Injecting Awareness into your Life: A Lesson in Injection Supplies

Before coming to HIPS, I was blank canvas in terms of drug and hormone injection. I certainly knew that both existed, but how it was done? The safest way to do it? What needles were used for what? All brand new to me. I very, very quickly learned the difference between different uses, both from coworkers and superiors explaining it to me, but also from our extremely knowledgeable and well-versed clients. Most folks who we encounter, particularly those who use syringes to inject drugs, know exactly what they like, where to inject, and what to use to inject in a given spot. I wanted to take the chance to explain what some of our different supplies are and what the similarities and differences are between needles since I feel like it helps to normalize the perception of those who use drugs. Just as one person might go into a store and be looking for a very specific type of sock - a certain color, a distinct material, a given height, a specialized weave - so are people particular about their needle use.

On the most basic level, there are three major differences from one needle to the next: 1) gauge, or essentially how wide the needle is, 2) length, how long the needle is, and 3) body size, or how much of the substance it can hold. The latter two are pretty self-explanatory, but the first is slightly counterintuitive - the BIGGER the gauge number the SMALLER the size of the needle. So a 27 gauge needle is 1/27th of an inch, while an 18 gauge needle is 1/18th of an inch (aka much bigger). Kaput?

Our most popular needles are definitely insulin needles. These needles have heads (the needles) and bodies (the barrels) attached. At 27 gauge and 1/2 an inch deep, they are long enough to reach the shallow veins of the arms and legs, without being as mug as some of out other needles. We also have ones we call "baby dies" (and I always think of Princess Diana - is that bad??) or baby diabetics which are narrower at 28 gauge, the same length and hold half as much substance. Baby dies are usually used for "skin popping" which is when people inject just below the skin, NOT into a vein. This usually causes a more mellow, slower, less intense high, and might be te initial way that soneone gets into injecting. People who use diabetics - in my experience - do NOT like baby dies.


Then we have the tips that are separate from the bodies, all of which fit on the same body. We have blueheads (25 gauge, 1 inch long, they're blue! Surprise, surprise), apples (23 gauge, 1 inch long,  they're bluish-green, perhaps like a granny smith apple?), and then groins (21 gauge and 1.5 inches long, important for their purpose). All three are used to inject into veins, but as the needles get bigger, they get more intrusive into the body. In particular, the groins are usually used to shoot into the groin (surprise, surprise) which can be particularly dangerous, since the vein is buried very deep in the leg and is located close to the femoral artery. It's really easy to miss the femoral vein and accidentally stick something else. Most of the time, people only resort to the bigger tips and the riskier injections sites (groin, neck, in between the toes, etc.) when easy-to-reach veins in the arms and legs have collapsed or are difficult to find.

From L to R: Diabetics, blueheads, apples, and groins.

When it comes to injecting hormones for M-to-F or F-to-M transgender folks, we have two needles each for the butt (23 or 21 gauge, 1.5 inches long) and for the shoulder/thigh (23 or 21 gauge, 1 inch long). Hormones tend to be extremely thick, so a needle with a bigger opening (21 gauge) will hurt more but take less time to inject, while a needle with a smaller opening (23 gauge) might hurt less, but the individual will have to hold it there injecting the hormones longer.

The bodies used for drugs and hormones are also different - purple bodies (drugs) hold less substance, and pink bodies (hormones) are able to hold more. However, the tips have a universal attachment, so any tip can fit on either body. In addition to being larger, pink bodies also come with a massive 18 gauge needle that can be used to draw up the super thick hormones (it is then taken off and a smaller tip is attached for injecting).

From L to R: Purple body for drugs, pink body for hormones.

We've also got a bunch of safer injection supplies like alcohol swabs, bandaids, sterile water for mixing drugs, tourniquets, and cottons and cookers (sterile bottle-cap-like containers to hold the drugs, and mini cotton balls to filter the drugs).

Clockwise from top left: blueheads, alcohol swabs and bandaids, 23 gauge shoulder/thigh, 23 gauge butt, 21 gauge shoulder/thigh, 21 gauge butt, tourniquet, sterile water, groins, apples.

Cottons and cookers (with an alcohol swab)

We also have syringe exchange cards that we make for every person who gets needles. The card proves that they are part of a needle exchange program, and allows people to carry needles on them without fear of arrest by the police. We always say that if they're caught with other stuff on them, then we can't help them out there, but carrying needles with the card is fair game.

So there you have it, the most basic lesson on HIPS' injection supplies, and ones we give out weekly, if not daily. We also have a slew of different - perhaps "specialty?" - needles in our stockroom, but these are our most popular. Get ready for an upcoming post on our safer sex supplies! Finger condoms, anyone?