Background: Much of the research on injection drug use practices has focused on adult populations and relatively little is known about safer and/or unsafe injection practices among youth who use injection drugs (YWID). Unsafe practices may be risk factors for blood borne illnesses, abscesses or other infections, and overdose. Multiple factors may create barriers to the access of clean supplies and the ability to practice safer injection. It is important to understand how YWID engage in safer and/or unsafe injection practices so that use of safer practices may be supported. Purpose: The purpose of this study was to explore the understandings and practices of safer and/or unsafe injection drug use among YIWD, as well as key social factors influencing these understandings and practices. Methods: Ten semi-structured qualitative interviews were conducted with YWID aged 18 to 29 in Halifax, Nova Scotia. Voluntary informed consent was obtained prior to conducting the interviews. All interviews were audio-taped and transcribed, then analyzed using a modified approach to grounded theory for key themes and subthemes. Results: The experiences of the YWID can be categorized into two overarching themes. The first theme relates to the power of the drugs and the control (or, at times, lack of control) YWID have over safer practices. This theme explores how access to clean supplies and understandings of safer use can influence the control YWID have over safer practices. The second theme describes experiences YWID have with “getting clean,” or gaining power over drugs, including experiences with methadone maintenance treatment. Discussion: YWID can and do practice safer use, however multiple factors, such as the perception of cleanliness in injection practices and the availability of clean needles in the community, impact how YWID understand and practice safer injection drug use. Barriers that impede YWID’s ability to practice safer use need to be addressed.