High-risk sites
The groin and the backs of the legs are high risk. No advice is given on how to inject into them because there isn’t anything you can do to make them safer: they are described here to explain the risks.

So that there will be someone around to get help if things go wrong, it makes sense not to inject into any of these sites when you are on your own.

If you do use any of these sites and are around injectors who haven’t yet tried injecting into dangerous sites, remember that seeing you do it may encourage them to try.

If you are only injecting into your arms it would be worth promising yourself that if you ever find yourself contemplating using any of the high risk sites, you’ll stop injecting.

Groin
Injecting into the groin is very dangerous. The femoral vein is deep inside the body and brings blood back from the legs. Injecting into something so deep is dangerous enough, but with the femoral vein there is added risk because it is wrapped around the femoral artery (which takes blood down into the legs) and the femoral nerve (which takes sensation to the legs). The exact position varies from person to person: you’ve got a one in three chance of hitting the vein. Get it wrong and you run the risk of losing your leg or hitting the roof with pain...

Once people have found the femoral vein they tend to use the same site over and over again. This has the added risk of:

• Infection travelling down the hole (which doesn’t heal properly)
• The artery and the vein becoming connected
• A blood clot forming (see deep vein thrombosis).

The point when you are thinking about using your groin is when you really should be thinking about other ways of taking your drugs: if you are thinking about using your groin (or are already doing it), it may help to get support and advice from your drug/needle and syringe program worker.

Back of the legs
Because they are furthest from the heart and because of gravity, blood flow through the legs is slow. If drugs are injected too fast the veins will be unable to cope and fluid will escape from the vein, round the needle, causing a miss.

Because the blood flow is slow it is harder for the body to heal injection-site damage and fight off infection. So abscesses and other infections are a greater risk for those injecting into their legs.

As the flow of blood in the leg veins is upwards, towards the heart, it is important to inject the right way - with the needle pointing up towards the top of the leg.

Varicose veins form, usually in the leg, because of damaged valves. They have tight, thin walls and are often raised, stretching the skin. They should not be used for injecting into as they can bleed very heavily.

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