Safer IM (Intramuscular) Injection Guide

A step-by-step guide on IM (intramuscular) injection, a publication by OnPoint NYC. OnPoint-NYC-EducationBinder_SIMI-Brochure


Preventing Injury and Infection

  • Use only new equipment, and do not share.
  • Wash hands, use a clean surface, and disinfect your injection site beforehand.
  • Rotate injection sites to allow areas to heal between injections. This helps reduce the risk of infection and scarring.




  • Some drugs are designed for only IM injection (steroids, hormones) and other drugs can be injected IV (opioids like heroin and fentanyl, stimulants like cocaine and meth).
  • Only inject IM drugs in the muscle and IV drugs in the vein. Injecting IV drugs in the muscle will likely cause an abscess.
  • If you’re having trouble with IV injection, do not try IM injection. Instead, consider booty bumping or another route of use. Talk to our staff for advice.

Street drugs are impure and can have dangerous cuts.

  • Purchase from someone you trust and can ask questions about drug quality/effects.




These tools are included in our safer injecting kit to help reduce the risk of injury and infection. Remember to use new tools each time!

Reusing syringes not only increases infection risk, but also blunts the needle. This can make injection more difficult, cause injury, and increase risk of scarring.

Use these to clean your hands before touching any equipment to help prevent infection.

Use these to clean your injection site. This will remove bacteria and dirt that can otherwise get pushed into your body!

Your injection site is an open wound! Apply these to protect it from dirt and germs after injecting.


Step-by-Step: How to Inject in the Muscle More Safely


  1. Get a sterile IM syringe
    You will need a 3cc syringe. Insulin syringes provided at most SEPs/SSPs are too small and short for IM injection. Gauge can be anywhere from 19-23g.
    Most people need 1-1.5 inch long needles. People with more body fat or muscle will need at least 1.5 inches.
  2. Select an appropriate injection site
    Option 1: top of thigh
    Option 2: deltoid muscle of shoulder
    Option 3: top of buttocks (if someone can assist)
  3. Clean hands and surface for preparing shot
    Wash your hands with warm water and soap or antiseptic wipes.
  4. Clean injection site
    Use either soap and water or an alcohol pad to clean site. If using alcohol pads, just wipe over the site one time. Wiping back and forth will just return germs to the area.
  5. Allow site to dry
    Avoid blowing on/touching it since that’ll just make it dirty again!
    Drawing up from a bottle:
  6. Disinfect bottle top
    Clean the bottle top with an alcohol pad.
  7. Prepare your bottle
    Fill the syringe barrel with air equal to the amount of liquid you want to inject, and inject that amount of air into the air space of the bottle.
    Why am I doing this?: Inserting air makes it easier to pull liquid into your syringe since the liquid is in a vacuum.
  8. Draw up liquid into syringe
    With the syringe still in the bottle, insert needle slightly further so the tip enters the liquid. Pull back on plunger until you get the amount of liquid you want.
    TIP: Use a second new needle to inject. It hurts less and is better for your skin since drawing up from the bottle can dull the point. Just twist the used needle off and twist the new one onto the filled syringe!
  9. Prepare muscle for injection
    Tighten the muscle first then relax it so you know exactly where the muscle is and what it feels like when it’s relaxed. Injection hurts less if the muscle is relaxed.
    Small muscle mass?: Place open hand over entire muscle. Grab and lift muscle. While holding, inject into area with other hand.
  10. Insert syringe
    Hold the syringe like a pen and insert at a right angle to the skin. Insert quickly then draw back slightly on plunger to make sure you’re not in a vein.
    See blood? Do NOT inject! Injecting IM drugs into the bloodstream is very dangerous! Pull the needle out a tiny bit and try again. Or, remove the needle entirely and insert with a new needle in a different area.
  11. Inject into the muscle
    Slowly push plunger to inject.
  12. Quickly remove syringe
    While using one hand to hold skin and muscle, quickly remove the syringe with the other.
    Bleeding?: Put pressure on the injection site with clean, dry tissue or gauze.
  13. Cover the site to prevent infection
    Use a fresh band-aid- with or without gauze–to cover the injection site.
  14. Safely discard used supplies in sharps containers
    Sharps containers are available at harm reduction programs and medical facilities. Ask us for a sharps container!

Have a Question about Safer Injection?

Email us your drug education questions at [email protected]

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