Audio, images, text on safe and effective filtering for IV users
This audio is a shortened version of a Podcast produced by Firesnake, as part of iPeer; Illicit Drug Community Peer Support and Education. It's purpose is to meet the lack of clear and pragmatic advice around Injecting Drug Practices. This episode focuses on oral medication, yet is applicable - and contains information - relevant to Safe Injecting. Listen at your Desktop and access the references from del.icio.us as they come up during the episode. If you use a portable mp3 device you can download the audio directly here. Images and text can be copied onto your device. If you use an iPod this episode can be found in iTunes by searching the store in "Podcasts" for "Firesnake". Episode 16. Detailed images, links and explanation here.
As opiate availability has fallen in Australia a concomitant rise in IV use of oral medication has become evident over the last few years. Whilst safe filtering of any gear prior to injection is vital, the use of Oral Meds in this manner requires critical examination [Drugs, Crime Prevention Committee - Interim Report on Benzo & other Drug Misuse Aug '06].
The psychoactive agent in oral medication makes up only a fraction of the pills volume. The remainder is filler material and may vary from maize starch and chalk to glue, talc, magnesium dioxide and alcohol - to name just a few unwanted guests.
In this episode we walk through how to filter your gear, regardless of what you may be injecting. The aim is to ensure you understand how to mix different oral medication before a whack, how and why to filter, what equipment to use, why and how to use it, where to get it and to be confident your hit is as clean as possible. We knock a couple of myths on the head, review why some filters don't really filter and reinforce safe injecting practices. NB: no filter can remove a virus and they will happily zip through all filters, up any sized pick and thoroughly enjoy setting up camp to replicate in your cells. It is possible to filter bacteria, and we touch on how and why 0.22 micron filters are a must for a clean hit.
1. Read up on HIV, HCV and Hepatitis B - great Fact Sheets.
2. Filtering Licit and Illicit Drugs for Injecting - Drug Info Clearing House, Fact Sheet. [HTML].
3. Traditional cotton filters, swabs and cigarette filters do a poor job and carry a huge risk of infection from unhygienic use, bacteria living in cotton and necrosis or serious tissue infection from fibers. Injecting non-sterile oral preparations requires an understanding of how to effectively mix and filter appropriately for benzos, oral morphine and buprenorphine. Each demands prefiltering, repetitive filtering and use of a wheel filter such as Sterifilt.
More so, avoiding heat is crucial to properly mixing oral morphine and buprenorphine. Wash hands and use sterile equipment, water, swabs. Don't heat these mixes. Add ample sterile water, agitate the mix as you crush the particulates [chalks, glues, starches, dust, skin cells, grandmas favourite tea cosy, or whatever's gotten in there that we don't want to hit] until you have a consistent milky solution. Small particles in a pill mix, prepared for a hit and not filtered, can make their way to the capillary bed, lodge, cut off oxygen supply to tissues and arrive packed in bacteria just to ruin your day completely. Gangrene is a reality and amputation of digits, limbs and limb parts is rising in Australia as a direct result of injecting oral medication. More water will not dilute the effect of any injected drug. Period.
The key to getting a mix suitable to filter through a wheel filter is to let it settle. Let the crap fall to the bottom, or float on the surface as may be the case. Use a large pore filter - such as 5 microns in size to filter out the settled glug. With oral morphine, a few goes is normal. Keep this up until you have a milky solution with no particulate matter.
OK. This has only removed the large, insoluble filler components that hold the drug in pill form. We now need to filter through a smaller filter - 0.22 micron wheel filters remove impurities, which would ideally be primed with sterile water. These go between - say - a 3ml syringe and a 9 gauge pick. Push the milky, crap free solution through the wheel filter and out the 9 gauge into a sterile spoon, fit or container.
Now, you're ready to hit a clean, particulate free whack. Again, be sure to wash hands and use sterile equipment, water, swabs. Dispose of everything as you go, leave nothing behind and use a sharps container.
Just to be sure - again - a step by step guide is here. The episode goes into detail in how to mix all gear properly and what not to do to ensure a clean hit.
Of course, it's worth remembering this is the safest most responsible way to manage what is highly risky behaviour. The probability of managing all this fiddling, rapidly decreases with frequency and users involved. Safe filtering is a very elaborate last ditch effort to maintain health, in spite of behaviour. Your mission - should you choose to accept it - is to use responsibly, access support services, understand actions reflect on the entire drug taking community and use freely available, perfectly legal, sterile equipment for the sake of the long term health - of everyone in our community.
We also touch on inevitabilities such as endocarditis and osteomyelitis - very real and common secondary infections from injecting poorly filtered or badly prepared gear and how abscess infection must be monitored and followed up. The Staphylococcus aurea bacteria live and colonise on our skin, and pose a constant risk - via initial wounds - of secondary infection. A number of dynamics on safe filtering, handling, effects of intoxication, high risk infection and safety, overlap and are doubly reinforced.
Injecting Buprenorphine that's been in any oral cavity - even your own is to be avoided. The scale of risk compared to any potential buzz is way out of proportion. The advice on how to, is simply don't. Candida yeasts and oral bacteria may cause complications including blindness. Oral hygiene may be compromised in HIV and other illnesses.
Support:
1. VIVAIDS may be contacted on Australia - 03 9329 1500
