The Pill Injectors Handbook
By: Toby Clark-Pickens, Austin Harm Reduction Coalition.
(Editor’s Note: THIS IS A GREAT RESOURCE IF YOU INJECT OR EVEN TAKE PILLS!)
- Pill injection is risky business: There is no “safe” way to inject prescription pills but there are ways that are much safer than others. Harm Reduction!!!
- If you inject pills you are 5x more likely to get HCV than inject heroin.
- Armed with the proper education and equipment, you can avoid most life-threatening problems that are associated with prescription pill injection.
- Many of the dangers of pill injection come from the various other ingredients in the pills, like binders and abuse-deterrents. (ingredients contain gelatin, wax, cellulose, sugars, starches, and alcohols, none of which you want in your bloodstream) .
- Acetaminophen is not water soluble- this is found in 5 and 10 mlg. oxycodone, or Percocet.
- Because preparation of prescription pills can be such a lengthy process, your final product has much more opportunity to be exposed to bacteria. Introducing bacteria into the bloodstream can cause blood infections that could lead to sepsis, increased abscess, poor circulation, poor wound healing, and bacterial endocarditis, which is a bacterial infection of one of the heart valves, which can result in open heart surgery, or lengthy IV antibiotic treatments.
- The micron filter is the solution to many of these problems, which can filter out many of these harmful ingredients and also bacteria. It does not filter out viruses, however, so HIV and HCV can still be a risk, if sharing equipment.
- This was written as a response to a CDC study which found pill injections 5x more likely to be infected with HCV as opposed to heroin.
WHY IS PILL INJECTION SO DANGEROUS:
Several factors could be attributed to this. Pill injection requires more water to render the drug from the solid form; so multiple injections may be needed to do a single dose with the normal insulin syringes. Longer injection times have been proven to increase the chance for transmission of disease.
Additionally, the use of a 3mL syringe, which would cut down on the injection time, as only one injection would be needed, could be a contributing factor. The 3mL syringe has more dead space, which can harbor the HCV virus for up to 63 days. Because this equipment is harder to come by, people may be more likely to share. There is NO scientific evidence to say if bleach will definitively kill the Hepatitis C Virus.
Finally, pill injectors sometimes run with a different crowd, or are concentrated in more remote areas, both of which can lead to less exposure to harm reduction information. This pill injection kit is an attempt to solve all three problems that put the pill injector at a higher risk for HCV.
By providing the equipment for safer pill injection, we can reduce injection times and the chance of sharing equipment. By providing education on safer pill injection, we can reduce the chances of problems associated with pill injection, as well as reduce the chance of HCV transmission.
Hopefully, by providing specialized equipment for pill injection, we will gain more clients to access our services. While this project was in the final stages, an HIV outbreak occurred in a small town in Indiana among Opana injectors, which fueled this project even more. It is dire that we get this information to the pill injector, and we need every one of you to help spread this message. Peer education is the best way to do this. We need you to share this information!
3 ml Syringe Butterfly Syringe
Syringe Choice and Pill Injection Pill injection is a unique case when it comes to syringe choice, and there are down sides to any syringe that you choose, so it is important to discuss syringes with pill injection. In a study by Greg Scott, we found that longer injection times can increase the risk for transmission of disease, like HIV and HCV. This is because the user has more opportunity for exposure to these diseases. Because pill injection requires so much water to be added, the injection is usually too much volume to fit into an insulin syringe and sometimes requires more than one injection.
Some will use the 3mL syringe for pill injection, as it only requires one injection. But, the 3mL syringe poses its own risks that are important to know. The 3mL syringe has a high dead space, which refers to the amount of space between the plunger and the needle (in the hub), in which a small amount of the solution remains in the syringe after injection. Because HCV can live in the barrel of a syringe for 63 days, the high dead space syringe can attribute to the transmission of HCV.
Normally, we recommend that users do not use high dead space syringes, but pill injection creates an exception to this rule. It is very important to note that you should NEVER share a 3mL syringe, and since bleach may not kill HCV, this is not a good alternative, either. It is far less risky to do several injections with an insulin syringe instead of sharing or bleaching a 3mL syringe. By providing these syringes at the exchange, we hope to cut down on the need to share them. With an adequate supply of 3mL syringes, this is probably the best choice for most pill injection.
One more alternative to using the insulin syringe is using a butterfly needle. This needle does not have the high dead space, and so the risk is a bit lower in that department. But, the butterfly syringe poses its own risks, too. First of all, the butterfly can more easily slip out of the vein if not properly anchored, which could cause an abscess.
Additionally, you have to flush the butterfly syringe with sterile water to get all of the drugs through the plastic tube. Because you are already injecting more water than a traditional shot, adding even more to flush is not always the best option. Adding too much water can blow out veins, but it cannot kill you, as many people think. If you are injecting many times in the day, a butterfly is not the best choice. A number of users have found that the butterfly is a good choice when injecting liquid methadone because there is such a large volume of solution
What is Micron-Filtering, Anyway? Micron filtering is used to ensure the sterility and safety of IV drug use, particularly with the use of pills. The Micron Filter has a very fine mesh inside, which will filter out the majority of the unwanted inactive ingredients found in pills. Some unwanted ingredients, like talc, which is found in Oxycontin and other pills, and this substance can eventually end up in your lungs, causing a lot of problems. The Micron Filter can also filter out bacteria, but not viruses.
These inactive ingredients can cause some real problems when injected intravenously. Talcosis comes from injecting talc, as it settles into your lungs. One man studied had to have a lung transplant due to Talcosis from injecting Ritalin. Injecting pills gives a higher probability that contaminants, such as insoluble particles, enter the body, which can irritate and inflame tissue and veins, causing infections in the skin, muscle (granuloma, abscess.)
Insoluble particles can also cause microcirculation capillaries to become blocked, which can clog up the heart or lungs. Granulomas in the lungs caused by inflammation, which can lead to scar tissue (fibrosis). Conglomerate masses lead to restrictive lung disease and pulmonary hypertension. These particles can reach other organs, causing tissue damage or function restriction. Bacteria and fungi can also be introduced without micron filtering, causing local or systemic infections. These inactive ingredients are essential to proper absorption when the pills are taken orally.
Without these binders, many medications would not make it to the stomach for optimum or proper absorption, as they would be dissolved in the mouth or throat. These binders keep the medication in tact until it reaches the stomach. The stomach is violent and acidic environment, and many of these binders are made to be broken down by stomach acid, but not before it begins to churn in this highly acidic environment. Can you imagine what these ingredients may do if they are in your blood stream, but strong enough to withstand the harsh stomach acids? Micron filtering will eliminate these harmful byproducts from entering your blood stream.
Some things to remember: Prescription pill injection is tricky because so many of the pills out there are abuse-deterrent. These mechanisms generally make the pill very hard to crush and they also “gel” when water is added. Of course, there are ways to get around these mechanisms, but it is often a lengthy and sometimes complicated process. Often times, the process involves additives that are dangerous if injected.
PILL RECIPES: FROM FORUMS< CONTACTS<INTERNET SITES-
The first challenge with some pills is to get the pill into powder form. Before beginning, you want to remove any coating that may be on the outside of the pill. DO NOT put the pill in your mouth to remove the coating if you plan to inject it. Your mouth can contain bacteria that could really harm you if injected. Be careful with applying much water because you do not want the pill to begin to gel.
Using a slightly damp paper towel works really well. With pills that are easily crushed, you can place it between two spoons, smashing the contents into a powder, or you could cover the pill with a piece of paper and crush it with the back end of a lighter before using the edge of the lighter to rub over the pill until it is a very fine powder. Unfortunately, many pills today are nearly impossible to crush this way because of their abuse deterrent properties.
Crushing some pills requires using some sort of filing device, so you can file the pill rather than crush it. A Dremel tool is a great option, if you have access to one. Most will use a PedEgg, or some other fine filing device. A hose clamp is another really great option that can be purchased at a hardware store for a dollar or two. Just straighten out the hose clamp and use it as a file.
Methods and Recipes: Extracting the Active Ingredients The next step is to extract the active ingredient, and because many of these abuse-deterrent pills gel in water, this can be challenging. One way of breaking the gel is cooking the powder. The powder can be laid onto a Pyrex baking dish, flattening it out as much as you can, and baking it at a low temperature until the powder turns a brown color. You can also achieve this by microwaving it. You must keep a close eye on it in the microwave because it can burn quickly and ruin the pill.
Another way to break the gel is by adding some other ingredient, such as alcohol or citric acid. Please note than injecting alcohol is dangerous, and you will need to burn the alcohol off before injection. Not all pills are the same, and their properties can even vary from maker to maker. The following recipes have been taken from various sources, from Internet forums to personal contacts. Some claim these recipes work, and others have not had good results. There are so many variables when it comes to preparing a pill for injection, that it is hard to say that any one method is foolproof.
Please remember that the lengthy process that can be involved also creates more of an opportunity for the drug to be exposed to bacteria or other contaminants, so try and maintain as clean of a workspace as possible and use sterile equipment when possible. Methods and Recipes: Using Isopropyl Alcohol to Extract Opana ER You must use 91% Isopropyl Alcohol to break the gel in Opana ER. Anything less has too much water and will not work.
This recipe is specific for a 30mg Opana ER, so you will adjust accordingly. 1)Grind the pill to powder. 2)Put the powder into a metal cooker. 3)Add 1 cc of 91% Isopropyl Alcohol 4)Swirl the contents. Let sit for 20 minutes, stirring every minute or so. 5)Using a draw needle, draw up the contents in the cooker. 6)Put cotton into a 3mL syringe, packing with the plunger. This is used for the first filtration. 7)Back load the contents from the cooker into the 3mL with the cotton, and push this through the cotton and back into a metal cooker. 8)Now, you must cook off the alcohol. Remember that Isopropyl Alcohol is VERY flammable. Be very careful if you use an open flame for this. Place the cooker on the eye of the stove at the lowest possible setting. You can use a candle, but only with caution. 9)Allow the solution to cook until ALL of the alcohol is burned off. You will be left with a film coating at the bottom of the cooker. 10)Remove the cooker from the heat, and scrape the film coating off the cooker, and cut into small pieces, while remaining in the cooker. 11)Add 1 cc of sterile water and stir vigorously for 5 minutes. You may have to add more water until the film is dissolved. 12)Using a draw needle, pull the solution into a 3mL syringe. 13)Replace the draw needle with a wheel filter. Be careful here, and tilt the syringe back so there is air near the top of the syringe, because you do not want to lose any of the solution when you switch to your wheel filter. Some people will backload the solution into a separate 3mL with the wheel filter already attached. 14)Push the contents through the wheel filter into a 3mL syringe with a new needle for injection. 15)Inject. Remember!! Oxymorphone (Opana) is 10 times stronger when injected compared to oral ROA. It is 3-4 times stronger when snorted. Less is more!
You can always take more, but once you have done too much, you cannot take it away. Methods and Recipes: Microwave Oxy Recipe Prepare the Pills 1) Grind the pills into a fine powder. 2) Spread powder out on ceramic plate. (not too thin) 3) Microwave 4-6 minutes. WATCH IT THE WHOLE TIME!! It can burn easily. Remember, cooking times vary in different microwaves. 4) As soon as the powder begins to turn brown, turn off the microwave. Almost all of the powder will be golden brown. (some white flakes are ok) 5) Place in the freezer 5-7 minutes. Carefully remove from freezer and place on counter. 6) Scrape up the powder, chop finely. You could snort or plug it now, but you need more work to IV. Prepare the Injection 1) Put the powder and sterile water into a cooker. 2) Stir. 3) Lightly run a flame under the cooker to heat the solution almost to a boil. (Another method would be to shake vigorously in a 10mL syringe until the solution is ready. This takes a lot of shaking, but won’t alter the properties of any binders. 4) Stir while cooling. 5) The water will turn brown and the pill material will become gooey. You can add more water, if needed. 6) It must be completely cooled before micron filtering. 7) Put a cotton into the cooker, and draw up, then re-filter the solution, and back load into your injecting syringe. 8) Inject.
Methods and Recipes: Citric Acid and MS Contin Morphine can be broken down with citric acid, in some forms. 1) Crush the pill. 2) Add a generous portion of citric acid powder. 3) Using sterile water, heart it slightly in the microwave, for about 45 seconds. 4) Pour warm water into either a 3mL or 10mL syringe. 5) Add powder. 6) Shake vigourously until the pill is dissolved. It may not completely dissolve, but what is left is a thin layer of wax, although it may look like a chunk of the pill at this
Another really fascinating gem that I came across is that Coca-Cola will break the abuse deterrent and time released properties of OxyContin. If you fill a shot glass with Coca-Cola, drop your pill in, and let it sit overnight, the pill will be dissolved in the Coca-Cola, without the time release. Take the shot of Coca-Cola orally, and many people feel the full effects of the OxyContin. DO NOT INJECT COCA-COLA!!!!
Thanks to Toby Clark-Pickens Austin Harm Reduction Coalition, for this primer!