page_title: Drug injection
section_title: Harm reduction
hierarchical_section_title: Drug injection / Recreational drugs / Harm reduction
caption_attribution_description: English: The contents of a needle exchange kit. The items are (also annotated in the picture), from the top clockwise: a torniquet, cotton balls, a pot for cooking drugs, a condom, sterile water, alcohol swabs, and (from l-r) a thin needle, a thinner needle, and the thinnest needle. Multiple needles of different bore sizes are included. Reason: The viscosity of drugs can be radically different, i.e. methadone is more viscous than heroin which is more viscous than cocaine. Pushing methadone through a small needle is impossible. Template:FACT
context_page_description: Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle and a syringe, which is pierced through the skin into the body. As of 2004, there were 13.2 million people worldwide who used injection drugs, of which 22% are from developed countries.
  A wide variety of drugs are injected, often opioids: these may include legally prescribed medicines and medication such as morphine, as well as stronger compounds often favored in recreational drug use, which are often illegal. Although there are various methods of taking drugs, injection is favoured by some people as the full effects of the drug are experienced very quickly, typically in five to ten seconds. It also bypasses first-pass metabolism in the liver, resulting in higher bioavailability and efficiency for many drugs than oral ingestion would. The effect is that the person gets a stronger effect from the same amount of the drug. Drug injection is therefore often related to substance dependence.
  In recreational-use drug culture, preparation may include mixing the powdered drug with water to create an aqueous solution, and then the solution is injected.
context_section_description: Harm reduction is a public health approach that serves as an alternative to abstinence-only guidance. While it does not condone the use of illicit or illegal drugs, it does seek to reduce the harms, risks and dangers associated with illicit drug use, both for the person using illicit drugs and the wider community. Injection drug users that re-use drug delivery components put themselves and others at risk for diseases such as HIV, hepatitis B, and hepatitis C, as well as increase their chances of getting a serious infection. In 2015, the CDC performed an HIV Surveillance Report and attributed 2,392 (6%) of new HIV diagnoses to IV drug use in the US.
  A prominent method for addressing the issue of disease transmission among intravenous drug users are needle exchange programs (also known as syringe exchange programs, syringe service programs or needle-syringe programs), where people who inject drugs (PWID) can access sterile needles, syringes, and other paraphernalia. In addition to providing sterile devices used in drug injection, these programs often offer access to infectious disease testing, referrals for drug abuse or mental health treatment programs, and more. 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.
  In countries where harm reduction programs are limited or non-existent, it is quite common for an IV users to use a single needle repeatedly or share with other users. It is also quite uncommon for a sterilizing agent to be used on needles and syringes. This creates a high risk population for the spread of bloodborne pathogens.
  A new approach to reduce harm to IV drug users was recently started in Southern Nevada in 2017. 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". 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. Individuals who use these vending machines are required to register with Trac-B and are allowed 2 boxes a week. The boxes contain sterile needles as well as other supplies necessary to reduce the risk of spreading blood borne pathogens. If this pilot program is successful in reducing the spread of bloodborne pathogens, we may see programs like this spread to other parts of the country.
  Although this is a new idea in the United States, it was tested in Europe over 20 years ago. In order to combat the AIDS epidemic that was spreading across Europe, France allowed pharmacies to dispense needles without a prescription and implemented needle exchange programs. In 1996, they began a pilot program of syringe vending machines, similar to a coin-operated vending machine. The first vending machines were placed in Marseille due to its high occurrence of AIDS caused by sharing of needles. The results of their study was published in 1999. They found that when the availability of syringes increased, more and more people began to purchase sterile needles. It also provided a discrete way for people to purchase needles without having to feel embarrassed going into a pharmacy. They theorized that with greater access to sterile needles, they would expect to see a reduction in bloodborne pathogen cases.
  Beyond just needle exchange programs, the other major harm reduction strategy for drug users are safe injecting facilities (SIFs). These provide a sterile environment for people who inject drugs to do so cleanly, and with sterile syringes which are forced to be thrown away after use so that no re-use occurs. The first of these facilities opened in Switzerland, but there are now over 100 globally including one in Vancouver - Canada, Sydney - Australia, and most recently, Melbourne - Australia.
caption: A sterile and safe injection kit obtained from a needle exchange program
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