Drug injection
As of 2004[update], there were 13.2 million people worldwide who self-administered injection drugs outside of medical supervision,[clarification needed] of which 22% are from developed countries.
This act is often colloquially referred to as "slamming", "shooting up", "smashing", "banging", "pinning", or "jacking-up", often depending on the specific drug subculture in which the term is used (e.g. heroin, cocaine, or methamphetamine).
The drug—usually (but not always) in a powder or crystal form—is dissolved in water, normally in a spoon, tin, bottle cap, the bottom of a soda can, or another metal container.
Due to the dangers from using lemon juice or vinegar to acidify the solution, packets of citric acid and Vitamin C powder are available at needle exchanges in Europe.
[8] Repetitive injections, especially those with unsafe practices, can result in additional medical concerns that include thrombosis formation and infectious endocarditis.
[8] Of all the ways to ingest drugs, injection carries the most risks by far as it bypasses the body's natural filtering mechanisms against viruses, bacteria, and foreign objects.
There will always be much less risk of overdose, disease, infections, and health problems with alternatives to injecting, such as smoking, insufflation (snorting or nasal ingestion), or swallowing.
A small proportion of PE is due to the embolization of air, fat, and talc in the drugs of people who inject substances.
[11] The idea behind harm reduction approaches is to slow disease transmission, such as HIV/AIDS and hepatitis B and C, and promote public health by reducing the practice of sharing used needles.
Trac-B Exchange - Southern Nevada Harm Reduction Program was approved in early 2017 to help reduce the spread of HIV in "People Who Inject Drugs".
[14] In Nevada, the sharing of needles for drug injections has led to an increase in the spread of HIV and hepatitis B and C. In an effort to reduce the spread of blood borne pathogens, Southern Nevada installed vending machines to give access to sterile needles to those using them for drug injections.
[16] Beyond just needle exchange programs, the other major harm reduction strategy for drug users are safe injecting facilities (SIFs).
[17] A large hairpin was used to make a hole in the skin and the dropper containing the drug (usually heroin) was inserted and the bulb squeezed, releasing it into the tissues.
The closest method to IV/overall injection use, in terms of rapid onset, optimal bioavailability, and reduced health risks for most drugs, tends to be rectal administration via concentrated liquid solution (also known as a suppository), usually consisting of only ~1-3ml of liquid (typically not exceeding 5-10ml) assuming the drug in question possesses sufficient water solubility.
[19] IV drug use is a relatively recent phenomenon arising from the invention of re-usable syringes and the synthesis of chemically pure morphine and cocaine.
The hypodermic needle and syringe in its current form was invented by the French scientist Charles Pravaz in 1851, and became especially known during the wars of that and the subsequent decade.
In or shortly after 1851, the drugs which had been discovered and extracted from their plants of origin and refined into pure crystalline salts soluble in water included morphine (1804 or late 1803), codeine (1832), narcotine/noscapine (1803–1805?
Injecting preparations which were not intended for this purpose is particularly dangerous because of the presence of excipients (fillers), which can cause blood clots.
Injecting codeine into the bloodstream directly is dangerous because it causes a rapid histamine release, which can lead to potentially fatal anaphylaxis and pulmonary edema.
The effect will not be instant, but the dangerous and unpleasant massive histamine release from the intravenous injection of codeine is avoided.
Some manufacturers add the narcotic antagonist naloxone or the anticholinergics atropine and homatropine (in lower than therapeutic doses) to their pills to prevent injection.
Canada and many other countries prohibit manufacturers from including secondary active ingredients for the above reason; their Talwin PX does not contain naloxone.
