Drugs may be sold as powder, crystals (rocks), or tablets. To reduce the risk of vein damage and developing infections, the drugs should be fully dissolved in sterile water when injected. The use of sterile water over unclean (e.g. puddle water) or non-sterilized water avoids harm from contaminated sources when injected.
Why should people who inject drugs use sterile water?
Because the water is sterile, users will be less likely to develop harmful bacterial infections like cellulitis and abscesses, septicemia (infection in the bloodstream) and endocarditis (infection of the heart valves).
What type of sterile water does BC Harm Reduction* Strategies and Services provide?
In BC, Sterile Water for Inhalation is provided. It comes in a 3 ml plastic ampoule with a snap off top. Because of its small volume it encourages single use. Sterile Water for Injection currently only comes in 10 ml ampoules which may encourage re-use or sharing and therefore cause transmission of infections.
Why does BC Harm Reduction Strategies and Services provide sterile water?
Water is commonly shared or obtained from non-sterile sources when sterile supplies are not readily available. We provide single use ampoules of sterile water to reduce sharing. Once the sterile water ampoule is opened any left-over should be thrown away, so that it does not become contaminated and cause an infection if re-used or is used by someone else. By reducing the sharing of equipment, the transmission of hepatitis B, hepatitis C, HIV, and other infectious diseases will be reduced. Since the water is sterile, users will also be less likely to develop other bacterial infections.1
Best practice recommends one sterile water ampoule should be used with a sterile needle for each injection.2, 3 In BC only half as many sterile water ampoules as syringes were distributed in 2009/10. Programs should strive to distribute as many water ampoules as required so the individual client can use a new water ampoule and new needle for every injection. Providing supplies to enable safer drug use to people who inject drugs creates a way to engage hard-to-reach and under-serviced populations in health care and social services. No studies have found that providing safe supplies makes people more likely to engage in harmful drug use.
How can Sterile Water be ordered?
Sterile water can be ordered by harm reduction distribution sites which are approved by the appropriate regional health authority. The harm reduction supply requisition form available online at BCCDC.ca should be used and the water for inhalation ordered at the same time as other harm reduction supplies. The completed form is faxed to BCCDC.
More information about the Canadian best practice recommendations for sterile water distribution can be found here.
*For a definition of harm reduction please see Health file #102, Understanding Harm Reduction
1. Hagan, Holly, Hanne Thiede and Don C. Des Jarlais. HIV/hepatitis C virus co-infection in drug users: risk behavior and prevention. AIDS 2005 19 (suppl 3) S199-S207.
2. Strike C, Watson TM, Lavigne P, Hopkins S, Shore R, Young D, Leonard L, Millson P. Guidelines for better harm reduction: Evaluating implementation of best practice recommendations for needle and syringe programs. (NSPs) Int J Drug Policy 2010; Apr 20.
3. Best Practices for British Columbia’s Harm Reduction Supply Distribution Program (2008) available here.