I do wonder, when I get a new user in the exchange, how much the person in front of me has actually found out about their drug of choice before they put it in their body. Especially when they are getting equipment to inject a drug for the first time like today's newest steroid client.
This guy was a 19 year old who has recently started using cocaine (both snorted and injected) and is intending to start his first course of steroids. While the guys knowledge of cocaine appeared to be quite basic, his knowledge of steroids was, as you'll see, very poor.
So being a new client we take basic demographic information during the brief NX assessment.
He was really nervous and it was his first time attending any form of exchange service, because I can look quite intimidating I tend to use humour a lot to relax people.
First we covered some issues about his cocaine use, he at first has said he both injected and snorted coke, personally I think he wasn't being very truthful about the injecting. We did discuss risks around the snorting and sharing of equipment, he showed that he was already aware of the risks of contracting a blood borne virus from shared notes.
I discussed overdose with him, while he was aware that there was an overdose risk from cocaine, his knowledge of the possible symptoms appeared to be confused with those of heroin overdose. So I explained to him what he should look out for in himself or others around him using cocaine or amphetamine.
Onto the steroids. He seemed unsure on which steroids he was going to be using, in the end we worked out it was Decca and Sustanon which in our area (and most others I've worked in) is the most common mix. I asked him where he was intending to inject and he nervously answered his arm. Now for anyone who doesn't already know this, steroids are not injected IV but into the muscle, this is important because this was the steroid is released slowly into the system. I advised him that of he is determined to use steroids he should be injecting himself ideally into the upper outer quadrant of his glute, this way he would be putting the steroid into deep muscle and avoiding the sciatic nerve. I went though the muscle injecting process with him in detail.
I asked him how long his course was going to be, 5 weeks. And how long was he intending as a break between courses 1 week (again looking nervous as he answered). I advised him that ideally he should be doubling his on cycle to get the length of his off cycle (at a minimum I want him to have a 5 week break).
Of course by this point I wasn't really happy that this guy knew what he was getting into by starting to use steroids, it was clear he had done no research past the point of asking someone to get him his supply. So I asked him if he knew the possible side effects, he as expected didn't. So I informed him of all the usual stuff to do with his heart and the stuff around having extra testosterone in his system (he was aware of the risks of aggression). I then pointed out to him that as he was only 19 years old he wouldn't yet have stopped growing, but if he uses steroid there is a good chance that the height he is now will be as tall as he gets. But even after all the risk factors had been covered he was still saying he was sure he wanted to use the steroids.
He wasn't sure what equipment he wanted when he was asked (at this stage I really didn't expect him to be) so I went though the standard injecting equipment with him.
- Green needles: for drawing up the steroid only, not for injecting.
- Short blue needles: this guy only had light muscle mass so short blues would do the trick.
- 2ml barrels: its not rocket science this stuff, a needle is no good without a barrel.
- Swabs: to clean the injection site.
- Sharps bin: to return his used works in.
When I gave him the swabs I told him that they should only be used pre-injection, and not post. I also told him that whoever is advising him on how to inject will try to contradict this information. The need to not post swab is because the swabs are alcohol based, using them after injecting will only encourage bleeding and therefore cause bruising.
Finally the guy wanted some condoms, as I was getting these I asked if he wanted lube as well (I always offer lube to steroid users but I'll go into why another time.) he seemed really happy we had lube so I made sure he got plenty. As he left I encouraged him to do some research before he actually uses his steroids, recommending some websites he could try.
Its clear this guy had no idea what he was doing when he attended, but though the conversation it was also clear that he was going to use steroids no matter what advice he was given. In situations like this it's important for workers to concentrate on the basics to reduce any levels of harm that the injector is facing. If you cover the basics well people will follow future advice you give them with more confidence. In this case at a could of points I did mention that his friends (or at least fellow injectors) may contradict some of the advice, but the reasons for the advice was given in detail so he could peer educate them himself.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.