The Hep C virus is spread through blood. One of the ways you can reduce the spread of Hep C is by taking care to inject safely. This means not using equipment that has been used before to prepare or inject any drug, including heroin, crack, steroids or hormones.
This is because blood could be on a needle, cooker, spoon, filter, tie or other equipment if it has been used before. It only takes a small amount of blood to spread Hep C from one person to another, and transmission can happen even if you don’t see any blood on the equipment.
You can avoid coming into contact with used drug equipment by not sharing, borrowing, lending, passing on, taking, buying or selling equipment from someone else, even if that someone else is a friend or a sex partner.
Following steps to prevent Hep C, listed below, can also prevent most other infections spread by injection drug use, including HIV. Using new needles every time will also help prevent scarring or track marks because dull needles are more likely to leave a mark.
The harm reduction information that follows is offered as a public health service. Its purpose is not to encourage or condone the use or possession of illegal drugs. It is to help people make safer choices in their use of drugs that will reduce the spread of Hep C and HIV.
Learning how to safely prepare and inject drugs for yourself
Knowing how to prepare and inject drugs for yourself puts the power over your use into your own hands.
Information on safer injection is provided on this page. If you want to learn more, you can watch this video that takes you through the steps or speak with someone at a needle exchange program near you.
Planning ahead of time: Do you have the equipment you need?
Having new sterile equipment—and enough of it every time you inject—is important for reducing your chance of getting Hep C. If you always have extra equipment around, it is easier to avoid situations where you borrow from or share with other people.
Needle exchange programs give out new sterile equipment for free. Available items that will help reduce infections include:
- alcohol swabs
- cookers and spoons
- sterile water
- vitamin C powder or citric acid
- tourniquet or tie (made of pliable, easy-to-tie-and-release material)
- sterile/unused syringes (one for each injection you’ll be doing, plus some extra for good measure)
You can also find most of these items for sale at your local pharmacy and create your own kit.
Picking a good location
Some places are safer than others for injecting drugs. Try to pick somewhere that has a lot of light, running water for washing your hands, and an area to lay out your stuff. Also, picking a place where you feel safe and away from interruption, especially from police, is important so that you can take as much time as you need.
Wherever or whatever you inject, cleanliness is your best bet for making sure you don't get dirt or germs in your veins. Think about all the things you touch or use during a fix and then think about how to keep them clean: your equipment, your drug, your work surface, your hands and your veins. It’s as if you are drawing an imaginary bubble around all these things and let you and your drug in but keep the germs out.
Think about all the things you touch or use during a fix and then think about how to keep them clean: your equipment, your drug, your work surface, your hands and your veins. It’s as if you are drawing an imaginary bubble around all these things and let you and your drug in but keep the germs out.
Whenever possible, wash your hands and the work surface with soap and water. You can also lay down a new piece of newspaper to use as a work surface.
Using an alcohol swab or BZK wipe (alcohol-free antibacterial wipes) to clean the skin around the vein you are going to use will get rid of germs the needle could otherwise push into your body. Wipe in one direction, not in circles or back and forth because this will just move the germs and dirt around and they will stay on the skin. Use as many swabs as you need until they stay white after wiping.
Taking care of your veins
Veins are an entry point for Hep C and other infections such as HIV and Hep B. With use, they can also collapse or become hard, making it more difficult for you to inject into them. There are a number of steps you can take to help keep your veins healthy:
- If you're injecting pills, the finer the powder, the easier it dissolves and the less chance you'll have of injecting un-dissolved pieces. Some people buy a pill-crusher from the drugstore to help with this. If the pill has a coating on it, the coating has to come off first before crushing and injecting. Any bits left can clog up your syringe and get into your veins and cause damage. Try to use sterile water and a clean piece of paper to rub it off—using your spit or your fingernails puts germs on the pill that can get into your veins when you inject and this can cause infections or abscesses.
- Drawing up your drug through a filter to keep out bits that didn’t dissolve can protect you from chalk lung.
- A used filter is impossible to clean and can easily have germs growing in it or Hep C virus from someone else who used it.
- Use a pinch of vitamin C or citric acid to dissolve drugs like brown heroin or crack (instead of lemon juice or vinegar, which can damage your veins).
- Rotating the sites on your body you inject into gives veins a chance to heal between injections. Some sites are very dangerous to use because injecting into them can cause serious health problems. These sites are the neck, groin, penis, breasts, eyes and feet.
- Flag to make sure you are injecting into a vein. To flag, insert the needle into the vein at a shallow angle (about 35 degrees) with the bevel (opening at the end of the needle) facing up. Pull the plunger back until blood rushes into the syringe. If the blood is dark red (instead of bright red), you’re in a vein. Injecting into an artery or tissue can cause pain, heavy bleeding or skin infections (like an abscess).
- Use a clean tissue or cotton ball to put pressure on the site after injecting to help stop the bleeding. Alcohol swabs will make it bleed more—the more blood, the easier it is to get Hep C. Using your fingers to wipe up the blood can cause infections.
All the equipment used to inject drugs has a chance of getting blood on it and can spread the Hep C virus. To dispose of the equipment safely when you are done, you can follow these two steps:
- Put all your used equipment (not just the needles) in a sharps biohazard bin. If you don’t have a bio-bin you can also dispose of these items in a hard plastic container that has a lid (such as a detergent bottle, pop bottle or glass bottle). Trying to recap a needle can lead to an accidental needle-stick and can spread Hep C or HIV.
- Clean up your work area, throwing away any used newspaper and tissues.
This way, there is less chance of someone else using your stuff or used equipment ending up in public places, like parks or alleys.
Taking extra steps when injecting with a group of people
Reducing your chance of getting Hep C or other infections when you inject with other people takes some extra time and effort. But it is worth it.
If you are injecting with a group of people, you may want to think about marking your equipment in a way that makes it easy to tell apart from other people’s equipment. Here are some different ways to mark your works:
- use a waterproof felt pen or nail polish
- put a piece of tape around the barrel of the syringe, the handle of the cooker and the tourniquet
- cut off half the plunger top and half the handle of the cooker
- scrape a number off the barrel of the syringe
Creating your own zone or space for injecting can also help keep your equipment away from other people and their equipment.
If you are sharing your drug with other people, how you share can also spread or prevent infections:
- Dividing the hit before cooking is the best way to prevent Hep C. When shared, the spoon is an easy place for Hep C to be transmitted from one person to another.
- The second safest option is to frontload or backload (piggyback) with all new equipment This involves drawing up the whole drug solution into one syringe and using that syringe to squirt solution into other syringes through the front end where the needle is (frontloading) or back end where the plunger is (backloading).
- If there is only one new needle, it’s important to use this new needle to divide the shot.
- Not sure about your frontloading or backloading skills? You can practice with water.
Finding a few other people who are also interested in safer injecting and working as a group to follow the tips on this page can help prevent Hep C in the long-run!