Alice —

Recently, my boyfriend began injecting cocaine. I've noticed that he and his friends share their needles, but "clean" them first with bleach and water. Is this a valid way to avoid contamination?

Signed
— Worried and Wondering

Dear Worried and Wondering,

Your boyfriend is fortunate to have someone who's looking out for his health and safety. Your concern over sharing needles and syringes is certainly warranted, because it raises the risk of transmission of blood borne pathogens, including Human immunodeficiency virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV). The most effective way to avoid contamination with injection drug use is to use a new, sterile needle every time. But, there are some harm reduction strategies — like cleaning needles — that may decrease the likelihood of contamination. It's critical to mention, however, that cleaning needles isn't 100 percent effective at eliminating the risk of transmission. And, though your question conveys concern over the risk to your boyfriend's health, if you and your boyfriend have a sexual relationship, your health may be at risk as well.

If clean needles aren't available, attempting to disinfect used needles appears to be better than simply reusing contaminated ones. To that end, it's good that your boyfriend is already using bleach as recent studies have shown that undiluted (not watered down) bleach is the most effective disinfectant for reducing HIV, HBV, and HCV in contaminated syringes. In fact, it can kill HIV in 30 seconds — but thorough after bleach treatment is recommended. The Alliance Health Project at the University of California, San Francisco, suggests using these steps to disinfect syringes (when there's not a better option):

  1. Fill the used syringe with clean water.
  2. Shake up the water-filled syringe.
  3. Squirt the water out. Repeat steps one through three until you no longer see blood in the syringe.
  4. Fill the entire syringe with undiluted bleach and leave it in there for 30 seconds or more (try humming the “Happy Birthday to You” song all the way through, three times over).  
  5. Squirt all the bleach out.
  6. Fill the syringe with clean water again, shake it up, and squirt the water out. Repeat this step a few times to avoid injecting bleach into the body.

While bleach may be the recommended disinfectant, it may dull the point of needles and break down the rubber in the syringes over time. Other household disinfectants may also be used (such as hydrogen peroxide, ethanol, and isopropanol), but they require multiple rinses before they are able to disinfect as effectively as bleach.

Cleaning needles may lower your boyfriend’s risk of contamination, but it’s won't eliminate the risk. Both HIV and HCV can survive on surfaces for up to four weeks, so it's recommended that users only inject themselves, set up a clean surface, avoid detachable needles, and wash their hands before and after injecting to avoid further contamination. Using new needles every time is the most effective method for minimizing contamination. If it's difficult for your boyfriend to get new syringes, try seeing if there's a needle exchange program near you. Organizations, such as the North American Syringe Exchange Network, can help you locate a center or program nearby.

Lastly, you don't mention whether you're worried about your partner's drug use in general, just that you're concerned about his shared use of needles. In addition to sharing this information about cleaning needles, it could be a good idea for you both to also talk about how his injection drug use affects you both. Sharing syringes for injection drug use increases the risk for a number of infections not just for him, but it could potentially have implications for your own physical and emotional health as his partner, too. Consider whether it makes sense for you both to talk with a health care provider about the risk for blood borne infections, preventive care (such as getting the hepatitis B vaccine), and getting tested for sexually transmitted infections (STIs). If you aren't already, you might also use barrier methods of contraception, such as condoms, during sex to help further reduce your own risk. If you're unsure about how to get a conversation started, consider reaching out to a health educator or health promotion professional to talk through how to approach the subject with your boyfriend.

Hope this will help you and your partner take action to support each other's health!

Alice!

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