Cities Are Teaching Drug Users How to Shoot Up Properly

Injecting drugs properly has only become more important as overdoses reach record highs and drugs like tranq continue to spread across the U.S.
drug-injection-training

As drug users grapple with an increasingly toxic drug supply, some are receiving training on how to shoot up properly and achieve the high they’re seeking.  

“What we learned really quickly when we started working with people who use drugs is that everything they learn about drug use generally comes from their peers, the Internet, TV, movies, and it's all wrong,” said Kailin See, senior director of OnPoint NYC, which runs New York’s safe injection sites, also known as drug consumption sites. 

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“You can't go to your medical doctor and say, ‘I'm really trying to achieve X, Y, and Z physical feeling or X, Y, and Z emotional feeling through my drug use’.” 

While people generally think of drug consumption sites as places that people go to use drugs and have their overdoses reversed if needed, these facilities often offer a range of services, including checking drugs for contaminants, wound care, and injection tutorials. 

And injecting drugs properly has only become more important as overdoses reach record highs and drugs like tranq, a combination of fentanyl and the animal sedative xylazine that’s been linked to skin ulcers and amputations, continue to spread across the U.S. Knowing what to do can also help empower younger drug users, women and queer people, who might find themselves particularly vulnerable in certain situations. 

For drug users, common knowledge gaps include people not knowing how to find veins or that they should be switching up which veins they use and not using tourniquets, according to See. She said she also notices people incorrectly injecting drugs away from the heart or injecting into their arteries.

“You never want to inject into an artery and you want to inject toward the heart,” said See, adding that injecting toward the heart means you’re going in the same direction as the blood flow.

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“You never want to inject into an artery and you want to inject toward the heart.”

OnPoint workers also teach people “the hierarchy of veins,” she added—which veins are the best to use on which parts of the body. She said the wrist, groin, and neck are all more dangerous spots to inject than the arm, for example.

See said it can be hard to convince people to give their favorite vein a break, but it’s important in order to preserve a vein’s health long term. 

OnPoint also shows people how to dose their drugs, which is crucial as people contend with a volatile supply. 

“Preparing methamphetamine and preparing cocaine and preparing crack is different than preparing heroin. You need a different gauge of syringe—you sometimes need to use ascorbic acid.” 

In Philadelphia, harm reduction advocate Sarah Laurel told VICE News people need to know how to inject drugs as hygienically as possible because tranq is dominating the street opioid supply. Philadelphia-based non-profit Safehouse has been trying to open a safe injection site in the city for years. 

Tranq slows down blood flow, making it harder for the body to heal. While no direct link has been studied, emergency department visits for skin and soft tissue injuries more than quadrupled between the first quarter of 2019 and the end of 2021, according to the Philadelphia. And tranq is spreading—data exclusively shared with VICE News shows it’s been detected in at least 39 states, Washington, D.C., and Puerto Rico. 

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“When people miss, it's causing more of these wounds,” said Laurel, who founded the harm reduction group Savage Sisters, which provides wound care to tranq users. “People that know how to properly inject aren't seeing the wounds as often.” 

Earlier this year, VICE News met Sam Brennan, a woman who “muscle pops” tranq, meaning she shoots the drug into her muscles rather than a vein. Brennan used to regularly inject into a vein in her neck, but she developed a sore and started using her muscles instead. 

“Sometimes I do intravenous in my neck, but because of all the scabbing and stuff right now, I just can't hit a vein,” she said. “But the tranq is so strong these days that it really doesn't have to go in my vein.” 

“The tranq is so strong these days that it really doesn't have to go in my vein.”

Muscle popping is a less ideal way to inject drugs because the chemicals don’t hit as fast since they have to go through the muscle first. And when it comes to tranq, Laurel said it’s just not a good idea.

“It causes wounds at a rapid pace,” she said. 

The adulterants and cutting agents in the drug supply also don’t dissolve well with muscle popping, so tiny particles that get “stuck in the meat of the muscle,” See said.  

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“That's when you get cellulitis, you get big abscesses, because that particulate matter has to push its way out of the muscle somehow. And that leads to some pretty big, terrible wounds.” 

Some harm reduction advocates also believe teaching drug users to shoot up is a safety issue that can potentially help fight against drug-facilitated sexual assaults. Erica Thomson, executive director of British Columbia and Yukon Association for Drug War Survivors, previously told VICE News women and girls often rely on men to prepare their doses and inject them, which has can lead to overdoses, robberies, and sexual assaults. 

“If you're very young, you don't normally learn how to do it yourself and you have someone facilitating that, and it causes a real big power difference for men and women,” Thomson said.

Despite their benefits, safe drug consumption sites are still federally illegal in the U.S. under the “crackhouse statute,” which says it’s unlawful to open a property that will be used to consume drugs, and protracted fights have happened in the cities that want to open the facilities. 

“We sometimes get accused of enabling in that way. It's not at all what it is—this is about keeping bodies healthy, brains healthy, hearts healthy, veins healthy, and keeping people alive,” See said.

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Safe drug consumption sites, however, exist across Canada, Europe, and Australia. No one has ever died at one, and research shows they’ve resulted in fewer overdoses, ambulance calls, and reduced HIV transmission rates. 

OnPoint opened the country’s first legally-sanctioned safe injection sites last November and has reversed more than 600 overdoses and overseen over 44,000 uses in that time, according to See. The facilities were previously syringe exchanges and served as underground drug consumption sites before former Mayor Bill de Blasio announced the police department would not try to shut them down if they operated in the open. 

When Safehouse tried to open a safe drug consumption site in Philadelphia in 2019, the U.S. attorney for the district at the time invoked the crackhouse statute to block it. The group is still tied up in court proceedings with the Department of Justice. Earlier this year, the DOJ told the Associated Press it was “evaluating” safe drug consumption sites. 

Rhode Island was the first state to legalize safe drug consumption sites—those sites will open next year. 

Follow Manisha Krishnan on Twitter. 

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