• Snorting
• Smoking
• Taking drugs up the arse
• Dabbing and stuffing
• Injecting

Snorting

When snorting drugs microscopic amounts of blood or mucus can pass from one irritated nose to another. It seems that sharing objects used for snorting (e.g. rolled up bank notes, straws, or 'bullets') could possibly spread Hepatitis C.

There's no evidence HIV is being spread in this way. To remove this risk, avoid sharing anything used for snorting.

Bank notes should be avoided as they may well have been used for snorting before and be contaminated. Post-it notes are a safer alternative.

Smoking

Sharing joints, pipes, bongs or cigarettes may spread the herpes virus, from mouth to mouth if someone has a cold sore. The same goes for syphilis if they have a syphilis sore on the lips or in the mouth.

If you're smoking drugs, the main potential risk of serious infection (hepatitis C and possibly HIV) comes from contact with mouth sores, or broken or bleeding skin when sharing pipes used to smoke crack cocaine.

Taking drugs up the arse

Taking drugs anally (known as a booty bump) can be done with many drugs in their powder form or when tablets are crushed and dissolved in water; examples are crystal meth, ecstasy, cocaine and heroin.

Drugs taken anally are absorbed faster than if swallowed. They're more likely to have a stronger effect, but also interact with other drugs, including some HIV medications. Once inside the rectum the drug soaks through the thin, absorbent lining of the inside of the arse into its many blood vessels, then goes to the brain.

Powdered drugs can be dissolved in water and then squirted up the arse using a syringe with the needle taken off. Sharing syringes this way involves less risk of passing on HIV or other infections carried in the blood (like hepatitis) than injecting into a vein, as there's no needle or direct contact with blood. But putting the end of a syringe inside one arse that's been up another arse still carries some risk of HIV being passed on. And it gives a way into the arse for more easily transmitted infections like warts, gonorrhoea, syphilis or herpes.

Syringes shouldn't be shared - but if you do, cleaning them between each user means less risk (see the section on Injecting lower down this page).

Dabbing and stuffing

Dabbing is another way of taking drugs anally. It involves putting a finger into the arse with powdered drug on it.

Stuffing involves putting a powdered drug wrapped in a cigarette paper into the arse or inserting a tablet into the rectum.

Dabbing and stuffing mean more risk of the drug burning your arse lining because it's not been dissolved in water. A damaged lining leaves you more open to infections.

Injecting

Injecting's the most dangerous way of taking drugs, with risks that don't exist or are much lower for people who take drugs by smoking, snorting and so on. Injecting a drug gives a more intense hit and so is more likely to lead to problem drug use. These risks include:

• overdose
• picking up life-threatening infections (including HIV and hepatitis C)
• blood poisoning
• collapsed veins
• abscesses
• blood clots and deep vein thrombosis
• becoming psychologically dependent on the ritual of injecting.

Whether taking drugs or steroids, injecting can also mean sharing injecting equipment such as needles, syringes, spoons, water, filters and swabs. This is the most efficient way of spreading infections that are carried in blood, such as HIV and hepatitis B and C. The blood that's present may be too small to even see.

Tips

If injecting:

• If possible, switch to a non-injectable form of the drug.
• Learn the difference between a vein and artery and where you're meant to inject: steroids are injected into muscle, not veins, and injecting any drug into an artery could be fatal.
• Know where to get clean injecting equipment and take back used equipment: both can be done at needle exchange programmes, drug agencies and many chemists. Register with a needle exchange.
• Work out how many needles you'll need, and make sure you have at least that many before getting the drugs so that you won't need to share.
• Use a new needle if you fail to find a vein straight away.
• Use the smallest needles you can (ones colour-coded orange are the smallest).
• If possible use surgical swabs on the part of the body you inject into to keep the area clean, or at least wash the area with soap and water. Swab after injecting too. Don't use a swab on two or more people.
• Don't pool drugs in a shared pot. There's a danger of contaminated blood getting into the drugs you're sharing.
• To reduce the risk of collapsed veins don't inject in the same part of the body.
• Get to a doctor if an injection site is swollen for more than a few days, red, hot or tender, or if there's any serious bleeding or the skin changes colour, is sore or weeps.

It's also important to know that:

• Injecting below the waist can cause serious circulation problems if a vein is damaged.
• The temptation to share is strongest for many people when they're coming down from the drug, not before they take it.
• Sharing with people you feel close to may feel safer but this is often an illusion, with infections spreading between friends, lovers and fuck buddies.
• You can sterilise injecting equipment. Find out how to do it now in case one day you have no option but to share. The Exchange Supplies web site has details on how to sterilise equipment in its Safer Injecting Handbook.

More info

If you want to know more about safer injecting read the Safer Injecting Handbook from Exchange Supplies. www.exchangesupplies.org, click on ‘drug information’ at the top, then ‘drug information’ on the drop down menu. Read the booklet ‘Safer Injecting Handbook’ and ‘Cleaning Used Works’.

You can get details of needle exchange facilities from drugs agency Mainliners.
Telephone: 020 7022 1890
www.mainliners.org.uk