Injection preparation processes used by heroin and crack cocaine injectors

Abstract

Background In the UK, most heroin and crack cocaine is not soluble in water alone. They require conversion to a soluble form before they can be injected. To accomplish this, users add weak acids, for example citric acid, lemon juice or vinegar. There is little information in the literature examining the preparation steps in detail. A better understanding would inform safer injecting research and practice.Aim To investigate the preparation of insoluble illicit drugs for injection with identification of the common procedures, materials and equipment used.Methods A novel interview design was used. This incorporated a semi‐structured questionnaire in combination with a practical demonstration of preparation of fake drug material. The preparation steps, materials and equipment used were recorded.Results Sixty‐five injectors were interviewed at three needle exchanges. The preparation of heroin, crack cocaine and ‘speedball’ injections was characterized. The steps to prepare injections were similar in the majority of cases. Each participant used acid in the preparation. Heroin and ‘speedball’ injections were heated; crack injections were not. Each injection was filtered. The equipment chosen and the proportions of drug, acid and water used varied.Conclusions This work indicates that the basic steps used by the sample of injectors were similar, but the details within each step varied. It highlights areas of injection preparation that can be targeted in harm reduction information and research. Further work could determine the prevalence of these techniques.