Sterile Water

Product Description

This is a Safer Injecting product.

Sterile Water for Inhalation (for injection use) comes in single-use 3ml plastic ampoules to be used to prepare drugs for injection. The water is used to dissolve drugs into a solution that can be injected.

The water is sterile, non-pyrogenic, preservative free and contains no bacteriostatic agent.



Best Practice

Best Practice:

Use Injection-grade sterile water for each injection to reduce transmission of HIV, hepatitis C (HCV), hepatitis B (HBV), and other pathogens, and to prevent bacterial infection from the use of non-sterile water and other fluids. Never reuse water left in an ampoule.
  • Provide single-use, 3 mL ampoules with twist-off caps in the quantities requested by clients with no limit on the number of ampoules per client, per visit. If 3 mL ampoules of sterile water are not available, distribute the smallest size of ampoule available
  • Offer a sterile water ampoule with each needle provided
  • Provide pre-packaged safer injection kits (needles/syringes, cookers, filters, sterile water, alcohol swabs, tourniquets and ascorbic acid only if needed to dissolve drug)
  • Educate clients to dispose of empty water ampoules in accordance with local regulations for biomedical waste
  • Educate clients about the HIV-, HCV- and HBV-related risks associated with sharing, mixing and the risks of using non-sterile water (tap, bottled, rain, puddle, urinal) and other fluids (saliva, urine), and the correct single-person use of mixing
  • All equipment used for injection should be new, sterile and never shared
  • Check that each ampoule does not have any leaks or puncture holes. This can be done by simply squeezing the ampoule before use to ensure no water escapes. If water does leak or squeeze out, do not use the water
  • Twist cap and pull it completely off the ampoule, turn ampoule upside down and squeeze out the desired amount of water. The speed in which the water drips out correlates to the pressure of the squeeze - the harder the squeeze, the faster it comes out (and in this case it is a steady flow not a drip)
  • Throw out any remaining water and the plastic container
  • Store ampoules at room temperature. Avoid excess heat and protect from freezing
  • Each ampoule has an expiry date printed on the end of the container. It is important to rotate your inventory to minimize wastage and to ensure shelf life does not expire
  • It is recommended to estimate approximately 1,000 needles per person, per year, so a Needle Syringe Program should estimate 1,000 ampoules of sterile water per person per year
  • Once opened, the water should not be kept for subsequent injections, as it will contain bacteria from the air and has the potential of being used by another individual
  • Because water freezes at low temperatures, it is important that ampoules are stored in a temperature-controlled environment to avoid ampoule rupture
  • Each ampoule is able to withstand quite a bit of pressure before exploding. It does not appear to break or explode when sat upon, but make sure there are no sharp objects in the pocket that could puncture the ampoule
  • An ampoule was placed outdoors overnight (temperature dropped to -2C) was exposed to the elements but under a shelter and did not freeze. The plastic when brought indoors was still pliable
  • It is important to rotate inventory to ensure that the shelf life of the product does not expire prior to distribution to clients
  • Sterile Water for Inhalation is being distributed for the purpose of harm reduction with people who inject drugs across North America including Ontario, British Columbia, Nova Scotia, Québec, Saskatchewan, Alberta and throughout the United States
  • Sterile Water for Inhalation is not designed specifically for injection use and may indicate "not for injection" on the packaging. Sterile Water for Inhalation may contain agents / particles having the potential to cause an infection of other health related problems - although there have been no know documented cases
  • A literature review out of British Columbia found no evidence of harm when injecting with sterile water for inhalation, nor did it find documented support for its use. Regardless, the province has been distributing this product since 2004 (National Survey of Sterile Water Use, 2006)
  • Best Practice Recommendations (2013, 2006) state that the provision of single use, sterile water ampoules is the best method to eliminate the risk of HIV / HCV when sharing and mixing water, and prevents bacterial infections that can occur when injecting with non-sterile water
  • Refer to OHRDP policy brief on sterile water products (November 2006) for more information and discussion on the debate between the use of sterile water for injection and sterile water for inhalation
  • Non-sterile water (for example bottled or distilled water) can be contaminated with bacteria and can lead to health problems, like skin abscesses and infections, having serious health implications
  • The injection of non-sterile fluids other than sterile water such as saliva, rain, puddle or urinal water will expose a person to bacteria and other organisms causing potential infection or illness

Sources & Resources

  1. Strike C, Hopkins S, Watson T, Gohil H, Young S, Buxton J et al. Best Practice Recommendations for Canadian Harm Reduction Programs that provide service to people who use drugs and are at risk for HIV, HCV and other harms: Part 1, 2013
  2. Ontario Needle Exchange Programs: Best Practices Recommendations, Strike C and Leonard L, 2006
  3. Getting off Right, A Safety Manual for Injection Drug Users, Harm Reduction Coalition
  5. OHRDP National Survey on Sterile Water Use, September 2006
  6. OHRDP Policy Brief on Sterile Water Products, November 2006