ones, due to lack of regulation. So if you notice something off about yourself, take a break for whatever amount of time you feel is reasonable and analyze your sober self. Are you as capable as you were before? If you aren't, take a longer break. If it isn't a temporary ailment, you need to address it, and continuing to use could worsen the issue. Read more about maintaining your mental health while using HERE.
Drug Interactions
As a general rule, mixing psychoactive substances is going to increase your risk of bodily harm, and should be avoided. You should always check to make sure any substances you are deciding to take together will not result in bodily harm. This includes substances which don't get you high - particularly medications prescribed to you.
Mixing alcohol with anything (Stimulants, Depressants, Opiates, and especially Benzodiazepines) except marijuana or psychedelics is very likely to cause a dangerous interaction - many people have reported unpleasant experiences mixing psychedelics and alcohol, despite lack of physical risk.
Mixing stimulants with depressants, including opiates, increases the risks that both substances carry. This risk is highest when a large amount of both substances has been taken, and lowest when only a small amount of one or both has been taken. The mixing of stimulants and depressants has also been known to cause what are often called "delusions of sobriety" in which the effects of the dissimilar substances seem to "cancel out", leaving the user feeling as though they are significantly less impaired than they actually are. This can easily lead to someone not noticing the signs of an overdose, or to deciding they are sober enough to drive when they really aren't.
Mixing stimulants with other stimulants largely increases your risk of brain damage - such as serotonin syndrome - and overdose risk.
Mixing depressants with depressants largely increases your risk of overdose.
Unusual Interactions
The following is a list of things that are harmful to ingest together, that aren't commonly mentioned:
- Alcohol & Ibuprofen
- Atorvastatin/Lovastatin/Simvastatin/Amiodarone/Aronedarone/Nifedipine/Verapamil/Felodipine, as well as certain kinds of immunosuppressants & Grapefruit or other citrus juices
- St. John’s Wort & SSRI's (Celexa, Lexapro, Paxil, Prozac, Zoloft, etc.)
- Alcohol and LSD, though physically safe to mix, are known to cause unpleasant cognitive effects
Drug Interactions Chart
Drug safety
Don't drive
Drink enough water.
Drink enough water.
Be in good physical health.
Never take unidentified pills.
Never reuse or share needles.
Avoid mixing substances in general.
Avoid mixing alcohol with anything except marijuana.
Don’t just trust anyone to tell you what a substance is.
Don’t just trust anyone to tell you what a substance is.
Be in a safe space where no one is going to bother you.
If you’re going to redose, take less than your initial dose.
Remember that you can always take more but you can never take less.
Always know what you are taking and have a general idea of the effects.
Don't go out swimming/floating/paddling on a river. A lot of people die this way.
Don't go out swimming/floating/paddling on a river. A lot of people die this way.
If you’re going to use needles really look into injection procedures beforehand.
If you are pregnant or breastfeeding, don't take anything. It's not worth the risk.
Always start with a lower dose, as purity of the substance and your tolerance vary.
Do a cold water extraction if you plan to take prescription opiates with fillers in them.
Be aware that tampons can make it more difficult for substances to flush out of your system
Don't be too lazy to do research or look up pill numbers, it's a really simple way to be more safe.
If you are pregnant or breastfeeding, don't take anything. It's not worth the risk.
Always start with a lower dose, as purity of the substance and your tolerance vary.
Do a cold water extraction if you plan to take prescription opiates with fillers in them.
Be aware that tampons can make it more difficult for substances to flush out of your system
Don't be too lazy to do research or look up pill numbers, it's a really simple way to be more safe.
Have someone with you who knows what to do if something goes wrong (ideally a sober person).
If you take any kind of medication, look up interactions it may have with a drug before mixing them.
Be aware that drugs effect your mental state, decision making, and long-term mental health. Read more HERE.
If you take any kind of medication, look up interactions it may have with a drug before mixing them.
Be aware that drugs effect your mental state, decision making, and long-term mental health. Read more HERE.
Remember that most substances take about an hour to take full effect, so please don’t increase your dose after 20 minutes because you aren’t where you want to be.
If you take two substances which both have the potential to cause nausea, your risk of feeling nauseous or vomiting increases more than you would expect from either of the substances individually.
If you are taking prescription medications, check the bottle to see what it has in it aside from the active ingredient. Sometimes you will overdose from the fillers faster than you will from the substance you are intending to use.
Don't use the same substance more than once or twice a week as you become very likely to form a physical dependence, which is hard on your body and mind. There are, of course, drugs which you cannot form a physical dependence on. Do not forget that psychological addiction is real and can be just as harmful as physical addiction. If you do find yourself with a physical dependence, you can try to ease off yourself or seek help.
If you take two substances which both have the potential to cause nausea, your risk of feeling nauseous or vomiting increases more than you would expect from either of the substances individually.
If you are taking prescription medications, check the bottle to see what it has in it aside from the active ingredient. Sometimes you will overdose from the fillers faster than you will from the substance you are intending to use.
Don't use the same substance more than once or twice a week as you become very likely to form a physical dependence, which is hard on your body and mind. There are, of course, drugs which you cannot form a physical dependence on. Do not forget that psychological addiction is real and can be just as harmful as physical addiction. If you do find yourself with a physical dependence, you can try to ease off yourself or seek help.
Drug use vs drug abuse
It is very important to recognize the difference between drug use and drug abuse. Here are a few terms and misconceptions on this topic as well as some information on the stigma around drug addiction and around non-harmful drug use.
Drug Use -
The use of any drug. This includes alcohol, tobacco, caffeine, and prescribed medication.
Drug Misuse -
Use of a legal or prescribed substance in a harmful and or unintended way. This can include taking more medication than prescribed to get high or forming harmful habits around alcohol, cigarettes, or caffeine.
Drug Abuse -
Recurrent substance use resulting in a failure to fulfill major role obligations in your school, work, home, or social life.
Addiction/dependence -
The term used to describe a situation in which a person would experience negative symptoms from immediately discontinuing use. This includes both psychological and physical repercussions. Addiction is assumed if the person has been using regularly (Once every 1-2 days) for longer than a week or two and is reluctant to stop. Addiction is also assumed if the person has gained a tolerance and needs to take more than they initially did to feel effects. It is important to note that a person does not have to be getting high to form a physical dependence on a drug. Also, psychological addiction is often co-morbid with physical addiction.
Misuse is when you use a substance in a way that it is not intended such as taking more medication than prescribed to get high or forming harmful habits around alcohol, cigarettes, or caffeine. This would turn into drug abuse if you began to experience an inability to live your life as you did before the drug use began due to the use of the substance. This could look like someone begins taking more anti-anxiety medication than prescribed and begins to ignore friends in favor of getting high.
Addiction is the point at which you experience withdrawal from discontinuing use. This happens because your brain becomes accustomed to the altered chemical levels and when they suddenly return to normal it is very unpleasant.
The answer I am sad to give to you is yes. Addiction does not always mean you are physically dependent. Psychological addiction exists and is just as harmful as physical addiction. Here are some examples of habits that aren’t physically addiction forming but CAN cause a psychological dependence:
- The use of many substances where, if all drugs had the same properties, it would form an -addiction.
- The use of a non-chemically addictive drug, such as marijuana, in a habitual and consistent way.
- Things like self-harm or purging
No one wants to be accused of encouraging risky behaviors so I will say this now: I am not telling you to use drugs. I do, however, very strongly believe in harm-reduction based education, especially in relation to substance use. I want to give you the all the facts you could need to stay safe, not just the ones that apply to legal behaviors.
Drug Use -
The use of any drug. This includes alcohol, tobacco, caffeine, and prescribed medication.
Drug Misuse -
Use of a legal or prescribed substance in a harmful and or unintended way. This can include taking more medication than prescribed to get high or forming harmful habits around alcohol, cigarettes, or caffeine.
Drug Abuse -
Recurrent substance use resulting in a failure to fulfill major role obligations in your school, work, home, or social life.
Addiction/dependence -
The term used to describe a situation in which a person would experience negative symptoms from immediately discontinuing use. This includes both psychological and physical repercussions. Addiction is assumed if the person has been using regularly (Once every 1-2 days) for longer than a week or two and is reluctant to stop. Addiction is also assumed if the person has gained a tolerance and needs to take more than they initially did to feel effects. It is important to note that a person does not have to be getting high to form a physical dependence on a drug. Also, psychological addiction is often co-morbid with physical addiction.
What is the difference between drug use and abuse?
Drug use is not always unhealthy while, by definition, drug abuse is impairing your ability to lead a normal lifestyle. It is possible to use drugs in a healthy, non life-impairing way. This applies to both legal and illegal substances. Drug use turns into drug abuse when they begin to use as an addict would, whether or not addiction has yet to form.
What is the difference between misuse and abuse?
Misuse is when you use a substance in a way that it is not intended such as taking more medication than prescribed to get high or forming harmful habits around alcohol, cigarettes, or caffeine. This would turn into drug abuse if you began to experience an inability to live your life as you did before the drug use began due to the use of the substance. This could look like someone begins taking more anti-anxiety medication than prescribed and begins to ignore friends in favor of getting high.
What does physical addiction mean?
Addiction is the point at which you experience withdrawal from discontinuing use. This happens because your brain becomes accustomed to the altered chemical levels and when they suddenly return to normal it is very unpleasant.
Can addiction exist outside of physical dependence?
The answer I am sad to give to you is yes. Addiction does not always mean you are physically dependent. Psychological addiction exists and is just as harmful as physical addiction. Here are some examples of habits that aren’t physically addiction forming but CAN cause a psychological dependence:- The use of many substances where, if all drugs had the same properties, it would form an -addiction.
- The use of a non-chemically addictive drug, such as marijuana, in a habitual and consistent way.
- Things like self-harm or purging
Is addiction always bad?
Drug addiction implies only that you are somehow dependent on the substance. There are people who smoke cigarettes and drink coffee every single day who would shake and have headaches if they stopped. These people are, in the most technical sense, addicted to drugs. Also, there are are people who are consistently taking opiates for pain and would experience withdrawal symptoms if they were to stop taking their medication. But we would not consider these people addicts in the same way we would someone smoking meth or heroin. This is the line that exists between addiction and abuse. Also, take a look at my post on misconceptions about addicts HERE to understand a bit more about the behavior of addicts.
A note before we get into this next section:
No one wants to be accused of encouraging risky behaviors so I will say this now: I am not telling you to use drugs. I do, however, very strongly believe in harm-reduction based education, especially in relation to substance use. I want to give you the all the facts you could need to stay safe, not just the ones that apply to legal behaviors.The stigma around drug education
We teach drug use in the sad and ineffective way we used to teach sex education: abstinence only. (Just kidding we still use abstinence only sex-ed in 23% of public schools in the U.S.*) It is silly to tell someone not to ever use drugs because it is bad for them in the same way it is ineffective to tell teens not to have sex because they could get an STI or cause a pregnancy. Both these things feel good but have risks and people are scared to talk about safety or experience in fear of being accused of encouraging risky behavior.Is there a difference between the use/abuse of legal and illegal substances?
Yes, absolutely. There are two main differences. The first is that most drugs that are illegal completely or only available as a prescription, have some danger of brain damage or death if used recklessly. The second, equally important difference, is there is less education on safe use. We will tell people “Don’t drink eight energy drinks in one sitting, you will get really tired and have lots of headaches and it could even be bad for your heart”. But we don’t tell people “Don’t do more than 1-2 points of ecstasy in a month because you run the risk of getting serotonin syndrome which can make life really tiring forever or even kill you”. The lack of availability of educational resourcesCan the use of illegal substances ever be helpful?
Many illegal substances have positive cognitive effects such as helping with depression or anxiety. They can also help with relaxation, sleep, and self-awareness. Of course, these positives do not erase the risks.For some ways to stay safe when using psychoactive substances, look HERE.
Ego death
Ego death is a term used to describe the highest level of memory suppression, in which you are no longer able to remember or understand conceptual information including concepts related with one's sense of self and identity. It causes your experience to be unaffected by memories, experiences, contexts, or bias, simply because you no longer have a sense of what "I" means. This does not erase the person your past has shaped you into, it only makes you not remember as it.
Fentanyl
Fentanyl is a drug that is often sold as opiates or benzodiazapines. It is a depressant, and has similar effects to these substances. It is used because it is much cheaper than any alternative. However, it is incredibly potent, and is diluted before being sold as other substances. But it is easy to misjudge how much fentanyl you're adding into heroin or putting on a pill, and even one extra drop can lead to a person overdosing from what they were told would be a safe recreational dose. Fentanyl is also the reason for the presence of areas in a substance (usually heroin) that are seemingly much more potent than the rest, or a "hot spot". You can buy fentanyl test strips HERE.
Harm reduction
Harm reduction is about focusing on education for risky drug-related behaviors, and choosing to teach people to be safe, rather than attempting to enforce abstinence. Many people use some kind of drug in their life, whether it be alcohol, marijuana, or something more illicit. When using any psychoactive substance it is important to remain safe, as there are always dangers. It is common practice to tell people how much would be dangerous to drink because it keeps them safe and aware. From a harm reduction standpoint we should treat all substances in this manner, whether they are illegal or not. By teaching people what substances do, what dangers they bring, and how to use them safely, we prevent brain damage, addiction, and death.
Mental Health and Safety in Relation to Drug Use
There are many physical risks to be aware of when using drugs, and I have talked about many of them in depth on the rest of this site. But there are also many mental/emotional/social factors to consider when using psychoactive substances. The things I talk about here are drastically more important for the hallucinogen, psychedelic, and dissociative side of things, though it can apply to any substance (Terminology). I also encourage you to take a look at my post on physical drug safety HERE.
A very very important note:
I talk about a lot of stuff in this section that may seem a little paranoid to the seasoned drug user. I would like to acknowledge that not all of these things apply to every person, for every substance, every time. These things are just generally good guidelines to follow if you have little experience, are trying something new, or if you are a nervous about your reaction. I do not want to scare you and say "drugs will make you lose control so lock yourself in a padded room and interact with no one if you must use them" because that is ridiculous and simply untrue. Intoxicated you, is still you. Nonetheless, substance use does have the ability to detach you from your memories, or awareness of social constructs, which can cause you to do things you otherwise would not. This is one of many reasons it is important to be careful with your dose and start low if you don't know what to expect, or are in a notably different setting from what you are used to.
A very very important note:
I talk about a lot of stuff in this section that may seem a little paranoid to the seasoned drug user. I would like to acknowledge that not all of these things apply to every person, for every substance, every time. These things are just generally good guidelines to follow if you have little experience, are trying something new, or if you are a nervous about your reaction. I do not want to scare you and say "drugs will make you lose control so lock yourself in a padded room and interact with no one if you must use them" because that is ridiculous and simply untrue. Intoxicated you, is still you. Nonetheless, substance use does have the ability to detach you from your memories, or awareness of social constructs, which can cause you to do things you otherwise would not. This is one of many reasons it is important to be careful with your dose and start low if you don't know what to expect, or are in a notably different setting from what you are used to.
People
When you are under the influence of a substance you are much easier to influence. If you are around people who would like to convince you of something you would not otherwise believe, it will be easier for them to change your mind if you are intoxicated. This can mean anything from someone talking you into an activity you wouldn't otherwise participate in to believing something is wrong that you would otherwise have thought was wrong. The latter is especially important to be aware of with psychedelic usage as the belief can continue to exist even after the substance is out of your system. Also, when you are intoxicated you are more likely to disclose things you otherwise would not, so keep that in mind. People you are with while under the influence should be people you have spent time with before and consider trustworthy.
Setting
Where you are can have an large impact on your emotional state while using any substance.Your setting should be somewhere private where you and anyone you're with will not be disturbed where you feel comfortable. It is also good to take into account the availability of a bathroom and kitchen. If you are with other people you should have some kind of space where you could be alone if you wanted to. It is also good to have access to both an inside and an outside area.
Aside from that, ask yourself if you would be able to do something stupid there. Intoxicated you is not usually the side of you who is diligent about physical safety. Is there a sword on the wall? Is there an 8th story balcony? Are you by a busy road? Set some limits based on these things.
Aside from that, ask yourself if you would be able to do something stupid there. Intoxicated you is not usually the side of you who is diligent about physical safety. Is there a sword on the wall? Is there an 8th story balcony? Are you by a busy road? Set some limits based on these things.
Present Life
Always remember that many substances, especially psychedelics, and to a degree alcohol, can amplify your current emotional state. If you are upset, confused, or grieving, ask yourself if you are ready to handle an amplified emotional state.
When you are under the influence of any substance, especially psychedelics, you have the chance of seeing yourself from an objective point of view. This means seeing things you have done and thought in the past with no memory of the motivations behind your choices. This state of mind can lead to individuals realizing just how badly they treated someone, or admitting something to themselves and others they otherwise would not have, this can entail things like:
- Large lies one has carried for a long time
- Cruel things you have done to others
- Cruel things you have done to others
- Substance abuse problems
- Hidden anger or love
- Sexuality/gender
- Mental illness
- Past trauma
- Guilt
Substance use not only increases the probability you may disclose these things to others but also makes them easier to admit to yourself or internalize. While that can be a good thing that helps you grow and understand who you are, if there is something in your past, or something about yourself, which you are not ready to face, maybe stay away from the psychedelic side of substances.
- Guilt
Substance use not only increases the probability you may disclose these things to others but also makes them easier to admit to yourself or internalize. While that can be a good thing that helps you grow and understand who you are, if there is something in your past, or something about yourself, which you are not ready to face, maybe stay away from the psychedelic side of substances.
Mental Health
The bad stuff:
Everything I said in the previous section applies even more in this area. Drug use can cause individuals with mental health issues to have to face how much it effects them, confront how well they have been taking care of themselves, see how their struggle has effected others, think on trauma more than they are ready to, or just plain make things worse for a little while.
Drugs in the stimulant class are worse for those with depression because the after effects (hangover) are similar to the effects of depression and it can render usually effective coping strategies useless for a day or two. This is especially true with MDA and MDMA.
I would also like to note that most people with psychosis, or psychotic disorders, often have very polarized experiences with psychedelics. If you have any type of psychotic disorder, taking into account the things from the previous sections is extra important.
Any drug which alters the reuptake or production of serotonin can cause something called serotonin syndrome which, to put it super simply, is like being stuck on the tail end of a flu. The drugs which put you at the most risk for this are cocaine/crack, MDA, and MDMA.
The good stuff:
Drug use can temporarily take away the symptoms of many mental illnesses. While this can be very compelling, it is also the reason that people with mental illnesses are much more prone to drug abuse and addiction. Healthy drug use is when you use the experience to give yourself an idea of what you want to feel like, and reach for it while sober. Substance use can help you understand what better feels like, but it cannot keep you there. One should never feel that good feelings can only be obtained through, or during, substance use.
Many psychedelics (namely psilocybin and LSD) have an "afterglow" effect where the user feels much more content with life, and themselves, for a day or two after use. Some substances, (namely psilocybin, LSD, MDA, and MDMA) can help people be more confidant and comfortable with themselves after use, both in a physical sense and in an existential sense. Psychedelics have no chemically addictive properties we have found and have even been shown to help suppress other addictions one may be struggling with. The use of psychoactive substances also gives one the experience of personal bias suppression which can give them an opportunity learn to treat people as equals and have respect for others points of view.
Anxiety:
Sometimes, people can have a lot of anxiety while using psychoactive substances, especially marijuana, and LSD. Here are a few tips on staying calm:
- Use a test kit
- Have a grounding object
- Know the possible dangers of the substance
- Close your eyes and focus on your breathing
- Keep in mind the outlined physical safety principals
- Have a person there to tell you they are making sure you are safe
- Be aware of how you can handle delusions and paranoia that may occur during use
- If this is a substance with overdose potential, know what to do in case of an overdose
Many psychedelics (namely psilocybin and LSD) have an "afterglow" effect where the user feels much more content with life, and themselves, for a day or two after use. Some substances, (namely psilocybin, LSD, MDA, and MDMA) can help people be more confidant and comfortable with themselves after use, both in a physical sense and in an existential sense. Psychedelics have no chemically addictive properties we have found and have even been shown to help suppress other addictions one may be struggling with. The use of psychoactive substances also gives one the experience of personal bias suppression which can give them an opportunity learn to treat people as equals and have respect for others points of view.
Anxiety:
Sometimes, people can have a lot of anxiety while using psychoactive substances, especially marijuana, and LSD. Here are a few tips on staying calm:
- Use a test kit
- Have a grounding object
- Know the possible dangers of the substance
- Close your eyes and focus on your breathing
- Keep in mind the outlined physical safety principals
- Have a person there to tell you they are making sure you are safe
- Be aware of how you can handle delusions and paranoia that may occur during use
- If this is a substance with overdose potential, know what to do in case of an overdose
Nalaxone (Narcan)
Nalaxone is a drug which can be administered to someone overdosing on opiates to help reverse an opiate overdose. Opiates include substances such as Heroin, Hydrocodone, Oxycodone, Morphine, and Fentanyl. It is sold in two forms, one of which is a nasal spray, and the other of which is injected. Emergency services should still be called after administering nalaxone.
The nasal spray costs much more in most places, but both forms are effective. Medicaid and most commercial health insurance plans cover at least one form of naloxone to some degree. For pharmacies, it’s best to call ahead to confirm product availability, cost, and insurance coverage. In all 50 states, nalaxone is available over the counter. For information on legality of nalaxone use, take a look at THIS site.
1. Do rescue breathing for a few quick breaths if the person is not breathing.
2. Affix the nasal atomizer (applicator) to the needleless syringe and then assemble the glass cartridge of naloxone (see diagram).
3. Tilt the head back and spray half of the naloxone up one side of the nose (1cc) and half up the other side of the nose (1cc).
4. If there is no breathing or breathing continues to be shallow, continue to perform rescue breathing for them while waiting for the naloxone to take effect.
5. If there is no change in 3-5 minutes, administer another dose of naloxone in the other nostril (if available) and continue to breathe for them. If the second dose of naloxone does not revive them, something else is wrong—either it has been too long and the heart has already stopped, there are no opioids in their system, or the opioids are unusually strong and require more naloxone (can happen with Fentanyl, for example).
Injection:
Injectable naloxone comes packaged in several different forms- a multi dose 10 mL vial and single dose 1mL flip-top vials with a pop off top. With all formulations of naloxone, it is important to check the expiration date and make sure to keep it from light if it is not stored in a box. If someone has an injectable formulation of naloxone, all of the steps in recognizing and responding to an overdose are the same except how to give the naloxone. To use injectable naloxone:
1. Do rescue breathing for a few quick breaths if the person is not breathing.
Use a long needle: 1 – 1 ½ inch (called an IM or intramuscular needle). Needle exchange programs and pharmacies have these needles.
2. Pop off the orange top vial
3. Draw up 1cc of naloxone into the syringe 1cc=1mL=100u.
4. Inject into a muscle – thighs, upper, outer quadrant of the butt, or shoulder are best. Inject straight in to make sure to hit the muscle.
5. If there isn’t a big needle, a smaller needle is OK and inject under the skin, but if possible it is better to inject into a muscle.
6. After injection, continue rescue breathing 2-3 minutes.
7. If there is no change in 2-3 minutes, administer another dose of naloxone and continue to breathe for them. If the second dose of naloxone does not revive them, something else may be wrong—either it has been too long and the heart has already stopped, there are no opioids in their system, or the opioids are unusually strong and require more naloxone (can happen with Fentanyl, for example).
Once naloxone has been delivered and if the person is not breathing, continued rescue breathing is important until help arrives. Naloxone only lasts between 30 – 90 minutes, while the effects of the opioids may last much longer. It is possible that after the naloxone wears off the overdose could recur. It is very important that someone stay with the person and wait out the risk period just in case another dose of naloxone is necessary. Also, naloxone can cause uncomfortable withdrawal feelings since it blocks the action of opioids in the brain. Sometimes people want to use again immediately to stop the withdrawal feelings. This could result in another overdose. Try to support the person during this time period and encourage him or her not to use for a couple of hours.
The nasal spray costs much more in most places, but both forms are effective. Medicaid and most commercial health insurance plans cover at least one form of naloxone to some degree. For pharmacies, it’s best to call ahead to confirm product availability, cost, and insurance coverage. In all 50 states, nalaxone is available over the counter. For information on legality of nalaxone use, take a look at THIS site.
Administering nalaxone
Nazal spray (Narcan):
2. Affix the nasal atomizer (applicator) to the needleless syringe and then assemble the glass cartridge of naloxone (see diagram).
3. Tilt the head back and spray half of the naloxone up one side of the nose (1cc) and half up the other side of the nose (1cc).
4. If there is no breathing or breathing continues to be shallow, continue to perform rescue breathing for them while waiting for the naloxone to take effect.
5. If there is no change in 3-5 minutes, administer another dose of naloxone in the other nostril (if available) and continue to breathe for them. If the second dose of naloxone does not revive them, something else is wrong—either it has been too long and the heart has already stopped, there are no opioids in their system, or the opioids are unusually strong and require more naloxone (can happen with Fentanyl, for example).
Injection:
Injectable naloxone comes packaged in several different forms- a multi dose 10 mL vial and single dose 1mL flip-top vials with a pop off top. With all formulations of naloxone, it is important to check the expiration date and make sure to keep it from light if it is not stored in a box. If someone has an injectable formulation of naloxone, all of the steps in recognizing and responding to an overdose are the same except how to give the naloxone. To use injectable naloxone:
1. Do rescue breathing for a few quick breaths if the person is not breathing.
Use a long needle: 1 – 1 ½ inch (called an IM or intramuscular needle). Needle exchange programs and pharmacies have these needles.
2. Pop off the orange top vial
3. Draw up 1cc of naloxone into the syringe 1cc=1mL=100u.
4. Inject into a muscle – thighs, upper, outer quadrant of the butt, or shoulder are best. Inject straight in to make sure to hit the muscle.
5. If there isn’t a big needle, a smaller needle is OK and inject under the skin, but if possible it is better to inject into a muscle.
6. After injection, continue rescue breathing 2-3 minutes.
7. If there is no change in 2-3 minutes, administer another dose of naloxone and continue to breathe for them. If the second dose of naloxone does not revive them, something else may be wrong—either it has been too long and the heart has already stopped, there are no opioids in their system, or the opioids are unusually strong and require more naloxone (can happen with Fentanyl, for example).
Once naloxone has been delivered and if the person is not breathing, continued rescue breathing is important until help arrives. Naloxone only lasts between 30 – 90 minutes, while the effects of the opioids may last much longer. It is possible that after the naloxone wears off the overdose could recur. It is very important that someone stay with the person and wait out the risk period just in case another dose of naloxone is necessary. Also, naloxone can cause uncomfortable withdrawal feelings since it blocks the action of opioids in the brain. Sometimes people want to use again immediately to stop the withdrawal feelings. This could result in another overdose. Try to support the person during this time period and encourage him or her not to use for a couple of hours.
Needle safety
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!
Nodding Off (Opioids)
Nodding off - also called "nodding out" - is a very common effect when taking a moderate to high dose of any opioid. It generally feels like having fallen asleep or lost awareness for a few moments. Some people experience something similar to a mild dream state while nodding off, and may be disoriented when it ends. Though nodding off frequently can be a sign that someone is high on opioids, it isn't usually something to be concerned about.
Overdoses
How to identify an overdose:
- Unconscious and unable to be woken
- Awake but non-responsive
- Difficulty breathing
- Bluish lips and/or fingertips
- Pale, clammy skin
- Vomiting
- Delerium
- Limp body
- Seizures
Not all of these need to be present for a person to be overdosing. In general, if a person is under the influence and meets the first criteria (unconscious and unable to be woken) you can treat it as an overdose situation. If an intoxicated person falls unconscious and cannot be woken, it always qualifies an emergency.
What to do if someone is overdosing:
Overdose prevention:
Follow my guidelines for safe drug use. The more relevant of which for this topic are knowing your dosage, knowing how much can lead to an overdose, avoiding mixing substances, and not taking drugs which may not be what they are supposed to be.
If you are using opiates regularly, it is worth your time to find some nalaxone in your area (name brand Narcan). Read more about nalaxone HERE. Also, many prescription opiates have filers in them which can lead to overdose faster than the psychoactive ingredient in the medication. This can be avoided using a cold water extraction.
- Unconscious and unable to be woken
- Awake but non-responsive
- Difficulty breathing
- Bluish lips and/or fingertips
- Pale, clammy skin
- Vomiting
- Delerium
- Limp body
- Seizures
Not all of these need to be present for a person to be overdosing. In general, if a person is under the influence and meets the first criteria (unconscious and unable to be woken) you can treat it as an overdose situation. If an intoxicated person falls unconscious and cannot be woken, it always qualifies an emergency.
What to do if someone is overdosing:
- If the person is unconscious but breathing, place them on their side in the recovery position. Make sure that the airway remains open by tilting the head back and lifting the chin. Make sure they are continuing to breathe.
- Do not try to make the person vomit.
- Do not give them anything to eat or drink, especially other drugs (nalaxone aside).
- Do not attempt CPR unless they are showing no signs of life. It is also inadvisable to attempt CPR if you do not have training.
- Do not attempt CPR unless they are showing no signs of life. It is also inadvisable to attempt CPR if you do not have training.
Seeking medical attention:
The Good Samaritan Law. This is a law which exists in these states:
The Good Samaritan Law exists to offer legal protection to people who give reasonable assistance to those who are, or who they believe to be, injured, ill, in peril, or otherwise in danger. When you call 911, State your location, state that there is a drug related emergency or overdose, and tell them exactly what drugs have been done if you know. If you call 911 and hang up they send police and fire as well as the ambulance. If paramedics know the situation upon arriving you won't be in legal trouble, though there is a chance they may confiscate any drugs in plain sight.
Even if your state/area doesn't have protections, calling an ambulance may still be a necessity. If you call an ambulance, bring any pill containers to the hospital so they can identify the drug taken.
Also, you can always call the Poisons Information Centre on 13 11 26 for advice on what to do to help for specific substances. It is completely confidential and can give you some peace of mind.
Overdose prevention:
Follow my guidelines for safe drug use. The more relevant of which for this topic are knowing your dosage, knowing how much can lead to an overdose, avoiding mixing substances, and not taking drugs which may not be what they are supposed to be.
If you are using opiates regularly, it is worth your time to find some nalaxone in your area (name brand Narcan). Read more about nalaxone HERE. Also, many prescription opiates have filers in them which can lead to overdose faster than the psychoactive ingredient in the medication. This can be avoided using a cold water extraction.
Research Chemicals
Research chemicals, or "RCs", is a term used to describe substances that are designed to be sold as variations on more well known substances. These research chemicals are usually made as an attempt at making a cheaper version of the drug, or as a loophole in laws surrounding buying and selling psychoactive substances. One of the things that make research chemicals dangerous, is that people haven't seen the long-term effects of the substance. For most substances, including illegal ones, we have seen what kinds of problems their use can lead to, and we have some level of awareness of their effects. But, because RC's are undesirable and people are essentially never told that what they're taking is an RC, we have fairly limited knowledge of their risks.
Research chemicals are often sold as something else, which can lead to someone having an experience that is not what you expected, or experiencing adverse effects that should not have happened with the substance you thought you took. RC's put people at risk, because it takes away their ability to accurately assess safe dosage, physical effects, and what risk they are putting themselves (and others) at. Also, these chemicals are usually more dangerous than the drug they are sold as, often holding higher risks of neurotoxicity, psychosis, serotonin syndrome, or overdoses.
Here are some commonly used psychoactive substances, the research chemicals sometimes sold as them, and a place where you can buy a test kit to detect possible adulterants:
MDMA/MDA - 5-APB, 6-APB, BZP, TFMPP, PMA, and PMMA.
Stimulants - Synthetic cathinones (bath salts)
LSD - 25i
Fentanyl is not an RC, but it is a chemical often passed off as opiates, or sometimes benzodiazapines. Read more about fentanyl.
Possible positive effects from use:
- Novelty enhancement
- Personal bias suppression
- Perceived thought acceleration
Possible neutral effects from use:
- Laughter fits
- Hallucinations
- Time distortion
- Enhanced pattern recognition
- Internal hallucinations
- Ego death
Possible negative effects from use:
- Nausea
- Vomiting
- Paranoia
- Abnormal heartbeat
- Muscle tension and cramping
- Anxiety
- Psychosis
- Seizures
- Headaches
- Temperature regulation suppression
Overdose amount: How much it takes to kill any individual seems to vary widely, but serious damage to the bodies and minds of those who have taken 25i occurs at all doses. 25i is absolutely something to be actively avoided. You can buy a test kit to detect it HERE.
Class: Psychedellic
Notes:
Do not take with 5-HTP, as this can increase negative effects. Do not mix with stimulants, as it increases neurotoxicity. Mixing with marijuana is known to drastically increase negative cognitive effects. Mixing with Tramadol or Lithium may increase risk of seizures. When taken orally/sublingually, 25i often causes a feeling of numbness in the mouth, and can result in difficulty tasting foods for a day or two.
25i is incredibly dangerous, is usually sold as LSD, and often has a distinct bitter metallic flavor. It begins to take effect much more quickly than LSD, often causes vomiting early on, and - unlike LSD - can be lethal. 25i is known for causing serious, long lasting or permanent, physical and mental health issues in many people. It is generally regarded as extremely unpleasant, and in many cases, leads to lasting anxiety issues and/or PTSD.
It's important to note that the higher the dose of LSD, the quicker it begins to take effect, so a fast come-up doesn't necessarily mean it isn't LSD - it could just be a higher dose than expected. Vomiting can occur at high doses of LSD as well. Also, since LSD is a liquid usually dropped onto tabs, candy, or other edible items, a copper-esque flavor isn't a foolproof detection method. Though regardless, "if it's bitter, it's a spitter" is still an important rule to follow since you would definitely prefer to lose a normal tab of LSD than to ingest a potentially deadly chemical known for causing extremely unpleasant experiences. Paper can be a bit sour. Gel tabs are often a bit sour. In that same vein, a slight copper flavor could be easily missed on a piece of candy. The only way to be sure, is to use a test kit.
Research chemicals are often sold as something else, which can lead to someone having an experience that is not what you expected, or experiencing adverse effects that should not have happened with the substance you thought you took. RC's put people at risk, because it takes away their ability to accurately assess safe dosage, physical effects, and what risk they are putting themselves (and others) at. Also, these chemicals are usually more dangerous than the drug they are sold as, often holding higher risks of neurotoxicity, psychosis, serotonin syndrome, or overdoses.
Here are some commonly used psychoactive substances, the research chemicals sometimes sold as them, and a place where you can buy a test kit to detect possible adulterants:
MDMA/MDA - 5-APB, 6-APB, BZP, TFMPP, PMA, and PMMA.
Stimulants - Synthetic cathinones (bath salts)
LSD - 25i
Fentanyl is not an RC, but it is a chemical often passed off as opiates, or sometimes benzodiazapines. Read more about fentanyl.
--------------------------------------------------------------------------------------------------------
25I-NBOMe (25i)
25i, sometimes called "N-Bomb", is a dangerous research chemical sometimes sold as LSD
Possible positive effects from use:
- Novelty enhancement
- Personal bias suppression
- Perceived thought acceleration
Possible neutral effects from use:
- Laughter fits
- Hallucinations
- Time distortion
- Enhanced pattern recognition
- Internal hallucinations
- Ego death
Possible negative effects from use:
- Nausea
- Vomiting
- Paranoia
- Abnormal heartbeat
- Muscle tension and cramping
- Anxiety
- Psychosis
- Seizures
- Headaches
- Temperature regulation suppression
Overdose amount: How much it takes to kill any individual seems to vary widely, but serious damage to the bodies and minds of those who have taken 25i occurs at all doses. 25i is absolutely something to be actively avoided. You can buy a test kit to detect it HERE.
Class: Psychedellic
Notes:
Do not take with 5-HTP, as this can increase negative effects. Do not mix with stimulants, as it increases neurotoxicity. Mixing with marijuana is known to drastically increase negative cognitive effects. Mixing with Tramadol or Lithium may increase risk of seizures. When taken orally/sublingually, 25i often causes a feeling of numbness in the mouth, and can result in difficulty tasting foods for a day or two.
25i is incredibly dangerous, is usually sold as LSD, and often has a distinct bitter metallic flavor. It begins to take effect much more quickly than LSD, often causes vomiting early on, and - unlike LSD - can be lethal. 25i is known for causing serious, long lasting or permanent, physical and mental health issues in many people. It is generally regarded as extremely unpleasant, and in many cases, leads to lasting anxiety issues and/or PTSD.
It's important to note that the higher the dose of LSD, the quicker it begins to take effect, so a fast come-up doesn't necessarily mean it isn't LSD - it could just be a higher dose than expected. Vomiting can occur at high doses of LSD as well. Also, since LSD is a liquid usually dropped onto tabs, candy, or other edible items, a copper-esque flavor isn't a foolproof detection method. Though regardless, "if it's bitter, it's a spitter" is still an important rule to follow since you would definitely prefer to lose a normal tab of LSD than to ingest a potentially deadly chemical known for causing extremely unpleasant experiences. Paper can be a bit sour. Gel tabs are often a bit sour. In that same vein, a slight copper flavor could be easily missed on a piece of candy. The only way to be sure, is to use a test kit.
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