Ascorbic Acid

Product Description

This is a Safer Injecting product.

Acidifiers are used to convert insoluble drugs like brown heroin or crack-cocaine into a water-soluble, injectable form by adding an acid. The Vitamin C (ascorbic acid) sachets provided through OHRDP are packaged in 100 mg packets, are air tight and water resistant with an expiry date printed on every sachet. It is important to check the expiry date prior to using the single-use Vitamin C sachets in order to ensure effectiveness.

Best Practice

Best Practice:

Use the smallest possible amount of ascorbic acid to dissolve drugs to reduce the risk of vein damage and bacterial or fungal infections associated with the use of other types of acidifier.
  • Ask clients if ascorbic acid is required to dissolve the drug(s) to be injected
  • If needed, provide single-use sachets of ascorbic acid in the quantities requested by clients with no limit on the number of sachets provided per client, per visit
  • If needed, offer acidifiers with each needle provided
  • Provide pre-packaged safer injection kits (needles, syringes, cookers, filters, sterile water for injection, alcohol swabs, tourniquets and ascorbic acid, if necessary) and also individual safer injection supplies concurrently
  • Educate clients about the potential HIV- and HCV-related risks associated with sharing acidifiers, the risks of fungal infections associated with using spore-contaminated lemon juice, vinegar, and acetic acids, and the correct single-person use of acidifiers including instruction on how to determine the amount of acid that is needed to dissolve the drug of choice
  • Educate clients about the correct disposal of used acidifiers
  • Vitamin C (ascorbic acid) is believed to be the safest acidifier to use in the preparation of brown heroin and crack-cocaine for injection
  • Vitamin C is used by heroin users to convert the active ingredient of heroin, diacetylmorphine/diamorphine, into a soluble form for injecting
  • In order to break down crack, acid is mixed with the drug in order to separate the cocaine and baking soda and allow for the drug to be injected
  • When an acidifier is required to breakdown a drug, only a pinch of Vitamin C is required (approx. ¼ the size of the rock)
  • It is important to rotate inventory to ensure that the shelf life of the product does not expire prior to distribution to clients
  • Needle Syringe Programs that prepare kits for distribution should consider their contents carefully; not all drugs require the use of an acidifier and including vitamin C in each kit is not cost effective and is wasteful
  • People who inject drugs have been known to use readily available forms of these acids like commercial brands of lemon juice, vinegar and other household products. Although these products do promote solubility, they are sources of harm and can cause bacterial and fungi infections such as endocarditis which affects the lining of the heart, weakening the valves and heart muscle; candidal endophthalmistis which affects the eyes; and candida albicans causing symptoms like lethargy, chronic diarrhea, yeast vaginitis, bladder infections, muscle and joint pain, menstrual problems, constipation and severe depression
  • Powdered vitamin C is less damaging to veins than vinegar or lemon juice
  • It is important to use the smallest amount of vitamin C necessary during drug preparation in order to reduce the damage to veins when injecting
  • HIV and HCV can be transmitted through the sharing of contaminated injection-related equipment. If several people were to use the same acidifier source for their injections, the acidifiers could potentially act as a reservoir for viral transmission

Sources & Resources

  1. Strike C, Hopkins S, Watson T, Gohil H, Young S, Buxton J et al. Best practice recommendations for harm reduction programs: needle and syringe distribution, other injecting equipment distribution, safer crack kit distribution (interim version). 2012
  2. City of Ottawa memo, from Paul Lavigne, Harm Reduction Project Officer, Jan 28,2004
  3. Strike C, Leonard L, Millson M, Anstice S, Berkeley N, Medd E. Ontario Needle Exchange Programs: Best Practices Recommendations. Toronto: Ontario Needle Exchange Coordinating Committee 2006
  4. Getting off Right, A Safety Manual for Injection Drug Users, Harm Reduction Coalition
  5. http://prescription.lifetips.com/tip/61519/basic-calculations/liquids/cc-s-ml-s-teaspoonfuls-and-tablespoonfuls.html
  6. E. Imbert, A. Aznar, R. Nator., "Lemons, vinegars, mushrooms and "black tar", A new stake in harm reduction", October 1995
  7. http://www.emedicine.com/med/topic586.htm