Sharing injection materials

HIV

HIV is a chronic, potentially life-threatening infection; however, there are effective treatments which slow the progression of the disease.

The most obvious risk associated with sharing needles and equipment is the unintentional transmission of the HIV.^[1] HIV can live in dead tissue for many days and thus can survive in communal spoons and water supplies. When injection users all use the same water source, the needle of the used syringe deposits blood into the water supply, and any person who subsequently uses water from this supply risks becoming infected with the virus. The blood that stays in needles and barrels of syringes can also be transmitted to communal spoons by the same mechanism.

Due to the nature of the HIV, it is transmittable through blood, sexual contact, and other types of bodily fluid exchange.^[2] A person that becomes infected and engages in sharing injection materials or unprotected sex furthers the spread of the virus in the community.

There is no vaccine available for HIV/AIDS, but there is currently a drug program called PrEP that consists of medications given to individuals that are at risk of contracting the HIV. If an individual takes PrEP daily, the medicines in the bloodstream can stop HIV from infecting and spreading in the body. However, if an individual does not take PrEP every day, there may not be enough in the bloodstream to block the virus.^[3]

If an at-risk individual presents these symptoms or thinks they may have come into contact with someone they suspect is HIV-positive, they should get tested immediately.

AIDS

AIDS is the final stage of HIV infection that occurs when the body's immune system is severely damaged by the virus.

HIV/AIDS is asymptomatic for most of the virus' lifespan. However, the asymptomatic carrier may infect others with the virus if it is left untested for or untreated. There is a period when the HIV is contracted that may present symptoms including nausea, fever, rash, fatigue, and sores in the mouth. Excluding the sores, which disappear after a short period of 1–2 weeks, the symptoms of acute HIV infection may mimic the common cold or other non-threatening ailments.^[4]

Hepatitis

Hepatitis A, B, and C are other blood-borne viruses that are transmitted through the sharing of injection equipment and contact with infected blood.

It is advised that all injection drug users or other at-risk individuals receive a hepatitis vaccination.^[5] All types of hepatitis may lead to a serious chronic infection that diminishes the quality of life and can often be life-threatening.

Hepatitis can be spread to others through contact with infected blood, or from mother to child. Contact with infected blood can occur in injection drug users through the vectors of shared needles, shared water supply, and shared injection tools (spoons, etc).^[6] Hepatitis A can even be transferred through vectors like food and unclean hands in addition to bodily fluids.^[7]

Hepatitis is a serious illness that causes inflammation, jaundice, and eventual cirrhosis of the liver. Viral hepatitis may go unnoticed for many years if not tested for. If symptoms do occur, they often include nausea, abdominal pain, fatigue, depression, anorexia, and jaundice.^[8] If left untreated, an initial hepatitis infection eventually leads to the development of chronic hepatitis. Chronic hepatitis B presents itself medically with poor liver function test results, blood test results containing the HBV virus, and inflammatory or irregular behavior of the liver.

Hepatitis A

Hepatitis A is an infectious disease of the liver caused by Hepatovirus A (HAV).

The Hepatitis A vaccine is recommended for at-risk individuals including sexually active persons and injection drug users.^[7]

Hepatitis B

Hepatitis B is an infectious disease of the liver caused by Hepatitis B virus (HBV).

Hepatitis B is sexually transmitted and may spread to other members of the population if left untested or untreated.^[9]

There is currently a vaccination available for hepatitis B.^[10]

Hepatitis C

Hepatitis C is an infectious disease of the liver caused by Hepatitis C virus (HCV).

Drug injection is a major risk factor for hepatitis C in many parts of the world.^[11] Of 77 countries reviewed, 25 (including the United States) were found to have a prevalence of hepatitis C of between 60% and 80% among people who use injection drugs.^[12][11]

There is no vaccine available for hepatitis C.

HCV can survive outside the body for up to 6 weeks.^[13]

Infection and bacterial disease

Other dangers of sharing injection equipment include the increased risk of bacterial infections that may lead to fatal complications. Other diseases, such as MRSA, are more common among injection drug users than in the general population.^[6]

Bacteria can be spread amongst the population through the sharing of bodily fluids, contact with surfaces that the bacteria is on, or contact with infected air that contains a pathogen. The possible bacterial pathogens that IV drug users are at risk for contracting include:^[14]

• MRSA - The Staphylococcus aureus bacteria can be spread and is a serious and sometimes fatal infection that requires immediate medical treatment.
• Group A Streptococcus - An IV user is especially susceptible to the invasive form of Strep A. This "invasive" infection causes necrotizing fasciitis and streptococcal toxic shock syndrome, both of which immediately require medical attention.
• Tetanus

Sexually transmitted diseases

Other than HIV/AIDS, other STDs can be transmitted through IV drug use. Sharing injection materials with individuals who have syphilis may lead to infection.^{[citation needed]}

Sharing needles is the most obvious way to contract a blood borne disease or infection. It is extremely important that one does not share needles with others or use needles that have been used by others in the past. Even if the safer injection guide injection procedure is correctly followed, using a previously used needle introduces a massive and unavoidable risk for disease and death.

People who use injection as a route of administration should ensure that their injection materials are not shared by others and disposed of properly. Medical waste, such as used needles and syringe barrels, should be taken to a needle exchange center or a medical waste facility. Do not simply throw these used needles in the trash! Disposing of the needles properly ensures that others will not re-use them.

In states where needles are illegal without a prescription, the chance of users sharing their needles increases. The lack of availability of clean needles and syringes has lead to an explosion in the disease transmission rate among injection users.^[15]

A needle is only meant to penetrate the surface of the skin once. After the first time penetrating the skin, the needle is dulled. Each additional time the needle is used contributes to the dullness and harm that can be caused by the needle. Reusing the same needle can lead to greater risk of bodily injury and abscessed infections.

When attempting to recap a used needle, great care should be taken to avoid accidental skin pricks that may spread blood-bourne diseases. Capping and disposing of a used needle properly ensures that others will not be put at risk for disease or infection.

Blood-borne diseases can be transmitted through communal water supplies and communal spoons and 'gear'. This is a major disease vector amongst injection drug users - not all infections come from sharing needles. Using multiple needles in the same water supply can easily spread illness and disease. Sharing the same spoons and other equipment used to prepare the injection solution is also a way to contract a blood-borne illness such as HIV/AIDS or Hepatitis B & C.^[6]

The following materials are required if one wants to ensure that they are not sharing any injection materials:

• Fresh water supply - If used communally, the water supply can harbor disease. If many people use water from the same infected source, they will become infected themselves.
• A fresh needle with attached syringe - Using a fresh needle every time you inject is an easy way to guarantee that you will not share needles with others, thus lowering your risk for disease and health consequences. One should still be vigilant about other possible sources of infection.
• Fresh/sterilized injection equipment - This can include spoons and other tools used to heat and dissolve the drug into a solution for injection. Viruses can live on surfaces for a number of days, which makes sharing injection equipment another possible source of disease transmission.

For all injections, it is important to familiarize oneself with the procedure found in the safer injection guide. Follow all of the same guidelines outlined there, but make sure to use a fresh needle, an unused syringe, a fresh/sterile/unused source of water, and a clean tool to heat and dissolve the substance into the solution. Once you have used this equipment to inject - dispose of it properly! Take the used needle and syringe to a needle exchange or medical waste facility to make sure that others do not re-use the needle.

Intravenous injections, intramuscular injections, and subcutaneous injections all require this level of care to avoid infections or disease.

If one suspects, or knows that they have used contaminated needles, supplies, etc. it is imperative that you go to your local health clinic (or anonymous clinics like Planned Parenthood^[16]) to get tested immediately. The test should include HIV/AIDS and other diseases such as hepatitis. If detected early, these infections and diseases can be managed and even treated. If one does not know that they are infected it leads to a massive increase in the risk of infecting others. It is imperative that you take responsibility for your health and the health of others. Some viruses, like HIV/AIDS, can be spread through sexual contact and other means than by just sharing injection equipment.

Diseases contracted during intravenous drug use can be treated and some can be cured with prompt treatment.

• Bacterial infections - Bacterial infections including MRSA or soft tissue infections at the injection site can be treated with antibiotics. If left untreated, these can lead to gangrene, tissue death, and eventual amputation and death of the user in extreme cases^[17].

• HIV/AIDS - Individuals who test positive for the HIV virus are given a mix of antiretroviral medications to combat the virus, reduce transmission rates, and extend the lifespan.^[18] These medications must be taken daily to have their intended effect of reducing the multiplication of HIV to manageable levels.

• Hepatitis - Hepatitis C is treated with medications that increase the lifespan and reduce the symptoms of the disease, sometimes even curing the individual of the Hepatitis C infection entirely.^[19] The possibility of being cured of hepatitis C serves as an incentive to get tested as soon as possible if one suspects they are at risk for an infection.

Flashblood

Flashblood (also called flushblood) is an intravenous drug administration technique used by recreational drug users in which an individual injects himself with blood extracted from another drug user, most commonly one who has injected heroin. The purpose of the technique is to experience substance intoxication (a "high") or to help combat symptoms of drug withdrawal. The practice was first documented in an announcement submitted by Sheryl A. McCurdy, et al., in an October 2005 issue of BMJ.^[20] First reported to be practiced in Dar es Salaam, Tanzania, the practice had spread to other areas in East Africa by 2010.^[21]

After injecting heroin using a syringe, a user will extract approximately five cubic centimetres of blood from their vein, which another user will inject into themself. It is unclear if there is enough heroin in the small volume of injected blood to get high or if the high that many users claim is a result of traces of the heroin that had been injected by the user, or if the high is simply the result of the placebo effect. Sharing blood in this manner carries a very high risk of transmitting viruses such as hepatitis and HIV, which are prevalent among injection drug users in East Africa.^[21]

• Responsible use
• Safer injection guide
• Tutorial index (Harm reduction)
• Routes of administration

• HIV/AIDS Transmission (aidsmap.com)
• Hepatitus B/C Transmission (nhs.uk)
• Medical Implications of Injection Drug Use (rutgers.edu)
• Information About Getting Tested (plannedparenthood.org)
• Hepatitis B vaccination information (cdc.gov)