Injecting steroids

There is much debate surrounding the question of whether injectable steroids are more or less effective and safe than oral steroids. It is suggested that the oral steroids, which have a special "17- alpha alkylated" chemical structure making them active orally and more difficult for the liver to break down, may be more toxic to the liver. In addition, these oral steroids are subject to "first pass metabolism" meaning the liver is exposed to the drug at its highest concentration immediately after it is absorbed from the gastro-intestinal system.

 

On the other hand, steroid users characteristically use very large doses of injectables and lesser doses of oral preparations. One might hypothesize that the potential for these high doses of injectables to cause harm to the liver would more than outweigh the intrinsically greater liver damaging effects of oral steroids in smaller amounts. In addition, injecting is potentially more dangerous because in penetrating the skin the body's natural defense against infection is bypassed. The user thus potentially exposes themselves to a whole host of harmful infections, like HIV, Hepatitis B and Hepatitis C. For this reason, the following advice is of the utmost importance if you choose to inject steroids or other substances.

 

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ALWAYS USE NEW AND STERILE NEEDLES AND SYRINGES, EVERY SINGLE TIME YOU INJECT. Also never share other injecting equipment which could have small traces of blood on it, for example, water, swabs, spoons, tourniquets, belts.

 

NEVER SHARE OTHER PEOPLE'S USED NEEDLES OR SYRINGES. NEVER OFFER OR ALLOW OTHER PEOPLE TO SHARE YOUR USED NEEDLES AND SYRINGES EITHER!

 

Sharing of needles and syringes may expose you (or other people) to the risk of HIV, hepatitis B and hepatitis c infection.

 

NEVER INJECT STEROIDS INTO A VEIN OR ARTERY because oil based drugs such as injectable steroids are made for intramuscular administration only and can cause small clots (emboli) if injected into an artery.

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Calculating Doses

Steroids usually come in a liquid form measured in milliliters. The actual dry weight of the steroid in this preparation is measured in milligrams - this is read as milligrams per milliliters on the vial (mg/ml).

 

To calculate dosages, multiply the mg/ml which is shown on the label of the vial by the number of milliliters (ml) of liquid, as measured by the syringe, to arrive at the total dose. For example, if the concentration of a drug is 50 mg/ml, then 2 ml of the drug is 100 mg. It is important to remember that different drugs come in different strengths and one milliliter (ml) of one drug is usually not the same as 1 milliliter (ml) of another, even if it is a similar drug. It is the milligram (mg) strength per milliliter which you should take most notice of when determining how much to use and when working out doses, you should think and speak in terms of milligrams, not milliliters (ml).

INJECTING DRUG USE - BEING PROPERLY PREPARED

I. What you need

-	alcohol swabs to clean the injection site of particles of dirt and bacteria. Sterile water (if mixing a powder steroid);
-	a 2.5 ml or a 5 ml syringe (the size depends on the dosage and type of drug to be taken);
-	when using oil based steroids a larger gauge needle may be required to draw up the drug. i.e. a 19 or 21 gauge needle;
-	a 21 or 23 gauge needle to inject the steroid;
-	a safe disposal container (rigid walled, puncture resistant and sealable).

II. Preparation

-	wash hands or wipe fingertips with a swab and using a separate swab, clean both the rubber cap of the vial and the injection site;
-	if you are using a water based steroid, shake the vial sufficiently well to mix and dissolve all particles in the solution;
-	attach a drawing up needle (19 or 21 gauge) to a syringe, ensure there is about 0.5 ml of air in the barrel so that drawing up is easier and stick the needle through the stopper of the vial. Draw up the required amount of steroid. Remove the needle and put it into a disposal container.
-	attach the injecting needle (21 or 23 gauge) to the full syringe. Hold the syringe upright and expel any air in the syringe. You will need to flick the barrel to get any remaining air bubbles to the top of the barrel next to the needle, and then expel these also.

 

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BEFORE INJECTING THE DRUG, CHECK TO SEE THAT YOU HAVE THE CORRECT DRUG AND THAT THE "CORRECT DOSAGE" HAS BEEN PROPERLY DRAWN UP. THIS IS VERY IMPORTANT FOR ALL DRUGS WHICH YOU INJECT OR SWALLOW.

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III. Injecting technique

-	Choose the injection site;
-	Swab the injection site thoroughly with a new alcohol swab or with soap and water using clean cotton wool;
-	Hold the syringe as if it were a dart, between the thumb and the forefinger of the hand you use the most. With the other hand, spread the skin tightly at the injection site;
-	Insert the needle at a ninety degree or right angle a bit like throwing a dart and with enough force for it to go into the skin and muscle smoothly. Push the needle in about 2/3 of its length, no further; unless you have good muscle bulk or carrying excess body fat.
-	Draw the plunger back a small distance;
-	If blood appears in the syringe, you have inserted the needle into a vein (or artery). Remove the syringe, apply pressure to the area for a few minutes and start again;
-	When the needle is safely in place, check again that you are not in a vein or artery and then push the plunger down into the syringe with a smooth motion;
-	Rub the injection site with a new swab to disperse the drug and reduce pain;
-	Apply pressure to the injection site with the swab for several minutes until any bleeding has stopped.

IV. Where to inject

The best injecting sites are in the larger muscles such as the backside, mid thigh and upper arm. Rotating injecting sites will reduce any marking or scarring.

Buttocks ("Backside")  

 

It can be very difficult to inject yourself safely into the backside (buttocks). Get a friend, who knows how to inject, to inject you. You should make sure when you are being injected that the other person uses a safe and clean injecting technique, just as you should when injecting another person.

 

To inject into the backside, draw an imaginary line vertically down the middle of one of the buttocks. Draw another line horizontally across the same buttock half way down, so that there is a cross, and so that the buttock cheek is divided up into quarters. Inject into the upper, outer quarter of the buttock where there are no large nerves. The sciatic nerve runs down the middle of the buttocks, and if you hit it with a needle you could cause yourself permanent damage. So always inject in the outer side of the buttock. If you do hit a nerve and experience severe pain on injecting, pull the needle out immediately and apply pressure on the area for a few minutes. An ice pack or crushed ice in a tea towel will also help reduce any bleeding or pain.

Thigh

To inject into the thigh, divide the thigh from the knee to the hip in thirds by drawing three imaginary horizontal lines across it. Inject into the outer part of the middle section.

 

The thigh has more exposed nerves and veins than the backside. Place a cotton ball over the injection site if the oil based steroid dribbles out a little bit - this suggests the injection wasn't deep enough into the muscle.

                           

Arm

To inject into the arm, divide the area from the elbow to the shoulder into thirds and inject into the upper outer third. This is the deltoid muscle.

V. Safe injecting hints

Injection Sites

-	Rotate injection sites - if you use the one injection site repeatedly, scar tissue will develop. This tissue can become bruised, sore, inflamed or hard. Injecting into scar tissue will interfere with drug absorption.
-	Injecting with blunt needles causes a "trampoline effect", whereby a blunt needle bounces and it is difficult to break the skin - the opposite to a clean, effortless and painless pierce of the skin.
-	Don't touch, breathe, or cough over the needle or injection site;
-	Do keep the needle capped until you're ready to use it.

Using Vials and Bladders

-	Piercing the rubber cap with the needle blunts and contaminates the needle. Use a different needle to draw up the steroid from the vial than the needle you inject with;
-	Vials with a rubber cap will have bacteria on them. Swab the rubber cap with a new alcohol swab to reduce contamination of the needle and steroid and wait for 30 seconds before piercing it with the drawing up needle;
-	Vials are hard to sterilize. Refilling vials puts you at significant risk of bacterial infections.
-	Some steroids come in bladders of about 200 ml. These could be cheaper, but they are easy to contaminate. They are used for a longer period of time and unless a new needle and syringe is used every time to draw out the steroid, they are easily contaminated with tiny particles of dirt, bacteria and possibly HIV or Hepatitis (B & C) viruses.

 

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Needles that go into bladders and vials must be new or sterile just as needles that go into your body must also be new and sterile.

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Always dispose of used needles and syringes safely. Sharps disposal containers are given out free at needle exchanges. Any strong plastic bottle with a sealable lid such as a strong plastic detergent, shampoo or fruit juice container can be used as a sharps bin. Soft drink cans and glass containers are not suitable, the former because soft drink cans are not sealable and the latter because glass bottles break.

 

Containers can be returned to needle and syringe exchanges or placed in a garbage or wheelie bin provided that they are of a suitably strong and secure design and provided they are tightly sealed before their disposal.

 

INFECTIONS FROM UNSTERILE INJECTING EQUIPMENT AND TECHNIQUE

 

Sharing needles and syringes or other injection equipment such as swabs, spoons or water can transmit HIV, Hep B and Hep C. Unclean injecting technique can cause a range of other infections.

 

Human Immunodeficiency Virus (HIV) is transmitted by unprotected sex, through sharing injecting equipment (needles, syringes, water, spoons or filters) and sometimes from mother to child during pregnancy, birth or breast-feeding.

 

HIV causes a dramatic weakening of the body's immune system and this ultimately leads to Acquired Immune Deficiency Syndrome (AIDS). When your immune system breaks down, the body loses its ability to resist infection and can result in an increased susceptibility to a variety of common as well as rare infections.

 

Hepatitis A (HAV) is caused by faecally contaminated water and foods and is transmitted by inadequate hand washing and close domestic contact. Almost all patients recover fully. An injection (gamma globulin) is available to prevent Hepatitis A when people have been exposed to infection.

 

Hepatitis B (HBV) is a serious viral infection which causes inflammation of the liver, and the virus is found in blood, semen, vaginal fluids, saliva and breast milk. In recent years a safe and effective vaccine consisting of 3 vaccinations over 6 months has proved to be 80-95% successful, depending on the age of the recipient (95% in young children and 80% in older people). This vaccine is available from doctors and free of charge from some community health centers. You should have a blood test 4 weeks after your third vaccination to check that you have developed an adequate immunity to hepatitis B.

 

Hepatitis C (HCV) is a hardier and more infectious virus than HIV and survives longer outside the body. Hep C is an inflammation of the liver and used to be called non-A, non-B Hepatitis. Hep C is transmitted through the sharing of injecting equipment, through blood and blood products and less frequently, sexually. Some people who have Hep C will over time clear the virus from their body. Others will develop chronic hepatitis, with or without symptoms. About 60% of people with Hep C will develop chronic hepatitis, and some of these people will develop cirrhosis of the liver and/ or liver cancer. There is no vaccine for hepatitis C.

 

An abscess is a collection of pus in body tissue under the skin. Squeezing abscesses will spread the infection under the surface of the skin. Injecting through abscesses can also cause the infection to spread. If the abscess gets bigger than a pea size you should go to your doctor or community health center to have it lanced and drained, cleaned and dressed. Antibiotic treatment may also be required.

 

Cellulitis is an infection and inflammation under the skin which spreads from an infected injection site.

 

Endocarditis is an infection of the lining on the valves of the heart which spreads via the bloodstream from the injection site and it may be caused by bacteria, viruses or parasites from contaminated (dirty) drugs, contaminated injection equipment or inadequate cleaning of the skin where injection occurs.

 

Using new and sterile needles, syringes and other injecting equipment each time you inject and practicing safe sex ensures that HIV or Hep C and B will not be transmitted. The proper cleaning of the injection site and the rubber stopper on vials with a clean alcohol swab or if unavailable, with clean soapy water followed by a water rinse using clean cotton wool, will reduce the chances of you getting an abscess or other types of infection. Using new equipment also reduces scarring and the development of tissue damage such as abscesses, cellulitis or endocarditis.