Do the best you can to keep things clean and sterile. To keep skin clean, wash your hands with soap and water or with hand sanitizer. Also, clean the skin where you plan to inject with

1. An alcohol wipe wiping in one direction (the best option)
2. Soap and water, or
3. Rubbing alcohol.

Less effective ways to clean your skin include using hydrogen peroxide or a baby wipe. Do not lick the needle or your skin prior to injecting. Cover the skin with a bandaid after. Avoid touching your works with your hands as much as possible. Try not to roll your cottons between your fingers.

Use sterile water when possible. Reusing bottled water or tap water is not sterile. If using bottled water, try to use a new bottle every time. If that is not possible, keep the bottle closed between uses. Re-capping the bottle between uses may not keep the water sterile but can help prevent further contamination. Be sure to put water directly into your cooker. Water is no longer sterile if placed into something else first. Sterile water can be purchased at drug stores or at harm reduction organizations. Boiling can sterilize water if the water is brought to a rolling boil for 1 minute and cooled boiled water can be sterile for up to 24 hours.

Safest	Less Safe	Least Safe
Sterile Water Sterile water packets from a drug store or harm reduction organizations, or water that has come to a rolling boil for at least 1 minute	Bottled or Tap Water Bottled water or fresh cold tap water	Standing Water Puddle or toilet water. If toilet water must be used, water from the tank is preferred over water from the bowl.

If you are splitting your drugs, try to avoid sharing your needle or cooker. Try to use new cotton as a filter every time and avoid using very old cottons, which can increase risk of a serious infection.

Steps to Injecting

1. Find somewhere safe to inject
Try to find somewhere clean, well-lit, with little risk of interruption (by police or otherwise) and with access to clean water. If there is someone you trust to be present while you inject, don’t inject alone. If the other individual is injecting as well, be sure to take turns so one can provide naloxone if needed. This can save your life if you have an overdose. If using alone, keep the door unlocked with naloxone out in plain sight. Consider calling the Never Use Alone hotline (800-484-3731) to have someone listening for a possible overdose.

2. Get ready
Make sure you have all your supplies ready. Clean your hands with soap and water.

3. Cook the drugs
Dissolve your drugs (powder/solid) in liquid/water to prepare them for injecting. You may need to heat your drugs to help them dissolve. If so, apply heat until you see bubbles form (at least 15 seconds) to help decrease the germs in the drug. If possible, applying heat for longer is better to help kill germs. Even with heating, there is still a chance there could be contagious germs in your substances. You can also add an acid (e.g. ascorbic or citric acid which is safer to use than vinegar or lemon juice) to help break down the substance. If needed, use the smallest amount possible.

Even if your drugs do not require heat to dissolve, applying heat is recommended as it can help kill bacteria and yeast, decreasing your risk of infection.

4. Filter the solution
Draw your dissolved substances up into your syringe through a filter to make sure no solids or contaminants get drawn up with it. Remember, if using a cotton filter, do not roll it in between your fingers or lick it to avoid adding more bacteria to your drugs.

5. Tie off
Use your tie/tourniquet upstream (higher up on your arm) to your injection site to help puff up the veins and make injecting easier.

6. Clean your skin
Use either an alcohol wipe or soap/water, clean your injection site to kill the bacteria and help prevent infections. Avoid licking your injection site.

7. Find a vein
The safest areas to inject are your arms and the back of your hands. Try to rotate sites to allow them time to heal. There are other veins you can inject in but they come with some risks – injecting in your legs can lead to blood clots and the veins in your feet are fragile. AVOID injecting in your neck and groin (near big arteries and can lead to bleeding emergencies) and your wrists (can lead to nerve damage or severe infections).

• Try to avoid injecting into arteries. Veins have no pulse and have a darker color blood. Arteries have a pulse that you can feel and produce bright red “gushing” blood.  If you accidentally hit an artery, untie your tie/tourniquet, apply pressure, and raise the limb to help stop the bleeding.  Injecting in an artery can cause bleeding and sends the substance injected directly into the tissues in the body.

8. Insert the needle
Try to use a new needle every time. Reusing needles can increase your risk of infection and your risk of damaging your skin or veins.

Position the needle with the sharpest point closest to your skin and with the angle cut facing up. This is called “beveling up” and helps minimize damage to your veins. Insert the needle going with the flow of blood (blood in veins always goes toward your heart). Pull back gently on the plunger until you see blood flow into the barrel (“flagging”) to ensure you’re in a vein. Avoid licking your needles at any time during this process.

9. Inject your drugs
Remove the tie/tourniquet to allow blood to flow again. It’s safest to inject a test dose first to make sure the drugs you’re using aren’t so strong they’ll cause an overdose.

10. Remove the needle
After injecting, remove the needle and apply pressure with a bandaid or clean cotton ball. Do not lick the injection site.

11. Clean up
Dispose of all your used equipment to avoid accidental injuries. If you have to reuse equipment, this is a good time to clean and sterilize (bleach) them. If bleach is not available, complete at least three rinses with clean water immediately after injecting (e.g. do not reuse the same water for each rinse, ideally use fresh sterile water).