Thought this might be a useful thread to help counter the popular myth that bottled spring water is safer to inject than regular tap water. This issue has been thoroughly researched by harm reduction services across the world, and the following has been published by Exchange Supplies. This advice was written for the UK, however it applies to basically all countries in the developed world, who have standards in place on the treatment of drinking water.
Hierarchy of Water Risks (Safest to least safe)
1) Unopened ampoule of sterile water
The 'gold standard' for safety, an ampoule of water for injections means that the water used for dissolving the drugs isn't going to be the source of viral or bacterial infection.
2) Boiled water
Boiling water in a kettle will kill virtually all organisms, and using boiled water from a kettle is the advice to injectors who do not have an ampoule of water for injections.
Although it is true that to guarantee that even the most resistant pathogens are killed the water should be boiled for several minutes, in practice the additional benefits are few and advice to boil water in a pan is problematic because:
* the water takes time to cool, and could become contaminated during cooling;
* the pan or lid used to boil the water could be contaminated; and
* the advice is unlikely to be followed, and there is a risk that injectors will take the view that if they can't follow the advice, then they might as well not bother doing anything because they are taking a risk anyway.
3) Kitchen tap - cold water
The reason the poster differentiates the kitchen tap from other taps in the house is that the kitchen tap is usually fed from the rising main which, in the UK, is usually virtually or completely free from bacteria.
Water from bathroom taps may have been stored in a cold water tank in the roof where it can become much more contaminated with bacteria: not a problem if you're drinking it, the acid of the stomach is able to kill low levels of bacteria without a problem, but not so good if the water is being injected.
4) Bottled water
The constant advertising and marketing of bottled water has created a strong perception in the public psyche of it as a pure, safe source of water that is better than tap water.
Certainly in the UK it is open to debate whether this is true in terms of drinking water – the UK has a very good safety record for our drinking water which is pure and free from contamination.
But for use as a liquid for dissolving drugs for injection, there is no debate: tap water is almost always better than bottled water because the bacteria count will be lower. The bacteria count in bottled water is much higher than in tap water, and varies according to the temperature at which it is stored, and can be very high if someone has drunk the water from the bottle.
This is not to say that the bacteria in bottled water are harmful if drunk – the acid in your stomach is perfectly well able to kill bacteria at these levels, however when injected intravenously, they can cause infections.
Distilled water
Distilled water is boiled and then condensed to ensure it is free of all minerals, and people could be excused for thinking that it might be sterile. However, the end use of distilled water is in machinery and there is no requirement for the water to be clean in terms of bacteria count. Indeed the condensing plates and bottling plants are often low tech, and dirty.
5) Hot water from a tap
The water in a domestic hot water tank is not hot enough to kill all bacteria. If the tank has been warmed and cooled, the bacteria count can grow.
6) Toilet water
It could be argued that pointing out the dangers of drawing water out of a toilet is stating the obvious, but having it there – and not at the bottom of the list – makes the point that the other sources of water below it are *really* dangerous.
There was some debate in the drafting process about whether the harm reduction advice to take water from the cistern rather than the bowl, but we didn't for two reasons:
* firstly, most public toilets have the cisterns secured and inaccessible; and
* secondly where people can access cisterns they can usually access a tap.
7) Puddle water
As with toilet water this is on the poster to highlight the serious nature of the risks associated with water that could be contaminated with blood.
The advice to catch rain water instead was suggested by homeless drug users, who described it as a harm reduction strategy they had developed.
8) Part-used ampoule
Many injecting drug users underestimate the risks of sharing the source of water that they use for preparing their drugs for injection.
Because ampoules of water for injections 'feel' medical, safe and sterile, injectors will sometimes choose to take water from a part used ampoule. Clearly this carries a very high risk of viral infection (hep C, hep B, HIV), and this is highlighted by the position of the opened ampoule below water from toilets and puddles.
9) Shared cup
Too often when there is a group of injectors together in a room, the source of water used for preparing drugs for injection, is a single cup of water.
Sometimes this same cup is used to draw water to clean injecting equipment, and to repeatedly draw water to prepare drugs for injection.
This presents a significant risk of blood borne virus transmission, and one of the key functions of the poster is to highlight this risk and danger - which many injectors are not aware of, or underestimate.
There was some debate during the peer review process as to whether the ampoule was higher risk than the cup, but as the ampoule has a limited volume it is unlikely that it could have been contaminated by more than one person, whereas the cup could have been contaminated by many – hence it's position at the bottom of the table.
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