Naloxone

What is naloxone / narcan? 

Naloxone, also known as narcan, is the life-saving medication that reverses opioid overdose. It is typically packaged as a nasal spray or intra-muscular injection and can be administered by drug users, family, and friends, as well as health care professionals, teachers, and law enforcement officers. 

 Naloxone has no potential for abuse” - Iowa Department of Public Health

Where can I get naloxone / narcan in Iowa?

Naloxone is available for purchase without a prescription at Hy-Vee and CVS pharmacies in Iowa. Other pharmacies in the state do not reliably carry naloxone in their stores and are not consistently willing to provide it to those in need.

As of June 1, 2017, IHRC provides free naloxone to all Iowans. To request an overdose reversal kit or to find out more about our weekly distribution locations in Eastern Iowa, please call or text (319) 214-0540. 


Syringe Service Programs

Is syringe exchange legal in Iowa?

No, needle and syringe exchange is not legal in Iowa, but is also not illegal in the state. Under Iowa law 

Where can I get new needles or syringes in Iowa?

Pharmacies in the state of Iowa do not require a prescription to purchase new syringes or needles. However, some pharmacists chose not to sell syringes to individuals who do not have a prescription with their pharmacy for a medication that must be administered intra-venously. 

What are syringe service programs?

Syringe exchange programs are one of the most effective public health interventions for decreasing the transmission rates of HIV and other blood borne diseases such as hepatitis C, as well as connect users to treatment and other important needs such as housing or food assistance.

In states with legalized syringe exchange programs, people who use injection drugs turn in their used or “dirty” needles in exchange for unused, clean needles.

By expanding access to clean syringes and ensuring a safe way to dispose of bio-hazardous materials, syringe exchange programs create safer environments for the community at large. Additionally, syringe exchange programs are shown to lead to a 66% reduction in needle-stick injury to law enforcement. 

35 states (plus the District of Columbia) operate successful syringe exchange programs, in which people who inject drugs may obtain new needles for free, and turn in needles they have previously used. These simple programs can make a big impact.  Running for over twenty years in some states, they are well known to reduce the risk of disease transmission among drug users. Some critics suggest that needle exchanges encourage drug use. However, the Surgeon General and reports in several major medical journals (including the New England Journal of Medicine) tell us that there are no data to support this claim. In fact, new syringe exchange program participants are five times more likely to enter into drug treatment than non-syringe exchange program participants. Former participants in syringe exchange programs are more likely to report significant reduction in drug use or to stop using all together, and to remain in drug treatment programs. For people who are struggling with addiction, needle exchanges can be a way to keep them healthy until they potentially choose to seek treatment. 

Does giving people new needles encourage drug use?

No. While syringe distribution programs have operated in the U.S. for over thirty years, there is no data that these programs lead to increased drug use. In fact, studies from syringe distribution programs show that needle exchange participants are more likely to reduce their drug use than community members who do not receive services through needle exchange programs. 

While it is a common myth that syringe exchange programs encourage, enable or increase drug use, as well as crime, decades of research from organizations including the World Health Organization and the American Medical Association, show that syringe exchange programs do none of those. In fact, many studies demonstrate that syringe exchange programs decrease drug use by connecting otherwise marginalized people to treatment. It is estimated that syringe exchange program participants are five times more likely to enter drug treatment than non-participants.

Is there evidence to support syringe exchange?

Yes! Syringe exchange programs are supported by extensive medical and public health research and endorsed by the former U.S. Surgeon General Dr. Vivek Murthy, the National Academy of Sciences, and the CDC. A few great places to start learning more about the evidence for syringe exchange include:

Why does Iowa need syringe service programs?

Needle sharing among people who inject drugs can lead to a number of illnesses, including HIV, hepatitis C, and endocarditis. Of these, hepatitis C (HCV) is currently the most common in the state of Iowa.

In Iowa, there are over 20,000 people living with HCV (as of March 2016). The Iowa Department of Public Health reports that this number is likely a gross underestimate. Many cases are currently undiagnosed, and as many as 110,00 Iowans may have the virus without being aware. Between 2000 and 2015, there was a 300% increase in HCV diagnosis among people 18-30 years old. Of these new HCV diagnoses, at least 55% occurred among people who inject opioids. This high rate of hepatitis among drug users is due to sharing needles and materials used to prepare drugs for injection (eg. cottons, cookers, wipes, ties). 

HCV is a viral infection that causes severe liver inflammation and increases the risk of developing liver cancer. Currently, HCV is the leading reason for liver transplantation, and directly causes a number of non-liver related illnesses which are estimated to amount to $1.5 billion in direct medical costs at the national-level. Until recently, HCV was incurable – but even now curative treatments for HCV remain out of reach for many people, as treatments can cost over $100,000 per course of medication.

Syringe service programs are the only proven way to reduce the risk of transmitting HIV, HCV, and other infectious organisms among people who inject drugs. Further, syringe service programs provide community members with many other benefits, including naloxone, HIV/HCV testing, case management, and connections to other health and social services. 

 


Taking care of veins and injection sites

The following is adapted from Chicago Recovery Alliance.

Cultivating Vein Health

How easy it is to see or feel your veins is due to many factors such as: genetics, your size, level of activity, and how well you’ve taken care of your veins. One way to control the ease of access to your veins is by controlling the size of the muscle fibers. The bigger the muscle fibers, the more your veins will stand out, and the easier access you’ll have. Regardless of your current vein condition exercising your muscles will make accessing your veins easier. The type of exercise does not matter, it is more important to keep it up! One heavy session will not do much to stimulate growth. Ongoing, smaller sessions are very beneficial. Squeeze a ball, make a clenched fist, lift light weights. Continuing this over weeks to months can make a noticeable difference in the appearance and accessibility of your veins.

Valves

As veins carry blood TO your heart, it is important for them not to allow blood to flow backwards. To prevent this, veins have valves, which allow blood to flow only toward your heart. You can find these valve by running your finger along a vein until you notice, by shape (or color), blood has stopped following your finger. Why does this matter? The better condition, the shorter the space you need to plump up in preparation for injection. Learn to identify and inject above or below your valves. It is much easier to access the vein with a needle; easier access= less damage, less infection, and quicker healing.

Clean Surfaces

Hepatitis B and C can live on surfaces for many months. You are at risk of diseases from surfaces. It is possible to reduce or eliminate risk from surface contagions with clean hands and surfaces. Turn the middle of a paper pad or an unread section of a newspaper into a new, clean surface for preparing and injection. This, along with clean hands, washed in soap and water, should greatly reduce risk of disease. 

Filters

The ideal filter is sterile, requires no manipulation to get it the right size, and has fibers that would not easily break off nor carry poisons (also called flavorings).  Good filters have been re-sized, so they do not need to be fooled with. They are often cotton balls that are made with flexible, natural cotton fibers. It is even better if they are sterilized! Each of these filters require manipulation by hand. This can result in contamination. The cigarette filter is composed of inflexible fibers which break off. The small particles and poisons are drawn up in the syringe and become part of the shot. They can get caught somewhere in the body: the lungs, where they can cause infection (cotton fever) and obstructions.

Sterilizing Water

Distilled water is not sterilized. Distributed because of cost limitations.  Allows one to have a clean source of their OWN water. Sterile water is ideal, as is sterile normal saline, which is salt water made from one part salt and 100 parts water. More like our blood, less shocking to our system when injected. To sterilize water at home, boil water for 10-15 minutes- this will kill the germs in it, giving a cleaner injection.

Syringes and Needles

There are many important features to consider about syringes and needles: Is your syringe sterile and new? Every injection should be made with a sterile new syringe to maximally prevent disease and tissue damage. The smaller the needle you can use, the less vein and other tissue damage you will cause via injection. What syringe is right for any given person depends on them, what they are injecting, where they are injecting and how they are preparing their shot.

Injecting Solids

It is crucial to do your best to get it into a liquid as much as possible. Use a technique like crushing solids between two spoons. This gives good control and can make a fine powder. The finer the powder, the easier it is to dissolve.

Ties

Things to consider: Is the tourniquet you're using so thin that it will hurt your skin when you pull it tight? Does it stretch? It will be much easier to pull it tight and release if it is, which is important for a gentle injection. Is it easy to make, cheap, available, and does it come in various lengths and widths so it can be fit to the person? Can you clean it? This is critical, especially if you and someone else use the same one.

Safer Places to Inject

You are better off injecting in the direction of blood flow- towards the heart. Injecting with the flow of blood, you may avoid problems caused by creating scar tissue or clots. This disturbs blood flow. Veins are usually nearer the surface. Their blood is darker red and under less pressure than arteries. The warmer your body, the more blood will be flowing through your veins. The veins can be accessed easier when warmer. If you inject in your neck, be especially careful and practice cleanliness. Infections here go directly to the brain and can be deadly. Groin injection: a large nerve and artery lie right next to the vein, so this site is not always ideal.

Preparing a Shot

Salt heroin is a type of heroin that is usually easier to dissolve in water than base heroin. Base heroin needs to be acidified with an acid, such as Vitamin C (ascorbic acid), before it can be dissolved in water. Both forms are usually heated to assist with dissolving them. Use dry powdered ascorbic acid (Vitamin C) when injecting base heroin. This is less damaging to use than vinegar (too strong), lemon juice (can contain a fungus), or lemon-flavored drinks (other ingredients contained). Dry ascorbic acid allows you to take some out if too much is added. Use as little as possible to avoid damage with injection. 

1. Use a syringe to measure an amount of water or saltwater to add to the heroin.

2. Heat the cooker (bottle cap, spoon, etc) to help dissolve. This does not kill all germs. Boiling would have to last for 10 minutes to kill all germs, which would remove all of the liquid.

3. Take a single cotton pellet (with clean hands) and drop into cooker as your filter. This is needed because there is usually some solid that will not dissolve. This will clog the syringe.

4. Draw the liquid up through the filter.

5. Tap the upright syringe to force air to the top, then push the air out.

6. Let the liquid cool down prior to injection.

More Liquid = More Dilute = Less Damage to Your Veins

Regardless of the drug, or the mix, the more water or saltwater there is in your shot, the less damage it will cause to your veins when injected.

Have Something Clean to Stop the Bleeding

Find some clean cloth or tissue paper and place it next to you before you inject. Make sure the material hasn’t been used or otherwise handled and that is thick enough to put strong pressure on the injection site after you inject to stop the bleeding without soaking through. Hepatitis B and C can live on surfaces for months. Having clean cloth or tissue paper is critical in avoiding infections. A finger or cloth that has been in contact with an unclean or unknown surface can easily pass germs.

Clean Hands and Injection Sites

Soap and water are very effective at both killing and loosening away all kinds of germs, including HIV and hepatitis B and C. Wash both your hands and potential injection sites prior to preparing your shot. This will greatly reduce the amount of germs and the potential for them to enter your body. The type of soap used does not matter, just lather and rinse well. Using warmer water can help make it easier to find a vein.

Use a Tourniquet or Tie Effectively

Use a tourniquet to make your vein fatter and easier to hit. Tie the tourniquet so you can release it with your mouth. You are less likely to lose your hit, and can inject the vein under less pressure. This means less leakage of blood and drug. This allows you to be more able to release it after a hit that may be really powerful. If the tourniquet is not released, tissue may die from lack of blood flow.

Wipe with an Alcohol Pad Before Injection

Soap and water likely work better, but sometimes they are not available. Using an alcohol pad or a piece of clean material with alcohol on it can help clean your skin before injection. Tie the tourniquet on and find and wipe several spots you may try to inject into. Allow the alcohol to air dry to kill any bacteria, this will also sting less.

Positioning the Needle

For minimal tissue damage and more effective drug delivery, you should place the needle hole up, at a sharp angle. This gives you more control and the angle makes it easier to get into the vein.

Getting a Hit

Release the tourniquet before injecting the drug. This gives a chance to get the drug back if it is too much or nasty. This also decreases pressure, resulting in less bleeding into tissues (decreasing bruising, promoting healing, and decrease infections). Getting a register/hit: as blood enters the barrel, pull back on the plunger. After the register/hit, release the tourniquet then inject the drug. There is less pressure in the vein and a more immediate impact of the drug.

Controlling your Shot

After getting a hit, a small amount of drug is injected. Then, stop to feel it. Inject some more, then stop again to feel it. Then, inject the rest. These extra measures can help prevent overdoses and other negative experiences while injection. This procedure is especially useful when you are not sure of your tolerance or are using a new source or different type of drug.

Stoping the Bleeding

Do not use an alcohol pad: it stops the bleeding from clotting. This leads to more bruising, more infections, and slower healing. Use a clean material immediately after withdrawing the needed and apply hard pressure to the injection site. This reduces bruising, excess bleeding, reduces infection, and promotes healing. The sooner the injection site heals, the quicker you can use it again (after the redness is gone) without making scarring and track marks.

Caring for Injection Sites

As long as you wait for the bleeding to stop, it cannot hurt to use lotions, creams, or ointments on a site of injection (or other skin wounds) to help promote healing or ease scarring. The act of massage and caring for your body is never out of place.

Capping and Safe Keeping

Place used syringes, without recapping, into a container that will not allow needles stick through. This protects everyone. Minimal touching of used needles is in the interest of everyone. Do not break the point off (the needle), this leaves it sitting around and can be very hard to see. If you do re-cap a syringe, this is one way to do it with minimal risk of a stick: Place the cap on a surface and then put the needle into the cap, rather than trying to hold the cap and syringe with your hands. Also, everyone should recap their own syringe.