September 9, 2003

DEFINITIONS OF AND NOTES ON KEY TERMS [1]

This report focuses on programs that facilitate access to sterile syringes and provide information and other tools associated with the safe injection of drugs.The following glossary explains many of the terms associated with sterile injection.It is meant neither to be exhaustive nor to act as a substitute for medical advice.

Alcohol pad: A small piece of fabric soaked with alcohol, used to swab the skin before injecting.(Washing with soap and water is thought to be more effective at reducing infection than rubbing with an alcohol pad.Cleaning hands and potential sites of injection also reduces the potential for infection.)

Biohazard containers: Puncture-resistant containers used for disposing of hazardous waste such as used syringes.The contents of biohazard containers are disposed of at a location specifically designed to negate the potential dangers of hazardous waste.The containers are ideally designed so that hazardous material cannot be removed once it is placed into the container.

Cooker: Any item used to heat injectable drugs in order to turn them from powder or other nonliquid form into a liquid suitable for injection.(According to some experts, injection drug users often reused metal spoons for cooking drugs until harm reduction service providers began promoting the one-time use of disposable items, such as bottle caps or similarly shaped objects, in order to reduce the risk of disease transmission.)

Cotton: Any item used to filter out particles of solids from injectable liquid drugs, in order to prevent them from clogging syringes.Tampons, cotton balls and Q-tips may be used for this purpose, though they require manipulation, which carries the risk that they will no longer be sterile.Cigarette filters are commonly used to filter drugs, but they have brittle fibers that can break off and become part of the injected preparation, sometimes ending up in the lungs.From the point of view of sterile injection, the ideal filter is a sterilized cotton pellet, made of natural cotton fibers and especially cut for this purpose.

Harm reduction: Refers to actions designed to diminish the individual and social harms associated with drug use, including the risk of HIV infection, without requiring the cessation of drug use.In practice, harm reduction programs include syringe exchange, replacement therapy using substances such as methadone, health and drug education, HIV and sexually transmitted disease screening, psychological counseling, and medical care.

Heroin: One of a group of opiates, or substances derived from opium poppy (Papaver somniferum).Other opiates include the pain relievers morphine and codeine.Base heroin, commonly marketed in Europe, is brown or beige in color and needs to be acidified with ascorbic acid (vitamin C) or another acid before it can be dissolved in water.Base heroin can be converted into salt form by the addition of ethyl alcohol, ether and hydrochloric acid, creating a powder that will readily dissolve in water."Black tar" heroin is sticky and dark brown or black in color and also dissolves in water.Heroin can also be snorted or smoked.

Injection equipment: Items such as syringes, cottons, cookers, and water used in the process of preparing and injecting drugs.The broader term "drug paraphernalia" comprises injection equipment as well as items, such as crack pipes, associated with noninjection drug use.

Methamphetamines: A group of substances, most of them synthetic, that have a stimulating effect on the central nervous system.Methamphetamines can be injected, snorted, smoked, or ingested orally.The popular term "crystal meth" usually refers to the smokeable form of methamphetamine.Other amphetamine-type stimulants include anoretics (appetite suppressants) and non-hallucinogenic drugs such as "ecstasy."

Syringes or needles: The main components of a syringe are a needle, a tubular syringe barrel, and a plastic plunger.Graduated markings on the barrel of a syringe are useful for measuring the water or saline solution used to dissolve a solid substance into liquid form.Syringes and needles vary in size and do not always come as one piece; a syringe with the needle attached is often referred to as an "insulin syringe."Colloquial terms for syringes and needles include "outfits," "points," "rigs," "works," and "sharps."(Public health authorities recommend a new sterile syringe for every injection.)

Ties or tourniquets: Items used to enlarge or "plump up" veins to facilitate injection.(Ties should be clean because blood on a tie can be a source of infection.Common ties include a piece of rope, a leather belt, a terry cloth belt, a rubber hose, and a piece of bicycle inner tube.)

Water: Water is used to dissolve solid substances (such as pills or powder) into a liquid form suitable for injection.Having a clean source of one's own water is important to prevent disease transmission.Harm reduction programs often distribute vials of distilled water, sterile water or sterile saline solution (all referred to as "waters") for this purpose.

Withdrawal: Clinical symptoms associated with ceasing or reducing use of a chemical agent that affects the mind or mental processes (i.e., a "psychoactive" substance).Withdrawal usually occurs when a psychoactive substance has been taken repeatedly and/or in high doses.