Opioids IM Injection Questions

[Draginz]

Hey friends, I inject hydromorphone into my deltoid and I had a couple harm reduction related questions:

1. Once in a while, I get significant back pressure or resistance when depressing the plunger. After I finish the injection, a fair amount of blood comes out and then suddenly stops, it's like the pressure build up from the injected fluid is pushing it out. What's going on here? Should I abort when I get back pressure? It isn't painful. Am I losing some of my dope or is it just blood?
2. I inject two times a day. Is this frequent enough to cause damage to the muscle? It does not get sore or even bruised, and I never inject more than 1ml at a time. I'm using the correct needle guage every time.

 

[negrogesic]

Not sure as to #1 since I haven't injected IM enough to have witnessed this happen. Do you get blood in the syringe? Generally you should not inject into something if you feel pressure

Daily injection into the same muscle isn't a great idea. Very frequently IM injections may have more complications than IV injections.

I sure hope you are micron filtering this before injection cause I'm assuming this hydromorphone isn't from a vial/ampule.

 

[Draginz]

Not sure as to #1 since I haven't injected IM enough to have witnessed this happen. Do you get blood in the syringe? Generally you should not inject into something if you feel pressure

Daily injection into the same muscle isn't a great idea. Very frequently IM injections may have more complications than IV injections.

Thanks for the reply, as for #1, no I do not get blood in the syringe, but I think if I let off on the plunger a bit it would have. Could this be a cavity from the previous injections? I was hitting right next to the last site from ~12 hours ago. I do believe I lost a significant portion of my shot when it bled out, judging by this mediocre high.

For your second point, do you have source material where I can read more about the harm? I always have trouble finding specific info on IM, not sure why.

 

[negrogesic]

Thanks for the reply, as for #1, no I do not get blood in the syringe, but I think if I let off on the plunger a bit it would have. Could this be a cavity from the previous injections? I was hitting right next to the last site from ~12 hours ago. I do believe I lost a significant portion of my shot when it bled out, judging by this mediocre high.

For your second point, do you have source material where I can read more about the harm? I always have trouble finding specific info on IM, not sure why.

Well, for example:

Injuries and diseases (IRID) like bacterial skin infections, chronic wounds and ulcers are associated with IM injection [7,8,9]. Other IRID include potentially life-threatening conditions like endocarditis, sepsis, bone and joint infections as well as thrombosis and emboli [10]. Compared to IV injection, higher incidences of abscesses and cellulitis have been observed [11, 12].

«One prick and then it´s done»: a mixed-methods exploratory study on intramuscular injection in heroin-assisted treatment - Harm Reduction Journal

Background Intramuscular (IM) injection of drugs is associated with high rates of injecting-related injuries and diseases. However, little is known about the role of this route of administration in heroin-assisted treatment. The aim of this study was to determine the prevalence of IM...

harmreductionjournal.biomedcentral.com

The circulatory system is fairly adept at handling introduced particulate matter and pathogens, but the muscles and subcutaneous regions are less able to cope. If you do plan on IM'ing frequently you want to be sure to micron filter anything you are injecting or it will merely be a matter of time before you experience a complication.

 

[Draginz]

Well, for example:

Injuries and diseases (IRID) like bacterial skin infections, chronic wounds and ulcers are associated with IM injection [7,8,9]. Other IRID include potentially life-threatening conditions like endocarditis, sepsis, bone and joint infections as well as thrombosis and emboli [10]. Compared to IV injection, higher incidences of abscesses and cellulitis have been observed [11, 12].

«One prick and then it´s done»: a mixed-methods exploratory study on intramuscular injection in heroin-assisted treatment - Harm Reduction Journal

Background Intramuscular (IM) injection of drugs is associated with high rates of injecting-related injuries and diseases. However, little is known about the role of this route of administration in heroin-assisted treatment. The aim of this study was to determine the prevalence of IM...

harmreductionjournal.biomedcentral.com

The circulatory system is fairly adept at handling introduced particulate matter and pathogens, but the muscles and subcutaneous regions are less able to cope. If you do plan on IM'ing frequently you want to be sure to micron filter anything you are injecting or it will merely be a matter of time before you experience a complication.

That's awesome, great info here, thanks! However, I am more interested in chronic muscle damage arising from the injection itself, not acute complications like abcessess or other infections. I noticed (11) and (12) citations refer to the injection of street drugs, do you know if the statement "Compared to IV injection, higher incidences of abscesses and cellulitis have been observed" also applies to injected sterile pharms? I imagine the severity would be reduced on average. I am well practiced with aseptic technique and I have no reason to believe there are particulates or pathogens in my shots. I assume this is a common 'low hanging fruit' form of harm reduction advice, but it's not what I'm after specifically. For example, if someone were to recieve two daily injections in either deltoid in a medically supervised setting, and assuming no complications from poor technique or contamination, what kind of damage is being done to the muscle?
My only other question is about the resistance/back pressure and subsequent spurt of blood which happens occasionally.

 

[G_Chem]

That's awesome, great info here, thanks! However, I am more interested in chronic muscle damage arising from the injection itself, not acute complications like abcessess or other infections. I noticed (11) and (12) citations refer to the injection of street drugs, do you know if the statement "Compared to IV injection, higher incidences of abscesses and cellulitis have been observed" also applies to injected sterile pharms? I imagine the severity would be reduced on average. I am well practiced with aseptic technique and I have no reason to believe there are particulates or pathogens in my shots. I assume this is a common 'low hanging fruit' form of harm reduction advice, but it's not what I'm after specifically. For example, if someone were to recieve two daily injections in either deltoid in a medically supervised setting, and assuming no complications from poor technique or contamination, what kind of damage is being done to the muscle?
My only other question is about the resistance/back pressure and subsequent spurt of blood which happens occasionally.

Is this IV vial of hydromorphone or pills?

-GC

 

[negrogesic]

That's awesome, great info here, thanks! However, I am more interested in chronic muscle damage arising from the injection itself, not acute complications like abcessess or other infections. I noticed (11) and (12) citations refer to the injection of street drugs, do you know if the statement "Compared to IV injection, higher incidences of abscesses and cellulitis have been observed" also applies to injected sterile pharms? I imagine the severity would be reduced on average. I am well practiced with aseptic technique and I have no reason to believe there are particulates or pathogens in my shots. I assume this is a common 'low hanging fruit' form of harm reduction advice, but it's not what I'm after specifically. For example, if someone were to recieve two daily injections in either deltoid in a medically supervised setting, and assuming no complications from poor technique or contamination, what kind of damage is being done to the muscle?
My only other question is about the resistance/back pressure and subsequent spurt of blood which happens occasionally.

My assumption is that you were shooting pills given the rarity of hydromorphone vials/ampules. Even with micron filtration I wouldn't describe shooting pill extractions as sterile.

But even with sterile solutions and perfect form, intramuscular injections are inherently pretty traumatic, and long-term, daily injections might result in various complications (tissue/nerve damage, fibrosis, hitting or grazing an artery, etc). Some of these things, like fibrosis, can be asymptomatic, especially initially. If you are somehow using hydromorphone vials/ampules that is certainly a plus, but over time I feel like the process could catch up with you. Twice a day means 700+ intramuscular injections a year.