Analysis of drugs in used syringes from sentinel European cities, 2020

Since 2017, the ESCAPE project aims to identify the range of substances being used by people who inject drugs in a sentinel network of cities in Europe and to monitor changes in patterns of use over time. It is intended that this will provide timely, city-level data that can complement other information and indicators on drug consumption and potential emerging health threats in the region.

A group of European researchers applied an innovative method to obtain information on injected substances by chemically analysing the residual content of used syringes collected in low threshold services or in automatic kit dispensers in 8 cities in 8 EU countries in 2020. The contents of used syringes were analysed in 8 laboratories using chromatographic and spectroscopic methods.

A total of 1247 used syringes were analysed. With the exception of Vilnius, traces of stimulants (cocaine, amphetamines and synthetic cathinones) were found in a high proportion of the syringes tested in each of the cities. The proportion of syringes containing heroin was high and stable over time in half of the participating cities. Injection of opioid substitution medications, namely buprenorphine and methadone, as well as benzodiazepines, is common in Helsinki, Vilnius, Prague and Lausanne. Carfentanil was detected in a third of syringes from Riga. Overall, a third of the syringes tested contained residues of two or more substances from different drug categories, which confirms that people who inject drugs often inject more than one psychoactive substance.

The study provides local and timely information that can be used for city-level monitoring and interventions. The study shows diversities between cities but also within cities and the importance of local contextual information. The injection of stimulants has implications for the risk of blood-borne and sexually transmitted infections such as HIV and hepatitis Band C viruses. The injection of potent opioids such as carfentanil, as well as the injection of multiple substances, elevates the risks of adverse health consequences and overdose deaths.