Routes of Administration, Pt. 1: Injecting

"I quit heroin a few years ago, but I've recently started using on occasion again. Unfortunately, my veins don't seem to have recovered. It's almost impossible for me to find a vein. I heard IMing causes abscesses, but I know you've mentioned it before. Is it safe to IM black tar?"

When talking about heroin, one of the topics that comes up all the time, among users, potential users and non-users alike, is routes of administration. There is usually a generally accepted preferred route of administration (or RoA) associated with each drug that most users stick to. Pot is smoked (although it can be consumed orally). Cocaine is insufflated (although it can be injected or smoked), LSD is typically dissolved on the tongue (although it can be taken sublingually, injected, consumed or absorbed through the skin) and so forth. Heroin on the other hand can be taken any number of ways and each user has their own method. The most common routes of administration include, insufflation, plugging (rectal administration), smoking, oral, skin popping, IV injection and IM injection. While heroin is most closely associated with IV injection, a recent study claims the majority of users in American insufflate heroin. But depending on your region, the statistics will vary greatly. On the east coast heroin comes as a powder, making it easy to blow. The same study showed that the vast majority of west coast heroin users inject. That’s because black tar does not lend itself to insufflation (although it can be water-lined with very nice effects, a process I’ll cover later). On the other hand, unlike white power, it can be smoked. In fact, black tar was actually created in response to users on the west who wanted an alternative to injecting. It’s got a good burn rate and when done by a skilled user, can produce and effect similar to the rush experienced with injection, a process called Chasing the Dragon. The downside is that it does require skill and experience, otherwise it can be quite wasteful and hardly worth the time.

Before choosing to use heroin, each person has to ask themselves what routes of administration they are willing to use. Many people have a strict no-needle policy. And in truth, there are a lot of benefits to avoiding the needle, both in terms of your health and socio-culture consequences. Multiple studies, both in the US and the UK, have reported a general trend away from injecting, even while heroin use appears to be on the rise. On the flip side, there are some drug users who are drawn to heroin, and IV drug use in general, because of injecting's taboo reputation. It’s considered the ultimate conquest, the final frontier of drug use. And some will be intent on trying it as a means to achieving status among the drug using elite. Unfortunately, many of these people aren’t prepared for the full spectrum of negative consequences that come with being an injecting drug user. I know that it’s very unlikely I’ll be able to talk anyone out of it if they are set on feeding their ego. But I would still strongly encourage everybody to carefully weigh the pros and cons before making the decision to inject. The wider your eyes are open, the better prepared you’ll be to handle the realities. Because it’s not all pretty.

Each route of administration comes with its own sets of pros and cons. Which one you choose use is a very personal decision. I would never attempt to tell you which one is right for you and neither should anyone else who has your best interest in mind. Just like sex, never do anything with your body that makes you feel vulnerable or uncomfortable. Whether it’s the drug itself or the route of administration, make the choice ahead of time so that you are one hundred percent sure that it’s something you want to do.  My goal is simply to provide you with as much information as possible so that you can make an informed and educated decision.

There is so much important information on routes of administration that I decided to break this up into three separate posts. The first and second parts will be in-depth breakdowns of those RoA’s. For our purposes we’ll break them up into two major categories: Those that use a syringe, namely Intravenous Injection, intramuscular injection and skin popping, and those that don’t, including smoking, insufflation and rectal. The third will be health concerns associated with each RoA.

The intention is to address many questions that I've been asked over the years about RoA’s in one fell swoop, as well as to clear up any misunderstandings and set the ground work for future posts addressing questions on how to care for RoA related health problems that I've been asked. So if you’re considering using heroin, or considering changing up your current RoA, hopefully this post will give you plenty of information to make an educated decision.

Subcutaneous (Or Skin Popping):

I used to think that skin popping was a thing of the past. I’d never seen or even heard of anyone I know doing it, until a few years ago and then suddenly like four or five people I know owned up to skin popping all around the same time, even my then heroin dealer. So I guess the tradition lives on. Basically, skin popping is a subcutaneous injection or injecting the heroin directly into the skin tissue, just under the surface of the skin. Many people like it because it’s a lot easier to skin pop than inject intravenously and while there isn't the rush experienced with IV, the high lasts longer, supposedly hours longer. It’s also much easier to hide your use because it doesn't produce track marks, although bruising can occur around the injected site. When skin popping, small doses are wasteful, so you want to gauge your tolerance closely. Start out with a lower dose and work your way up, because overdose is still a risk, although less of one than with an IV injection. But for the max benefits, dose on the higher end of your tolerance. Because it takes between 5-15 minutes to completely absorb, it can cause infections like abscesses, just like missing an IV injection. So it’s important to change injection site frequently and limit the number of daily injections.

The process goes like this:

1. Cook the heroin in a clean metal container, like a spoon or cooker from a needle exchange, by dissolve it in water over a

   

   Cooking Up Heroin

   flame. This helps cook out any impurities, and with black tar actually activate some chemicals as well.
2. Drop a small piece of cotton into the dissolved heroin.
3. Press the tip of a clean syringe into the cotton and suck up the liquid into the chamber by pulling up on the plunger.
4. To practice strict harm reduction, back-fill a new syringe with the heroin and tap out all visible air bubbles.

*Quick note on air bubbles. Somehow a rumor started that air bubbles can kill you. This is not the case. You can inject up to 4 cc’s of air before any damage will occur. That’s 4 full syringes of air. So don’t stress or worry about a few tiny air bubbles you can’t see.

5. Locate a spot on your arm or thigh to inject and clean it with alcohol.
6. Remove the cap carefully, so as not to make contact with the syringe tip.

   

   Sucking up Heroin

7. Inject the needle just under the skin. If you start to bleed in excess, stop and apply pressure; you might have hit something. But once you are just under the skin, very shallow, simply push the plunger down and allow the fluid to collect under the skin. A large bubble will develop. That’s okay. The skin is very elastic and the bubble will go away as the heroin is absorb. The bubble can be a bit alarming at first, but you’ll get used to it.
8. Once all the heroin has been injected, simply remove the syringe and in 5-15 minutes, you’ll be high.

You may experience slight discomfort, but it shouldn’t be too unbearable. The main things to consider when choosing to skin pop are the likelihood of infection, and to make sure never go to deep. It’s got a lower bioavailability than IV or IM, but it produce a longer lasting high.

Back-Filling the Syringe

Intramuscular Injection:

Intramuscular is my go-to route of administration if I can’t IV for some reason (usually do to lack of usable veins). It’s a got the second highest bioavailability at 86% and is extremely easy to do. However, it can be extremely painful, especially with black tar and it does leave lumps around the area of injection, but almost no bruising whatsoever. So if you’re looking for a good way to inject without leaving any trace, IMing is the way to go. As long as you administer the shot slowly, the pain can be significantly reduced to almost zero. I like it because while it doesn’t have the same intense rush as an IV injection, there still is a slight, yet noticeable rush that comes on about 3-5 minutes after the shot. You definitely know you’ve taken it; you’ll even get the same taste in your mouth, although slightly less intense. If you’re squeamish about IV or just don’t have any veins left, you’ll be most satisfied with an IM injection, in my opinion. The chance of infection is much lower than both IV or subcutaneous, as long as you go deep enough into the muscle. In all of my years of IMing, I’ve never had an infection and I’ve only IM’d black tar. But if you do get an infection, it will probably be very deep, so you’ll need to get medical attention right away,

Blood Filling the Syringe

before it can make its way to the bone.

The process is simple.

1. Prepare the shot by following steps 1-4 under skin popping.
2. Locate a spot on your upper arm or buttock, thigh is acceptable as well, but hurts like the Dickens, so I would avoid it, and clean it will alcohol.
3. Insert the syringe until the entire tip is deep within the muscle.
4. Push down slowly on the plunger until all the heroin has been injected. The high will come on in about 3-5 minutes. So sit back, relax and enjoy

If the pain is too intense, you can also choose to rotate spots part way through the injection, or pause and take breaks. The pain will only last during the injection. Although you may feel some tenderness around the area for a couple of days. And honestly, I’m just preparing you for the worst here. It’s honestly not that bad at all. It’s only when I've used the same injection site for a while that I ever experience any notable pain. One more word of caution; it may be very tempting to want to IM after you’ve been struggling to IV for a while but can’t locate a usable spot. I’ve done it a lot, lots of junkies have done it a lot, especially when you’re feeling sick and just need relief. It won’t kill you, but it will greatly increase your risk of infection. Your body doesn't know how to handle its own blood when inserted into a place it shouldn't be, like your muscle. So if your needle is filled with blood from trying to IV, it’s best to avoid IMing if you can. But I won’t judge you. We've all been there. Also, like skin popping, it’s a good idea to rotate spots, to avoid painful lumps on top of each other.

Injecting Heroin

Intravenous Injection:

Intravenous injection comes with the best payoffs and the worst downfalls. It has 100% bioavailability, so it’s by far the least wasteful. It produces the greatest rush, which many junkies are just as addicted to as the high. But it comes with many physical problems, including collapsed veins, bad infections from missed shots, thrombosis, endocarditis, the risk of infectious diseases like Hepatitis C and Aids, cirrhosis of the liver, just to name a few (health risks associated with heroin use is another topic I will cover shortly). It also leaves permanent scarring from multiple injections. Unfortunately, the scaring also comes with its own social stigma. It’s almost impossible to hide track marks, making it easy to point out an IV drug user. Many people will use this knowledge to discriminate against you. This should hold equal weight as any of the physical side effects of IVing when choosing which route of administration to use because in reality, it will have the biggest negative impact on your life. It does take a little more skill to administer an IV injection, but after a bit of practice, it’s not that hard.

The process goes as follows:

1. Follow steps 1-4, as above.
2. Locate a usable vein and clean the area with alcohol.
3. Take your tourniquet and tie off the area you plan on injecting, the same way they do when drawing blood. Sit down and make yourself comfortable, supporting the area you plan on injecting.
4. Hold the syringe like you would a pencil. It should be at about a 45 degree angle. You want to point the syringe with the flow of blood, towards you heart. Insert the needle into the vein.
5. When you think you’re in the vein, pull up slowly on the plunger. If you’re in the vein, a plume of blood will fill the syringe. If you don’t see blood trying readjusting the needle slightly until blood fills the chamber. But don’t poke around in your vein too much. If it doesn’t happen, pull out and try another area.
6. Once you’ve got a good flow of blood into the chamber, proper protocol says to untie the tourniquet. If you’ve got good veins, this shouldn’t be a problem. Your syringe will stay in place.
7. Once the tourniquet has been removed, simply push down on the plunger and inject the heroin.
8. Slowly remove the syringe from the vein. You can put a cotton ball on it if you want to stop the bleeding. Or just apply pressure. I typically swab the area with alcohol again. But many people choose not to because alcohol can increase bleeding and can be slightly painful. You should feel the rush within 5 seconds.

I’ve already covered many of the questions you may have regarding which veins to use and how to make veins accessible in a prior post. To read all about it, please visit Making Veins Pop.

As I mentioned before, IV drug use comes with many health risks. And while every route of administration causes addiction, IV injection poses a much greater risk of addiction than other RoAs. Some say 200% more. In fact, even the act of injecting drugs can be addicting – extremely addicting. I often say I’m equally as addicted to the needle as I am to the drug. It’s very, very hard to stop after you start and it should not be taken lightly. There are so many negative consequences associated with injecting drugs, I couldn’t even begin to list them all. I would be a hypocrite if I told everybody not to do it, since it’s a daily part of my life. But I would strongly council anyone who is considering it to try another method of injection first. IMing is much less dangerous and eliminates the social stigma you’ll face.

In the next installment, I’ll cover the routes of administration that do not require a needle. Following that, I’ll discuss health risks associated with heroin use. In the meantime, let me know if you have any questions regarding this topic, or any other heroin related topic.