Over the years the advice I’ve given to injectors has developed and changed. Sometimes this is because of new research, and sometimes it’s just because I realise that there is better advice I could be giving. This article explains why I no longer tell steroid injectors that the glute is the best place to inject.

Accepted wisdom

I’m sure I’m not alone among needle programme workers in giving the standard advice to steroid injectors of “You should inject in the upper outer quadrant of the glute” in fact over the years I’d developed a standard way of presenting this that normally goes along the line of:
You need to divide your buttock into four, not with a knife, just in your head. Then inject in the thickest part of the upper outer quarter. Anywhere else you’ll risk hitting the sciatic nerve, if you hit that you’ll know it, and so will anyone in a two mile radius.
But the more steroid injectors I meet the more I see a problem with this advice, and it’s a problem that significantly increases risks for some people.

The Problem

I see a lot of steroid users come though the NSP for equipment. Some of them are quite average looking guys who are just starting to use, some are regular users who are bigger but still quite flexible. Then we come the the BIG guys, sometimes it’s pure muscle, often it’s muscle and fat. But either way it causes a problem with injecting in the glute.

These guys simply lack the ‘rotation’ to be able to reach around to inject themselves. So when we as conscientious workers keep telling people to inject in the glute we are in effect encourage them to get friends to injecting them. This increases the risks of injury and blood borne viruses like HepC.

The alternative

Instead I recommend people inject in the thigh, this is still a deep enough muscle to allow the slow distribution needed by steroids, and has a number of other advantages.

Injecting in the thigh allows the injector far more control over the speed of injection, as well as improving visibility on whats going on. But the main way I get people to inject here is by telling them about Z-Tracking.

Z-Tracking

This is the way that people doing intra-muscular injection can ensure they don’t get ‘leakage’. Although quite a rare problem with the thicker oil based steroids this can happen quite easily with the thinner ones. The process of Z-tracking is quite simple:

• Before inserting the needle use your finger to depress and slightly drag the skin next to where you want to inject. (first image to the right)
• Insert the needle
• Inject the steroids
• When you’ve removed the needle release the skin
• The ‘track’ left is distorted preventing any drug from escaping (second image to the right)

Important note

Intra-muscular injecting is NOT safe for injectors of other illicit drugs like heroin etc as it greatly increases the risks of developing abscesses.