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Ways to use psychoactive substances

Possible ways of use:

The most common ways of taking psychoactive substances are:
• Ingestion
• Smoking
• Sniffing
• Injection

Injecting drugs carries the most risks.

Risks from drug injection

Injecting psychoactive substances hides the following risks:
• Infections - HIV virus (the cause of AIDS), viral hepatitis (B, C), syphilis
• Bacterial infections
• Overdose
• Damage to the veins

Ways of safer drug use

The use in any manner of any psychoactive substance carries some risks. These guidelines aim to reduce the risks, but nothing can remove them completely.

Injection (intravenous use)

  • It is not possible to avoid all risks of intravenous use, but they can be reduced. Refraining from intravenous use significantly reduces the likelihood of overdose, reduces the damage to the body and the possibility of infections with HIV, hepatitis or other.
  • If the reality of the above risks is not enough to dissuade you from intravenous use, it is important to follow some important techniques (rules) for a safer injection.

Rules for safer injection

  • Do not use another’s tools to inject - needles, syringes, caps, spoons, filters and cotton balls, and do not provide your own for use by others.
  • To reduce the risk of infections, keep your tools for using drugs away from contact with other people’s tools.
  • Before and after use, wash all the tools that you will use with alcohol or with hot water, and use syringes and needles only once.


Do not mix for use different psychoactive substances. Very often death of overdose is caused precisely by such combinations. Beware especially of mixing sedatives - alcohol, diazepam (or other benzodiazepines), zopiclone, methadone and heroin (or other opiates).

It is difficult to correctly assess the risk of mixing substances if one of them is swallowed, and the other is administered intravenously. If swallowed, the effect is felt after hours (from one half hour to 4 hours). The expected effect during this time depends on many factors. The injection intake at this time may be the cause of an overdose. Combining depressants (heroin, alcohol, methadone, benzodiazepines) with stimulants (cocaine, amphetamine, methamphetamines, ecstasy) also carries major health risks.

Even if you know that you have developed a tolerance to a certain substance and have an idea about what it is, note that your usual dose can also be a cause of overdose. Two factors are very important to the effect of the dose. The first is a change in the purity of the substance and the second is a change of context (place of use, mental state).

If you are not sure about the purity of the substance you want to use, you can try a small amount and wait to see what effect it will have. This precaution may reduce the risk of an overdose or other negative effects on your health (physical and mental) if the purity of the substance is unexpectedly high.

It is important that you use psychoactive substances when you are not alone. If you have someone with you, they can give you first aid in case of overdose or help you in the case of occurrence of other negative effects.

Bacterial infections

You cannot do much to prevent such infections. Bacteria are everywhere around us. The water you use, your tools, your hands and skin at the puncture site are not sterile; only the syringe and needle after removal from the package are sterile. In pharmacies, they sometimes sell water for injection that is also sterile.

Before you prick the site of injection, it can be cleaned with wet wipes with alcohol. Note that mineral water, purchased from the store, may carry more bacteria than tap water.

Sterile injection kits you can get for free from the organizations working in harm reduction, offering services in some cities of the country (Подвижни кабинети за работа с употребяващи (аутрич) – this information is available in Bulgarian only).