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DIRTY HITS
A "dirty hit" is a general term for a shot that makes someone sick or causes an abscess as a result of being contaminated with infection-causing microbes or toxic substances. Dirty hits can be caused by any number of things, such as:
* contaminants in the water you used to dissolve your drugs;
* bacteria, fungi, or other microbes from old cottons;
* chemicals in a cigarette filter that was used to filter a shot;
* adulterants or contaminants in the drugs themselves; or
* not properly cleaning the skin prior to injection.

A dirty hit can result in a fairly quick and intense reaction or might take days or weeks to produce an effect. Symptoms often include sweating, headache, fever, and trembling. While the effects of a dirty hit may pass by themselves, you should seek medical attention if they are particularly strong or persistent.

BLOOD POISONING (Septicemia)
Blood poisoning (septicemia) is a bacterial infection of the bloodstream that can be caused by injecting with contaminated water, re-using old cottons, or failing to clean the skin prior to injection.

Early symptoms include chills, fever, and extreme fatigue. If you experience these symptoms, seek medical attention. Septicemia can be fatal!

ENDOCARDITIS
Endocarditis is an infection of the heart lining that is caused by bacteria, fungi, and other infection-causing microbes that enter the bloodstream during injection and build up around the valves of the heart, weakening them as well as other parts of the heart muscle. Endocarditis can eventually cause a heart murmur, as well as fever, chest pains, fainting spells, shortness of breath, and heart palpitations. It can be treated with antibiotics if detected early, but can be fatal if it goes untreated.

You can help prevent endocarditis, septicemia, and "dirty hits" by always using clean water (and a clean water glass) when preparing your shot; using new, clean cottons for every injection; making sure your spoon or cooker is clean; and thoroughly washing your hands and cleaning your skin prior to injection.

TETANUS
Tetanus is a bacterial infection that occurs when tetanus spores enter a wound and release tetanus bacteria, usually after a scab has already formed. The bacteria then enter the bloodstream and cause an infection, which is characterized by muscle spasms or rigidity, especially in the neck and jaw (tetanus is commonly called "lockjaw"). Tetanus is fatal if not treated.
Most local health departments offer free tetanus boosters, which will protect you from tetanus for five years, so you might consider getting one.

Tetanus spores live in the soil and on rust, which is why a tetanus shot is recommended if you step on an old nail or other rusty object. If your needle, syringe, or other injection equipment is contaminated with tetanus spores due to dirt or rust, you could infect yourself. Skin-poppers and muscle-poppers are particularly susceptible to tetanus infection and should always use new, sterile equipment.

NECROTIZING FASCIITIS (Flesh-Eating Disease)
Necrotizing fasciitis is a bacterial infection commonly known as "flesh-eating disease" that enters the body through broken skin and then affects the surrounding tissue and nearby muscle. It can be transmitted by the exchange of blood during needle sharing, and has recently been traced to "black tar" heroin on the West Coast.
Symptoms of necrotizing fasciitis include increasing redness and swelling and extreme pain at the wound or injection site accompanied by a fever. The flesh around the site of infection begins to decay and looks as if it had been "eaten" away. Since this infection is fatal, early treatment with antibiotics is crucial to survival, although even appropriate therapy does not prevent death in all cases. Wounds must be kept impeccably clean.

Always using new, sterile injection equipment; never sharing injection equipment; thoroughly washing your hands and cleaning the skin prior to injection; and preparing your drugs on a clean surface will all help prevent necrotizing fasciitis infections.

WOUND BOTULISM
Wound botulism is caused by a bacteria that produces a toxin on the skin where a puncture would is made and that eventually stops your breathing by paralyzing your muscles. Recent cases have been associated with the subcutaneous injection of "black tar" heroin on the West Coast. The source of the botulism could be the drug itself, a cut in the drug, dirty injection equipment, or contamination during the preparation process. Wound botulism can be prevented in the same ways as necrotizing fasciitisby following excellent sterile technique when preparing and injecting your drugs. Symptoms of wound botulism include droopy eyelids, blurred or double vision, and a dry, sore throat which may progress into difficulty speaking and swallowing, a weakness of the neck, arms, and legs, and difficulty breathing.

If untreated, wound botulism will cause death by paralyzing the muscles used for breathing. Early treatment for wound botulism is essential. If you experience any of the symptoms listed above, seek medical attention immediately. Treatment usually involves an antibiotic regimen and the draining of any abscesses or infected wounds.

ABSCESSES
Abscesses begin with redness, swelling, and tenderness at an injection site and develop into an infection with a hard, pus-filled core. Abscesses result from missed hits (injecting into the tissue surrounding the vein), injecting a solution with a lot of particles in it, failing to clean the injection site prior to injecting, using dirty injection equipment, or skin-popping drugs like coke or speed that cause damage to muscle tissue and skin.

If you notice a hard, warm lump developing at an injection site, apply warm compresses at least three times a day to either make the abscess that is forming go away or come to a head (soften and fill with pus). If it comes to a head, you can get the abscess opened and drained at a hospital or clinic. If you experience fever, chills, extreme fatigue, or pain associated with an abscess, seek medical attention immediately because you could have a blood infection. Pain in the groin or armpits also means you most likely have an infection for which you should seek medical treatment.