Harm Reduction Tips

On this page:

 
  • Syringe Parts: Tip length, gauge, barrel size, etc.

  • Supply Details: Info about all the supplies we offer

  • Common Issues, Tips, and Tricks

  • FAQ

 
 

 

 

Supply Info

Details about all the supplies we offer. Click the ▾ symbol to learn about each item.

 
 

Pencil drawing of a hazardous waste

Sharps Container (1 Quart) ▾

If you do not have a sharps container Sharps disposal regulations vary by community. We can provide some guidance however your local health department will have more information about specific rules in your area. You can also make an inquiry with your local trash disposal company. When you ask about appropriate disposal, always remember to request information about "diabetic syringe disposal". There is no reason for anyone to know your business.

Some places that may take appropriately secured containers of used syringes include: Doctor/Medical Office Hospital/ Clinic/ Nursing Homes Pharmacy Fire or Police Station Household Hazardous Waste Collection Site (i.e., a site that also accepts paint and motor oil.) Make sure to call ahead first to ask if the facility accepts household sharps. If you have a syringe exchange program anywhere in your vicinity, these are great places to drop off used syringes AND receive new ones. If you are able to purchase your own sharps containers, they are available at your local pharmacy and online.

If you're disposing syringes in your household garbage make sure it is in a sharps container or a thick plastic detergent bottle. Either way the container should be closed securely with thick tape and labeled: "SHARPS - Do not recycle." Fill your sharps container until it's 3/4 full, as overfilling creates a needlestick risk. Throwing syringes down the toilet will wreck your septic system.

If you have to throw away used loose sharps for any reason, gently break off the needle tip, and put it in the barrel of the syringe, then replace the plunger. This will reduce the likelihood that anyone will be be stuck by this sharp.

Safe Needle Disposal- safeneedledisposal.org Your one stop shop for syringe disposal questions. They have a zip code specific resource map, state by state specific disposal regulations, and more information about best disposal practices.

FDA Sharps Site (Google: FDA Sharps) The FDA provides information about what to do if you don't have appropriate disposal options and DOs & DON'Ts.

The Point New York thepointny.org Great New York geolocation resource to find disposal options in your area.

 
pencil drawing of a syringe clipper

Syringe Clipper ▾

Syringe clippers can be used to safely and easily remove diabetic syringe needles from their body. They can be thought of as easily portable and discrete hazardous waste disposal devices. Once the tip is clipped off a syringe, you can dispose of the syringe body in your general household garbage without fear that you are putting others at risk of needlestick. Syringe clippers are also effective ways to ensure that a syringe can not be re-used. You can purchase syringe clippers independently through an internet search term "needle clipper". Syringe clippers work with 28g-31g syringes.

 
pencil drawing of a syringe

Syringes (General) ▾

There are three important components and size details in syringe equipment: needle length, needle diameter (gauge) and syringe volume (the amount liquid held by the barrel).

Insulin syringes are designed with attached needles and are intended for subcutaneous use –i.e. injecting below the skin into fat. In many regions, they are the equipment most commonly used and most widely available from syringe service programs (SSPs).

Insulin needles come in a variety of lengths and diameters, usually ½ inch long and ranging from 29-31 gauge. (Gauge is the measure of needle diameter –the size of the hole it makes in the skin and vein. The larger the number the smaller the diameter.) While a very small diameter needle might seem like a good idea, the smaller the needle is in diameter, the more fragile it is and the more likely to clog. Generally it is best to pair different sized veins with different gauges. If you usually inject in your hand with a 30g syringe but only have a 27g, use the 27g for your arm instead of the smaller hand veins.

Remember that the larger the needle diameter, the larger the hole you're creating in your body will be. Use the smallest needle that makes sense for you and your injection site (i.e. if a 27g feels too big or too painful, try a 28g or 29g.)

Barrel size: Commonly available equipment comes in 1/3, ½, 1cc and 3cc sizes. 3cc barrels are commonly available packaged with longer, larger detachable needles –typically 1 inch or 1 ½ inch long—and used for intramuscular injections (for example vaccines, steroids, hormones, and naloxone).

Often, the larger the barrel, the harder it is to move the plunger, an issue if you are injecting yourself, especially in an arm when only one hand is free to manage the injection. Pumping the plunger prior to injection can make it move more smoothly and facilitate injection. ½ cc barrels are often those with the smoothest glide (least resistance) and easiest to use one-handed.

If you do prefer a larger barrel and are having trouble injecting yourself, try putting a keychain at the top of the plunger [insert Kacey's image/video here] to help steady your hand.

Very small insulin needles are best used for small surface veins like those in the hands and feet, but are usually too short for other injections. Assuming injecting at a 15-30 degree angle (i.e. with the needle almost flat to the skin) so that the needle can be threaded fully into the center of the vein [Getting Off Right image here], the shortest needles of the insulin syringes are usually too short for any but the most surface veins. Because these veins are fragile and in visible areas of the body, they are not usually recommended injection sites, assuming other areas are available. To reduce damage to these sites and the itching, bruising and swelling associated with hand and foot shots, inject the liquid slowly. And as always, bevel up, in the direction of blood flow (so needle points toward the heart) and remember to open the tie before removing the needle from the injection site.

 
pencil drawing of a syringe

pencil drawing of a syringe

Terumo 27g, 1/2 cc, 1/2 inch tip length ▾

27 gauge syringes are the easiest to register and may be preferred if your veins move around or your have vein damage. If you inject cocaine, pills, or thick substances. If you are injecting in a hurry.

1/2cc: Good for newer/ occasional use If you have fewer issues hitting a vein If you need something easy to hold (smaller hands, injection anxiety, use of non-dominant hand)

 
Sharps200px.png

McKesson 27g, 1cc, 1/2 inch tip length ▾

27 gauge syringes are the easiest to register and may be preferred if your veins move around or your have vein damage. If you inject cocaine, pills, or thick substances. If you are objecting in a hurry. 1cc:

Has better action, use if you have trouble registering

Larger barrel makes it easier to go from site to site if you can't keep a vein

 
pencil drawing of a syringe

pencil drawing of a syringe

BD 28g, 1/2 cc, 1/2 inch tip length ▾

28g syringes:
If you are decently good at finding a vein
If you can spend time finding a vein
REcommended for keeping veins healthy, reduce your chance of scarring

1/2cc:
Good for newer/ occasional use
If you have fewer issues hitting a vein
If you need something easy to hold (smaller hands, injection anxiety, use of non-dominant hand)

 
Sharps200px.png

BD 28g 1cc, 1/2 inch tip length ▾

28g syringes:
If you are decently good at finding a vein
If you can spend time finding a vein
REcommended for keeping veins healthy, reduce your chance of scarring

1cc: Has better action, use if you have trouble registering
Larger barrel makes it easier to go from site to site if you can't keep a vein

 
Sharps200px.png

BD 29g 1cc, 1/2 inch tip length ▾

29g syringes:
If you are very good at finding a vein.
If you can spend time finding a vein.
Recommended for keeping veins healthy and reducing scarring.

1/2cc: Good for newer/occasional use
If you have few issues hitting a vein
If you need something easier to hold (smaller hands, injection anxiety, use of non-dominant hand)

 
pencil drawing of a syringe

Easy Touch 30g, 1cc, 1/2 inch tip length ▾

30g syringes:
If you have no problem hitting a vein on the first try
Good for minimal scarring

 
pencil drawing of a syringe

Easy Touch 31g 1/2 cc, 5/16 inch tip length ▾

31g syringes may break or bend a lot easier than thicker gauge sizes.
This size will clog easily, they are not meant to register blood.
31g syringes are best for places with surface-level, visible veins, like backs of hands and tops of feet.

1/2cc: Good for newer/occasional use
If you have few issues hitting a vein
If you need something easier to hold (smaller hands, injection anxiety, use of non-dominant hand)

 
pencil drawing of a syringe

Easy Touch 31g 1 cc, 5/16 inch tip length ▾

31g syringes may break or bend a lot easier than thicker gauge sizes.
This size will clog easily, they are not meant to register blood.
31g syringes are best for places with surface-level, visible veins, like backs of hands and tops of feet.

1cc: Has better action, use if you have trouble registering
Larger barrel makes it easier to go from site to site if you can't keep a vein

 
pencil drawing of syringe with removable tip

Blue tips ▾

These syringes have a removable tip which are good for booty bumping. These are not recommended for intravenous drug use because the gauge is thick (25g). This is the size of syringe most often distributed with intramuscular (IM)/injectable naloxone.

 
pencil drawing of an alcohol prep pad

Alcohol Prep Pads ▾

Use and alcohol pad to clean an injection site. Use the alcohol pad once in a one-direction swipe. Do not rub the alcohol pad in a circle or use it multiple times. It's important to only use alcohol pads before injection. Using an alcohol pad to clean a site after you inject will prevent the blood from clotting at your injection site, which will interrupt your skin's natural healing process and facilitate more bleeding.

Alcohol pads can also be used to clean your fingertips and palms if you do not have access to soap and water.

 
pencil drawing of

BZK Towelettes ▾

BZK Towelettes are made with benzalkonium chloride. These towelettes are good to clean your hands and injection site if warm water and soap, or alcohol pads are not available.

They are considered a general use antiseptic for skin cleaning and can also be used on external genital and perineal areas.

 
pencil drawing of small bag of cottons

Cottons ▾

Using small pieces of cotton to filter your drug solution when pulling it up from a cooker prevents reduces the amount of foreign matter from getting in your shot. Using clean 100% cotton from the cottons provided from NEXT, from q-tips, or cotton balls is the safest material to use. Pieces of tampon may also work well, as long as you are sure they are 100% cotton -- some tampons are made with chemicals that should not be injected. Cigarette filters may contain fiberglass particles and other harmful substances you do not want to inject into your body. Before retrieving a cotton from a bag of NEXT cottons, wash your hands, or wipe with an alcohol of BZK wipe. Not doing so mitigates the cleanliness of the cottons for that present shot and others after it.
Using fresh, clean cottons will prevent cotton-facilitated infections, bacteria, and viruses. Sharing cottons is problematic because it is easy for bacteria and viruses, especially Hepatitis C, to live inside of them for extended period of time. Even reusing your old never-shared cottons could precipitate "Cotton fever" (LINK) which is an infection with flu-like symptoms such as fever, chills, and sweating. Cotton fever occurs because the moist environment within a cotton is the perfect host for bacteria and fungus to grow.

If you are afraid of running out of cottons and think you may have to reuse yours, freeze them for a few days. Cold can help to kill bacteria and fungus. If you do not want to reuse but are worried you may be tempted, swallowing your cotton after use will have no impact on your body, and will ensure that the cotton is gone!

 
pencil drawing of sterifilt

Sterifilt ▾

Sterifilts are single-use filters that attach to your syringe and filter out impurities. They are made of polypropane, and filter out an estimated 99% of impurities, but none of the drug itself. They have been tested with brown heroin, white heroin, and crushed pills.

 
pencil drawing of bottle caps/cookers

Bottle Caps ▾

Bottle caps, "cookers", or spoons are used to dissolve powdered or solid drugs into injectable form. Viruses and bacteria can be transmitted through cookers. It's best practice to use your own cooker every time and ensure others do not use your cooker. Like your syringe, it's essential that your cooker is clean prior to use. If not using a spoon, you can use a twist tie, paperclip, or thin metal wire to fashion a 'handle' to the cooker.

If using a spoon, find one that is deep enough to prevent solution from spilling out.

When pulling up from a cooker, make sure the bevel, or 'eye' of your needle is pointed down. This prevents the needle from blunting, or becoming less sharp, as you pull up your drug solution.

 
pencil drawing of tourniquette

Tourniquette ▾

Tourniquets restrict blood flow which engorged veins and helps bring them visibly to the surface of the skin. Some people use belts which can cause the vein to 'roll' making it thinner and more difficult to hit. A latex tourniquet like the one provided by NEXT is the best option. If none are available you can use a condom, latex glove or other items like a stocking, long sock, or necktie.

If torniquets are not available, it is best to use an alternative with some elasticity, or stretch. Things like condoms, latex gloves, bra straps, elastic hair ties, and even cords from landline phones are examples. Elastic material will be easier to quickly remove.

When you use a tie you are using it to find a vein and register. Once you've registered, release the tie before injecting. If you have difficulty registering, need to find another vein, or transfer your shot to another syringe, untie your tourniquette while you do this.

If you have any loss of sensation in your limb or if it feels tingly or looks blue, untie the tourniquette. Your body needs oxygen.

 

 
pencil drawing of gauze sponges

Gauze ▾

Have a piece of gauze ready after you remove the syringe from your skin and apply it to your injection site raising above your heart if possible (this will reduce bruising). This will prevent blood from getting on your clothes or the location where you are injecting. Remember not use an alcohol pad after injection, that will only cause more bleeding.

 
pencil drawing of adhe

Adhesive Bandage ▾

If you want, you can use an adhesive bandage to cover your injection site until it heals.

 
pencil drawing of fentanyl test strip

Fentanyl Test Strip ▾

Fentanyl test strips detect fentanyl and several fentanyl analogues in your drugs. One line means the drug is positive for fentanyl, two lines means that fentanyl is not detected.

For heroin, pills, or cocaine/crack that you are injecting, you can add a few drops of water to your cooker after pulling up your drug supply, and then add the strip for about thirty seconds. Put it across the cooker, and in less than a minute, you should have your results.

If you are snorting or smoking, add water to the bag after emptying your drugs onto a clean surface to test residue that way.

If you are swallowing pills, it would be ideal to crush the whole pill and put it in water to test (as fentanyl can lump together with other fentanyl particles), and then drink the solution. If you cannot do this, scrape off a bit of the pill and mix with water to test before swallowing.

Methamphetamine and MDMA testing is different. For these substances, test only the residue, and add at least a half-cup of water to the test. Fentanyl test strips are incredibly sensitive to meth and MDMA, and if you do not dilute the residue (and only the residue!) this way, you will get a positive regardless of whether fentanyl is present or not.

 
pencil drawing of

Ascorbic Acid Packet ▾

Absorbic Acid, or Vitamin C, is used to break down pills, black tar heroin, and crack-cocaine so that they can dissolve into water for injection.

 
pencil drawing of sterile water ampule

Sterile Water ▾

Because of the weight of single use sterile waters increases the cost of shipments, NEXT mails water in limited instances. Single-use waters are best to have if you are in locations with no running water or ability to boil water for injection such as a car.

Sterile water can be purchased at pharmacies or medical supply stores, however water boiled for 10 minutes is just as good. Using this method, boil water for 10 minutes and when cool enough, relocate it to a sterile jar that can be sealed with a lid. This 'home made' sterile water can be used over time as long as it is never contaminated by drawing up water using a previously used/non-sterile syringe.

If sterile or boiled water is not an option, fresh cold tap water or bottled water are the next best options. Be sure to have your water in a clean container. Remember that it is important to keep any water source 'clean' by never using a pre-used syringe to draw up water.

This technique would contaminate the water for anyone else using it. If you are using water to clean out your used syringe, transfer it to another container to draw up and flush it out and then immediately discard this water to ensure no one else uses it. Viruses and bacteria invisible to the naked eye can be transmitted by using a 'contaminated' water container.

 
pencil drawing of a straight

Straight Pipe ▾

Straight pipes are used to smoke crack-cocaine. To smoke, insert copper-wire (i.e. a small piece of chore boy) to act as a filter. You should burn the chore boy / copper wire a little before using. Use a wooden pusher to push the chore boy to the end of the pipe, leaving a small space for the crack. A wooden pusher is better than a plastic or glass pusher, as it will not scratch your glass pipe. Scratches on your pipe can turn to cracks and cut you! Move your flame along the stem so the crack burns evenly. Take a break between hits so that you don't 'overamp,' or smoke more than you mean to.

If you are sharing a pipe, use a rubber mouthpiece made from the end of a spark plug to cover the end that you put your mouth on. Each person should use their own rubber mouth piece. Because lips can burn and crack when smoking from a pipe, it is possible to bleed on it and transmit Hepatitis C that way.

 
pencil drawing of

Bulb Pipe ▾

Bulb pipes are used to smoke crystal meth. Pour your meth into your pipe, and tap the pipe gently until all the meth is in the bulb of the pipe. Hold this pipe about halfway down the stem, apply your heat source to the bulb, and keep moving the heat source so as not to burn up all the meth. Heat will vaporize the meth, filling the pipe with smoke. Inhale the smoke and exhale IMMEDIATELY -- holding meth smoke in your mouth can be very damaging to the mouth and lungs.

 
pencil drawing of intramuscular naloxone

IM Naloxone Kits ▾


Coming Soon

 
pencil drawing of narcan intranasal naloxone

Narcan brand naloxone ▾


Coming Soon

 
pencil drawing of narcan intra

Narcan brand naloxone (expired) ▾


Coming Soon

 
pencil drawing of intranasal naloxone with atomizer

Intranasal naloxone w/atomizer ▾


Coming Soon

 
pencil drawing of a male condom

Male Condom ▾


Coming Soon

 
Insertive.png

Insertive Condom ▾


Coming Soon

 
Lubricant.png

Lubricant ▾


Coming Soon

 

Common Issues, Tips, & Tricks

Syringe Issues ▾

Clogged syringe

  • If you do not have another syringe: You will need sterile cold water in a clean container (glass, bowl, bottlecap) and another clean container in case you decide to empty your syringe during or before this process. Draw up a small amount of sterile cold water to attempt to unclog the syringe.
  • if you do have another syringe: empt... Bent syringe tip
  • Plunger is not creating good suction, will not draw up - Plunger keeps getting stuck in barrel, does not move easily
 

Vein tips ▾

When injecting:

  • Keep the bevel/ hole of the needle pointed up
    Regardless of where you are injecting on the body, point your syringe towards the direction of your heart/ with the flow of blood
  • It's easy to find a few veins that are easy to hit and use them over and over however consciously working to find other veins when you are in the state of mind to do so is smart and can help you learn more about phlebotomy. If you can, use the bigger veins before you move to smaller veins. Veins in the hands and feet are easy to see but they are thinner, may hurt more to inject in, and can blow easily. xt
 

Trouble ▾

  • Rotate injection sites
  • Drink a 2 glasses of water approximately 10 minutes before you inject, this will plump up your veins and make them more visible. Avoiding caffeinated beverages such as soda and coffee are smart, caffeine dehydrates your body which causes veins to thin.
  • Exercising before you inject is a great way of getting your veins to the surface of your skin. Try to do 1 full minute for push-ups (they can be modified!) and see if this helps you better locate a vein.
  • You want to makes sure you are in a vein before you inject. Injecting when not in the vein can cause abscesses.
  • Applying warmth to the area where you intend to inject can be helpful, you could also run your site under warm water or apply a heating pad to help bring the veins to the surface
 

Habits to unlearn ▾

There is no way to sharpen the tip of a syringe. They types of syringes most commonly used for injection are single use. They begin to burr after the first use. Attempting to sharpen a dull needle point will only create many little burrs on the tip. The metal is inexpensive and can't be manually 'made new' or better.

 

Booty Bumping ▾

Use your own equipment, if it makes sense for the situation, make sure everyone has their own supplies. Sharing booty bumping supplies spread blood borne illnesses and parasites. If you need to share, clean your equipment thoroughly with bleach and water. Boofing too often can put you at risk of tearing the skin of your rectum which could put you at risk of HIV and STIs if you are sexually active and engage in anal and anal play. Consider alternating boofing with other methods of such as smoking to give your ass a break.

 

Abscesses ▾

  • Abscesses are soft tissue injections. The show up as pockets of pus enclosed by inflamed tissue. Abscesses occur when bacteria is introduced beneath the skin. No injection practice is 100% abscess preventable but you can take several steps to prevent abscesses from occurring.

  • Inflammation can be identified by heat, swelling, redness, and pain.

  • Most often, abscesses occur: (a) when you miss a vein, and/or (b) when people are frequently skin-popping. If you've just missed a shot and are worried an abcess will develop, you want to raise the injection area if possible (i.e., hold arm above head for 10-15 minutes, or prop leg up on a pillow/pile of blankets/container/whatever), and ice it (or put something ele cold -- frozen fruit/veggies in a bag, snow, etc.) on the area to decrease swelling. This will not prevent an abscess from forming, but will reduce swelling from the missed shot / also reduce swelling if an abscess does develop later. If an abscess does develop within the next 2-3 days: switch from cold to heat -- heat the area for 10-15 minutes 3-4x/day. If you do not have access to a heating pad, you can: submerge the area in warm water; put a wash cloth run under warm/hot water on the area; use hand/feet warmers; use salted water/saline water (which will mimic heat). Heat will draw the pus to the top of the infection. Other than when heating the abscess, keep it clean, dry, and covered in as-clean-as-possible wrapping. You can apply some antibiotic ointment before covering if you would like.

  • Abscesses should start to improve (or at least not get worse) by about the one-week mark after first noticing swelling/redness/pus. If, after about a week, your abscess is still getting bigger, moving from one place to another, getting smellier, turning green or black, or has an orange-peel like texture, it is likely time to seek medical attention.

  • Abscess covering: best to cover using gauze and medical tape, if available. If not available, breathable material like cotton is preferred to synthetics. To change covering, slowly and carefully peel up the corners of the gauze/tape. Wash and dry the area completely before covering again. Keep abscess coverings like gauze, tape, antibiotic ointment, saline, etc. in a cool, dry place. Do not cover abscess with wet material for extended periods of time if you can avoid it.

  • ABSCESS DON'Ts: It's really tempting to squeeze/poke/stick your finger or rig into an abscess! However, these pratices should be avoided. If you feel like squeezing, instead spread the skin surronding the abcssess out in the opposite direction/away from the infection -- this will help to reduce the pain and swelling. Sticking your finger (or syringe!) into the abscess could cause further infection. Also, if you are able, inject either above the abscess, or in an entirely different limb/area altogether. Injecting into your abscess could cause more bacteria to enter the wound, and injecting below your abscess site means that the drug solution (and whatever else is in it) will have to pass through the infection to reach your heart.

    It's not recommended to try to drain the pus in your abscess on your own -- this can create a big, open wound that would need to be packed. If you are heating your abscess regularly and keeping it covered, the pus should begin to drain on its own within about a week.
 

FAQ

 

What is the best way to clean an aluminum cooker? Bleach? What if no bleach is available? ▾

The best way to clean an aluminum cooker is the same as the best way to clean a syringe: water/bleach/water if you have bleach. If you don't have bleach, an alcohol wipe followed by a water rinse is a good idea. Eater/soap/water is better than just water for cookers (unlike when cleaning a syringe, where just water is better than soap + water because soap can easily get stuck in a syringe but can easily be washed out of a cooker, which is wide and deep-bottomed). BZK wipes will be slightly better than water, and even rinsing with water is better than nothing.

 

Do BZK towelettes prevent infection? i.e., cookers ▾

BZK wipes kill some but not all bacteria. They are better to use than nothing (about as good as soap), but not as good as bleach or alcohol wipes.

 

Can you booty bump residue from old cottons instead of injecting it to avoid cotton fever? ▾

You can, and this will certainly reduce the risk of getting cotton fever (as the residue isn't entering the bloodstream as immediately as it is with IV injection, however, because cotton fever comes from bacteria entering the blood stream, using residue from old cottons always carries the risk of giving someone cotton fever. Best practice if folks want to use residue from old cottons is to -- if they can wait and have access to a freezer -- freeze the cottons for a few days after first use until it's time to do a cotton shot. Cold kills most bacteria.

 

Can I use Hirudoid cream for injection sites? Arnica gel? ▾

Arnica gel is a big no. Great for bruising, not to be applied to open wounds. (https://firstaidcreams.com/find-creams-for-common-complaints/homeopathic-creams-for-wound-healing/). It does reduce bleeding, but can be potent -- hence why it works for bruises (bleeding occuring under the skin)

Hirudoid cream is also a no -- it can sting on open wounds. While not potent on open wounds like arnica, it's similar to arnica in that it works best to reduce bleeding under the skin, aka bruising.

 

Does using a tie facilitate bruising? If not then why do some people report that? ▾

If tied too tight or left on during injection, a tie can definitely facilitate bruising -- because what ties do is put pressure on skin/muscle. To reduce risk of bruising, take tie off as soon as you have flagged/registered. (https://tourniquets.org/tourniquet-injuries-mechanisms-and-prevention/)