Training Guide

Getting Off Right: A Safety Manual for Injection Drug Users


Disclaimer: This manual was originally published around 2012 by a team of harm reductionists working together to produce critical information that has supported the beginning of new programs across the country. Since that time, we have made minor edits to the document to update with new information (know better, do better). This is a living document and may still have some outdated information; however, we do our best to keep resources up to date with the best of our knowledge. Use caution with employing medical advice from the manual.

If you notice that the resource needs to be updated with new information, please send us an email to

One of the results of the United States’ “zero tolerance” approach to drug policy is a serious lack of accurate information about drugs and drug use. This lack of information makes it extremely difficult for people to make rational and informed decisions about using drugs. “Just say no” is an inadequate message to give anyone about drugs, and is especially dangerous for those individuals already using them. People who use drugs and those thinking about using drugs need unbiased, non-judgmental, reliable information about the desired effects and undesired risks of the drug(s) they are using or contemplating using.

In addition to the benefits they may experience, some individuals experience extremely negative consequences as a result of using drugs. Some of these harms may be attributable to the effects of the drug itself on the body and the mind. More often drug-related harm is the result of the numerous social, economic, legal, cultural, and political factors that shape the way illicit drugs are made available and the conditions under which they are used. Poverty, racism, social isolation, past trauma, gender-based discrimination, and other social inequalities all affect people’s vulnerability to and capacity for dealing with drug-related harm. Punitive laws, social policies, and the intense social stigmatization of and discrimination against people who use illicit drugs serve to drive us away from friends and family, as well as health and social services. These are just a few of the factors that increase the dangers associated with using illicit drugs.

Contrary to popular opinion, there are many things that we can do to take care of ourselves and reduce the risks associated with using illicit drugs. This manual challenges us to take a close look at all the steps we engage in when preparing and injecting drugs in order to figure out if that process can be made safer anywhere along the way. Even if you’ve been injecting for years, chances are that there are things you can change about the way you do it to help you avoid disease and maintain good health; reduce your likelihood of experiencing injection-related injuries or accidents; help make the fact that you inject drugs less noticeable (if this is something that concerns you); or ensure that injecting remains a viable, comfortable, and safe option for administering your drugs in the future. Reading this manual might also make you decide that injecting drugs carries too many risks, and that snorting or smoking are more preferable alternatives. Such a decision would be a valid and important way of reducing drug-related harm.

Share this booklet and what you learn with other people who inject drugs! Most of us taught ourselves how to inject through a process of trial- and-error that undoubtedly included lost shots, painful misses, swollen limbs, and a great deal of frustration. This manual is intended to help minimize these problems. We need to take responsibility for helping each other live safer and more satisfying lives, free from unnecessary disease and illness and with dignity.

National Harm Reduction Coalition (NHRC) does not condone or condemn the injection of illicit drugs. Rather, we recognize that drug injection is a potentially hazardous and intensely stigmatized behavior which many people already engage in and will continue to engage in — in many instances for years at a time — and a behavior that many others will experiment with or come to adopt in the future. A compilation of medical facts, injection techniques, wisdom from people with lived experience, and common sense, this manual reflects NHRC’s commitment to providing accurate and unbiased information about the use of illicit drugs with the goal of reducing harm and promoting individual and community health.

Using drugs is a complex experience and issue which affects those who use, their loved ones and the communities in which they live. We hope that this manual will serve to reduce the associated dangers for people who use drugs or who are affected by drug use. While we can’t predict every possible scenario you might encounter, we hope the examples presented in this manual show you how common sense and planning can make any drug using experience safer.

The NHRC is committed to publishing non-judgemental information that is relevant to the lives and health of people who use drugs. NHRC will be following through on this commitment with future publications.

Please let us know what in this manual is useful, what isn’t useful, what you would like more information about, and any other comments or suggestions you might have.