of prescriptions per year in the United States alone. Insulin historically was injected from a vial using a syringe and needle, but may also be administered subcutaneously using devices such as injector pens or insulin pumps. An insulin pump consists of a catheter which is inserted into the subcutaneous tissue, and then secured in place to allow insulin to be administered multiple times through the same injection site. Recreational drug use Subcutaneous injection may also be used by people to (self-) administer recreational drugs. This can be referred to as skin popping. In some cases, the administration of illicit drugs in this way is associated with unsafe practices leading to infections and other adverse effects. In rare cases, this results in serious side effects such as AA amyloidosis. Recreational drugs reported to be administered subcutaneously have included cocaine, mephedrone, and amphetamine derivatives such as PMMA. Contraindications Contraindications to subcutaneous injections primarily depend on the specific medication being administered. Doses which would require more than 2 mL to be injected at once are not administered subcutaneously. Medications which may cause necrosis or otherwise be damaging or irritating to tissues should also not be administered subcutaneously. An injection should not be given at a specific site if there is inflammation or skin damage in the area. Risks and complications With normal doses of medicine (less than 2 mL in volume), complications or adverse effects are very rare. The most common adverse reactions after subcutaneous injections are administered are termed "injection site reactions". This term encompasses any combination of redness, swelling, itching, bruising, or other irritation that does not spread beyond the immediate vicinity of the injection. Injection site reactions may be minimized if repeated injections are necessary by moving the injection site at least one inch from previous injections, or using a different injection location altogether. There may also be specific complications associated with the specific medication being administered. Medication-specific Due to the frequency of injections required for the administration of insulin products via subcutaneous injection, insulin is associated with the development of lipohypertrophy and lipoatrophy. This can lead to slower or incomplete absorption from the injection site. Rotating the injection site is the primary method of preventing changes in tissue structure from insulin administration. Heparin-based anticoagulants injected subcutaneously may cause hematoma and bruising around the injection site due to their anticoagulant effect. This includes heparin and low molecular weight heparin products