Ask Sasha

1. How do most heroin overdoses occur?

a. Most heroin-related overdoses occur when someone mixes depressants; that is, they use heroin in addition to another sedative. Benzodiazepines (e.g., Xanax, Ativan, Klonopin, Valium), alcohol, barbiturates (e.g., Nembutal, Seconal), antihistamines (e.g., Benadryl, Promethazine), and other opioids (e.g., Fentanyl, Morphine, Percocet, Vicodin, Tramadol) all have sedative effects. Using multiple sedative drugs will significantly increase respiratory depression, which is why overdose is common with these combinations.

b. Another common reason for overdose is reduced tolerance. If someone has taken a break from usage (including recently returned from detox or incarceration), then their tolerance will be reduced. Someone with reduced tolerance is more likely to overdose, especially if they do not adjust their dose to account for the reduced tolerance

c. Lastly, street drugs are notoriously impure and can have dangerous adulterants that increase the risk of overdose and other adverse effects. Fentanyl and its analogues (e.g., carfentanil,acetyl fentanyl) are common examples of dangerous adulterants that can cause overdose. For this reason, we recommend using a fentanyl test strip to check for the presence of these adulterants before use.

2. Why should I use a new syringe every time?

a. Even if you haven’t shared your syringe, re-using injecting equipment can introduce your body to infection-- whether that be bacterial, viral,or fungal-- including abscesses. Re-use also blunts the needle tip, which can cause damage to the vein and injection site.

b. Re-using syringes isn’t the only way to expose yourself to infection. Be sure to also use new cookers and cotton each time as well to prevent infection.

3. I think I have an abscess. What should I do?

a. An abscess is infective matter that gets trapped under the skin, leaving a painful, often reddish, lump.

b. I know it’s hard, but resist the urge to squeeze or cut it out! Instead, use hot compresses and/or warm salt water to soak the abscess 3-4 times a day for about 10 minutes. Be sure to wash your hands/ use gloves before handling your or someone else’s abscess, as well as wash up afterwards. To prevent further infection, keep the site covered lightly with gauze.

c. Once the abscess starts draining, stop using compresses/ soaks and just clean it with soap and water. Gauze can still be used to cover the site. Once it’s fully drained, clean the abscess with saline solution or water and soap.

d. Antibiotics are not normally necessary unless you require medical attention. Seek medical care immediately if you have fever or swollen lymph nodes, or if your skin has a hot, hard or bumpy texture (like an orange peel), dark streaks running toward your heart, or looks greenish or bubbly. These could be signs of something more serious, such as blood poisoning or gangrene.