You are hereby sentenced to five years in prison plus a lifetime infection of HIV and hepatitis B and C! Such is the practice, if not the actual words, of our correctional system today for those who inject drugs.
Red, a Chicago native who has spent 11 years locked up (five of those years maintaining a habit), says, “When you use in prison, you’re putting yourself at great risk for lots of hazards”—unknown drug purities, unclean injection equipment and the costs of violating prison rules.
While access to clean works is an international issue, one place advocacy has not been successful is the American prison system. Switzerland, Germany, Spain, Canada and Australia all have made sterile syringes available to inmates. Yet the U.S. government refuses to take this life-saving measure for any drug user—in or out of prison—and no state has a prison needle-exchange program.
Still, there are steps you can take right now to reduce drug-related harm while you’re inside. From the least to the most risky, they are:
NO USE: In prison or out, the only sure way to avoid drug-related harm is not to use drugs.
USE WITHOUT INJECTING: While injection may get you the best bang for the buck, it’s the easiest way to pick up HIV or hep B or C. Snorting (use your own straw to avoid another’s blood), smoking, swallowing or “shelving” (rectal insertion) all minimize the risk of infections.
INJECTION WITH PRECAUTIONS: If you must inject and cannot get sterile syringes each time:
- Keep a personal syringe. If you have to reuse a syringe, better it be one that only you have used, to avoid getting others’ viruses.
- Clean a used syringe. Whether you reuse your own or someone else’s, you need to thoroughly clean it each time. But even if practiced correctly (see below), no method is foolproof in preventing disease, and research has been all too sparse.
- Take OD precautions. If possible, have someone nearby who can help if there’s a problem. Try a small amount first—is it too strong or nasty? When you get a hit, pull the tie. If you lie down after using, lying on your stomach (head to the side) may avoid suffocation in case you vomit.
A safety manual for injection drug users is available from the Harm Reduction Coalition at 22 W. 27th St., New York, NY 10001; phone: 212.213.6376; Website: www.harmreduction.org. For a flyer on safer drug use, or a copy of Dr. Flynn’s decontamination study, call UC Davis at 916.734.7233.
You can transmit HIV and hepatitis if you share makeshift tattooing equipment, including needles, guitar strings, staples, threads and inks. To lower the risk:
- Make sure you use tattoo needles that are not shared (or clean them first with bleach and water).
- Clean the gun completely (barrel, tip and so forth) with bleach, and then give it a water rinse.
- Never use inks that someone else has used. Don’t put used ink back in the bottle from the cap.
- Always wear latex gloves when giving a tattoo.
Boiling: Thoroughly rinse the syringe in cold water to remove blood and dirt. If you don’t want to risk damage to the plunger—the piece most vulnerable when boiled—pull it out and wash it vigorously in hot, soapy water. Then fill the barrel with water and bring it to a rolling boil for 10 minutes. This should kill all microbes, and avoids the need to use other disinfectants.
Bleach: Disregard any outdated literature that recommends diluted bleach—it’s been known for years that full-strength bleach offers the best chance of eliminating any viruses that may be present.
Alternatives: A study by Neil Flynn, MD, of the University of California at Davis, found that liquid dishwashing detergent can also eliminate HIV. If nothing else is available, you might try hydrogen peroxide, rubbing alcohol or strong drinking alcohol—each is better than nothing. “Tunnel wash”—a mix of soap, diluted bleach, vinegar and water widely used in prisons—might also help.
Remember: Any cleaning is better than no cleaning.
When injecting, follow each of these six steps:
- Fill the syringe with cold water and flush it as many times as needed to remove any blood. Beware: Blood is not always visible (hot water will cause it to clot). Don’t reuse the water.
- Fill the syringe with the cleaning agent and shake vigorously, then squirt it out. Most HIV prevention programs recommend doing this for 30 seconds (time it with a watch or count to 100) and repeating three times (each with fresh cleaner). But one study of cleaning dental equipment found that a disinfectant takes at least two minutes to eliminate hep-B virus, which, like hep C, is much hardier than HIV.
- Flush your needle and syringe with fresh, cold water three times—injected cleaning agents can make you sick.
- After use, repeat the above three times to remove any blood.
- For each shot, use a new cooker (or one thoroughly cleaned with bleach or soap), plus fresh water and a new filter.
- Prepare your shot on a clean surface with clean hands, to help prevent the spread of hep B and C, which can survive for weeks on surfaces. Clean the injection site with soap and water or alcohol before injecting.