Safer Injecting – and what to do in a crisis

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If you inject drugs, there are practical things that lower your risk of infection, vein damage and overdose. This page covers those, and what to do if someone overdoses.

Safer injecting

Use new equipment, every time

• Use a new sterile needle and syringe for every injection. Reusing your own blunts the needle and does more damage to your veins each time.
• Never share. That means needles and syringes, but also spoons, filters, water, tourniquets and swabs. Hepatitis C can be passed on through any of them, not just needles.
• Equipment is free from needle and syringe programs, and many pharmacies. Take more than you think you need, so you are never stuck.
• If you are with other people, keep your gear separate and marked so it does not get mixed up.

Preparation and hygiene

• Wash your hands before you start. This matters more than almost anything else on this list.
• Use a clean, flat surface, and get everything ready before you begin.
• Use sterile water where you can. If you cannot, use freshly boiled water that has cooled. Never use water from a toilet, puddle or shared container.
• Use a new filter each time. Filters catch particles that can block small blood vessels and cause damage.
• Clean the injection site with an alcohol swab and let it dry before injecting. Do not use the swab afterwards to stop bleeding.
• Do not lick the needle or the site. Your mouth carries bacteria that cause infections.

Looking after your veins

• Rotate your sites. Using the same spot repeatedly scars the vein and eventually collapses it.
• Give each site time to heal before you go back to it.
• Never inject into an area that is red, swollen, hot, painful or infected.
• Afterwards, press with clean cotton wool or gauze until the bleeding stops. Do not rub.
• Some sites carry much higher risk of serious injury: the neck, groin, hands, feet and breasts. If you are using these, talk to a needle and syringe program worker or peer educator.

When something has gone wrong

Get medical help promptly for any of these. Infections in the bloodstream can become life threatening quickly, and they are very treatable if caught early.

• Infection at a site: redness, heat, swelling, pain, pus, or a lump that keeps growing.
• Spreading infection: red streaks running away from the site, fever, chills, feeling generally unwell. This needs same-day attention.
• Hitting an artery: bright red blood, pulsing or spurting, and sharp burning pain. Pull out straight away and press firmly for at least 10 minutes. Get medical help.
• A missed hit: swelling, stinging and a lump under the skin. Warm compresses can help, but see someone if it does not settle or gets worse.

Lowering your overdose risk

• Do not use alone. Most overdose deaths happen when nobody is there. If you have to use alone, tell someone, leave the door unlocked, and stay on the phone with someone who knows what to do.
• Watch your tolerance. It drops fast. A few days without using, a stint in hospital, detox or custody, and your usual amount can kill you. Start with much less than you used to.
• Test a small amount first, especially with a new batch or a new source. Strength varies enormously.
• Mixing is what kills. Opioids together with alcohol, benzos or pregabalin slow your breathing far more than any of them alone.
• You cannot tell what is in it by looking. Fentanyl and nitazenes keep turning up in drugs sold as heroin, but also as speed, cocaine, ketamine and benzos.
• Carry naloxone, and make sure the people you use around know where it is and how to use it.

Disposal

Put used needles and syringes straight into a sharps container without recapping them. Sharps containers are free from needle and syringe programs and many pharmacies, and they will take full ones back. If you have nothing else, a hard plastic container with a screw lid will do until you can get a proper one.

Blood-borne viruses

Get tested for hepatitis C, hepatitis B and HIV regularly, even if you always use new equipment. Testing is simple and confidential.

Hepatitis C is now curable. Treatment is usually a course of tablets over 8 to 12 weeks, with few side effects, and it is available through GPs as well as specialists. You can be treated more than once if you are reinfected. There is a free vaccine for hepatitis B, and effective treatment for HIV.

If someone overdoses

Naloxone is a medicine that reverses an opioid overdose. It works within minutes, it is free, and anyone can carry it and use it. It will not harm someone who has not taken opioids, so if you are not sure what they have had, give it anyway.

How to tell someone has dropped

• They will not wake up, or they do not respond when you talk to them or squeeze their shoulders
• Their breathing is slow or shallow, or has stopped
• Snoring, choking or gurgling sounds
• Blue or grey lips, fingernails or face
• They are on the nod or slumped over
• Tiny pinpoint pupils
• Cold, pale or clammy skin

If you are not sure, treat it as an overdose. It is better to act and be wrong than to wait.

What to do, step by step

The letters DRSABCND are a way to remember the order. Work through them one at a time.

• D is for Danger. Look around before you get close. Move any uncapped needles or sharp objects out of the way.
• R is for Response. Say their name loudly. Squeeze their shoulders. Ask them to open their eyes.
• S is for Send for help. Call 000 and ask for an ambulance. Put the phone on speaker so your hands are free.
• A is for Airway. Open their mouth and check nothing is blocking it. If something is, roll them onto their side and clear it.
• B is for Breathing. Tilt their head back. Look, listen and feel for two normal breaths in 10 seconds. If they are breathing, roll them onto their side and watch them. If they are not breathing, give two rescue breaths.
• N is for Naloxone. Give it now. The steps for each type are below. Note the time.
• C is for CPR. If you have no naloxone, or they are still not responding, start CPR. Push down hard on the centre of the chest, about 5cm deep, at a rate of 100 to 120 pushes a minute. That is faster and harder than most people expect. Do 30 pushes, then 2 breaths, and keep repeating.
• D is for Defibrillator. If there is one nearby, turn it on and follow the voice prompts.

How to give naloxone

Naloxone comes as a nasal spray, a pre-filled syringe, or a small glass ampoule. Find yours below.

Where to inject naloxone

Naloxone goes into a muscle, not a vein. Use the upper outer arm, the upper outer thigh, or the upper outer buttock. Go straight in at a right angle. You do not need to take their clothes off. Put the used syringe and needle into a sharps container.

After you have given it

• Stay with them. Naloxone only lasts 30 to 90 minutes, and most opioids last longer, so they can drop again once it wears off. Always call 000, even if they wake up.
• Once they are breathing on their own, roll them onto their side and keep watching their breathing.
• Tell the ambos what you know: what the person took, how much, and the time and number of naloxone doses you gave.
• Waking up like this feels bad. They may be confused, angry, sick or in withdrawal. Tell them what happened and try to keep them calm.

Will the police come?

Police do not routinely attend an overdose. They only attend if the overdose looks suspicious, if someone has died or is likely to die, or if the ambulance crew asks for help. Fear of police is one of the main reasons people delay calling 000, and that delay is what kills people.

Getting naloxone and equipment

Naloxone is free and you do not need a prescription. You can get it from a participating pharmacy anywhere in Australia. Depending on your state or territory, you may also be able to get it from a needle and syringe program, an alcohol and other drug service, a supervised injecting facility, or an outreach service. To find your nearest supplier, use the Take Home Naloxone site locator on the Australian Government Department of Health website, or ask your pharmacist.

You can get it for yourself or for someone else. You do not have to explain yourself. Anyone who might witness an overdose can have it.

Sterile needles, syringes, filters, water, swabs and sharps containers are free from needle and syringe programs, and available from many pharmacies. Peer educators at some sites can also talk you through vein care and technique in person, which is worth doing at least once.

Where to get help

• National Alcohol and Other Drug Hotline: 1800 250 015. Free and confidential advice, information and counselling, 24 hours a day, 7 days a week. It puts you through to the service in your state or territory.
• Counselling Online: free and confidential online counselling, 24 hours a day.
• Path2Help: the Alcohol and Drug Foundation’s tool for finding services near you.
• Your state or territory health department can tell you where naloxone and needle and syringe programs are available locally.

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Adapted from the Alcohol and Drug Foundation, the Australian Government Department of Health, Disability and Ageing, the Mental Health Commission of Western Australia, and Drug and Alcohol Services South Australia. General information only, not medical advice. In an emergency, always call 000.