Table 3.

Summary of drug preparation steps and safe injection counseling points

Drug Preparation Step	Counseling Points69,70,102–106
Injection site preparation	Wash hands before and after injection Use alcohol pads, gauze pads, and bandages at injection site Clean other surfaces blood may have touched (ie, tourniquets) To minimize SSTIs, avoid “skip popping” (injecting subcutaneously) or “muscle popping” (injecting intramuscularly) if unable to find veins Avoid major arteries and small veins Rotate injection sites
N/S	Avoid reusing N/S Although often done to recover residual drug, avoid licking needles If no clean N/S available, wash with full-strength bleach for >2 min
Filters	Cigarette or other filters that require manual manipulation increase infection risk Consider small, preformed pellets Use new filters with each injection
Cookers	Cooking drugs can decrease bacterial burden. Avoid reusing or sharing cookers
Dissolving drug	Use sterile water when possible
Acidifiers (used if injecting solids such as base heroin or crack cocaine)	Use vitamin C packets to minimize risk of fungal infections and vein damage Avoid excessive use (ie, entire vitamin C packet) owing to risk of vein damage Consider adding small amount of sodium bicarbonate to buffer solution at the end of drug preparation process105
Environment	Take your time; find a clean, safe space Avoid injecting alone To decrease overdose risk, inject yourself, rather than having someone else do it

Abbreviations: N/S, sterile needles and syringes; SSTIs, skin and soft tissue infections.