Water for Inhalation

Product Description:

Sterile Water for Inhalation USP (for injection use)

Sterile Water for Inhalation comes in single-use 3 ml plastic ampoules to be used for injection use. The water is sterile, non-pyrogenic, preservative-free, and contains no bacteriostatic agent.

The water is used to dissolve drugs into a solution prior to injection and to flush syringes (see below for definitions).

Practice/Usage

• 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 the ampoules at room temperature. Avoid excessive heat and protect from freezing.
• Each ampoule has an expiry date printed on the end of the container. The shelf life of this product is approximately 2 years. It is important to rotate your inventory to minimize wastage and to ensure the shelf life does not expire.
• Each ampoule appears to be able to withstand quite a bit of pressure before exploding. It does not appear to break or explode when sat upon but make sure that there are no objects in the pocket that could puncture the ampoule.
• An ampoule was placed outdoors over night (temperature dropped to -2°C) exposed to the elements but under a shelter and it did not freeze and the plastic when brought indoors was still pliable.

Discussion/Associated Risks

• The distribution of 3ml ampoules of sterile water for inhalation (for injection use) gives an alternative to Needle Exchange Programs who indicate that their clients report sharing the sterile water for injection from the 10ml vials.
• Sterile water for inhalation is being distributed for the purpose of harm reduction with people who inject drugs across North America including British Columbia, Nova Scotia, Quebec, 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 infection or other health related problems.
• A literature review, out of British Columbia, found no evidence of harm when injecting with sterile water for inhalation, nor did it find support for its use, regardless the Province has been distributing this product for three years. (National Survey of Sterile Water Use, 2006)
• Best Practice Recommendations (2006) states 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 to be used for injection.

Definitions

• Pyrogen - any substance that can cause a rise in body temperature.
• Pyogenic - bacterial infections that make pus or form abscesses. It is often a technique used by invasive bacteria to protect itself from host immune defenses (http://en.wikipedia.org/wiki/Pyogenic).
• Endotoxin - a toxin produced within certain bacteria that is released only when the bacteria disintegrates.
• Bacteriostatic agent - a substance that inhibits the growth of bacteria (http://www.answers.com/topic/bacteriostatic-agent).

Sources

• 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
• OHRDP Policy Brief on Sterile Water Products November 2006
• OHRDP National Survey on Sterile Water Use September 2006