Injecting substances intravenously or intramuscularly, though practised by some individuals, comes with a unique set of risks that cannot be overlooked. While this route of administration may offer certain advantages in terms of rapid onset or bioavailability for some substances, it also introduces a host of potential dangers to the user's health and safety.

This article aims to provide comprehensive insights into the general risks associated with injecting drugs, along with harm reduction principles that can mitigate these risks to some extent. Additionally, it addresses specific concerns related to injecting psychedelics, a practice that presents its own set of challenges and considerations.

General risks of injecting

• There are inherent risks to injecting drug use. Safe practices reduce, but cannot remove these risks

• Risks include: injecting site infections and abscesses, heart valve infections, blood clots which can threaten life, lungs and limbs, blood vessel damage, spinal abscesses and blood-borne virus transmission

• There is often a greater risk of overdose

• The risks associated with adulterated substances may be greater if injecting

Harm reduction principles

• Never share or reuse injecting equipment. Clean injecting equipment is accessible through a range of services including AOD services, hospitals and some pharmacies. In some areas it can be delivered by outreach services.

• Always disinfect the skin with an alcohol wipe before injecting, and allow the site to fully dry before injecting

• Avoid injecting repeatedly in the same site as this can lead to vessel damage and clotting.

• Always use a filter (“wheel-filter”) to remove particles. Particles entering the veins can form clots. These can travel to the lungs which can lead to death

• Never inject in the neck or at other sites close to arteries – particles entering the arteries can block blood supply

• Always dissolve the substance in a sterile, single-use spoon or a thoroughly disinfected vessel and use sterile saline.

• Never inject anything that has been in someone’s mouth or other body cavity.

• Never inject non-water soluble substances like most benzodiazepines, or solutions containing alcohol. This risks vessel blockage and damage. These substances are generally rapidly absorbed sublingually (by holding in the mouth) and will also bypass first-pass metabolism via this route.

• Some drugs may require significantly lower doses when injected rather than ingested, particularly those that undergo extensive first-pass metabolism when ingested.

• If injecting into the muscle, look up where on the body is safest to avoid potential nerve and vessel damage. Always pull back the plunger before injecting - if this draws blood, you are in a blood vessel and should not inject.

• Have naloxone on hand and be familiar with identifying signs of opioid overdose and how to use naloxone

• Get training in basic life support

Injecting psychedelics

• Most psychedelics are not manufactured with injecting in mind

• You should never inject crude plant or fungal extracts. There is a high risk of infection and the presence of particles, fats or oils that can block vessels or form clots.

• Injecting psychedelics may result in a much faster onset, which could be challenging

• Some psychedelics are increasingly prone to adulteration with other substances including potent opioids or other novel psychoactive substances. 

• The safety of injecting many psychedelics, particularly newer substances, is not well-established

• Injecting presents little advantage over other routes of administration for substances that do not undergo significant first-pass metabolism (breakdown in the liver after absorption from the gut). Per-rectal or sublingual/buccal administration can also reduce first-pass metabolism without the risks associated with injecting.
  
  Disclaimer: This information is general in nature and is not intended as medical advice.

If you need assistance please make contact with the services below:
Harm Reduction Victoria: https://www.hrvic.org.au/
Alcohol and drugs foundation: https://adf.org.au/help-support/
Turning Point: https://www.turningpoint.org.au/
Beyond Blue: https://www.beyondblue.org.au/