Acidifiers

Product Description

Acidifiers are used to convert insoluble drugs like brown heroin or crack-cocaine into a water-soluble form by adding an acid. Acids that can be used to facilitate solubility in this way include citric, ascorbic, acetic and lactic acids. The Vit C (ascorbic acid) sachets distributed by OHRDP are packaged in 300mg packets, are air tight and water resistant and come in strips of 10 with an expiry date printed on every sachet. Vit C sachets are for single use only.

Practice / Usage

Vit C (ascorbic acid) is believed to be the safest acidifier to use in the preparation of brown heroin and crack-cocaine for injection. Crack comes in rock form, which is made of cocaine and baking soda. "Breaking down crack" means to separate the cocaine from the baking soda by mixing it with the acid. Vitamin C is also used by heroin users to convert the active ingredient of heroin, diacetylmorphine/diamorphine into a soluble form for injecting.

• When an acidifier is required to breakdown a drug use a pinch of Vit C (approx. ¼ the size of the rock)
• Needle Exchange Programs should provide each client their requested amount of Vit C sachets.

For stocking purposes:

• It is important to rotate inventory to ensure that the shelf life of the product does not expire prior to distribution to clients.
• NEPs that prepare kits for distribution should consider their contents carefully. Not all drugs require the use of an acidifier and including Vit C in each kit is not cost effective and is wasteful.

Discussion/Associated Risks

• 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 like: endocarditis affecting the lining of the heart, weakening the valves and heart muscle; candidal endophthalmistis affecting the eyes and candida albicans causing symptoms like lethargy, chronic diarrhea, yeast vaginitis, bladder infections, muscle and join pain, menstrual problems, constipation and severe depression.
• Powdered Vitamin C is less damaging to veins than using vinegar or lemon juice which are too strong and can cause fungal infection.
• It is important to use the LEAST amount of Vit C possible in order to reduce the damage to veins when injecting.

Sources

• City of Ottawa memo, from Paul Lavigne, Harm Reduction Project Officer, Jan 28,2004
• 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
• Getting off Right, A Safety Manual for Injection Drug Users, Harm Reduction Coalition
• www.exchangesupplies.org/publications/safer_injecting_briefing/section3.html
• http://prescription.lifetips.com/tip/61519/basic-calculations/liquids/cc-s-ml-s-teaspoonfuls-and-tablespoonfuls.html
• E. Imbert, A. Aznar, R. Nator., "Lemons, vinegars, mushrooms and "black tar", A new stake in harm reduction", October 1995.
• http://www.emedicine.com/med/topic586.htm