Monitoring intravenous drugs use in Spain through syringe residue analysis

The analysis of residues in used syringes is a new indicator that allows to objectively know the actual consumption of substances through intravenous administration [1]. Moreover, is useful to monitor temporal consumption tendencies and to detect the appearance of new substances before surveys and authorities’ seizure data collection.

Bearing this in mind and collaborating with several organizations from four different geographical Spanish locations, a sampling campaign at harm reduction exchange points and supervised drug consumption facilities was carried out in 2023 in the context of the Spanish project SYDRES and the European network ESCAPE.  

The syringes sample preparation protocol was based on that published by ESCAPE network [2] and consisted of rinsing with 1 mL of methanol and filtration through a 0.22 μm syringe filter. Afterwards, a dilution 1:10 was performed before the injection into a high-performance liquid chromatography system coupled to high-resolution mass spectrometry (HPLC–QTOF), using auto MS/MS mode. Data treatment was performed using a suspect screening approach. For that purpose, a MS/MS library was created containing 201 substances and the identification was performed based on the coincidence of fragmentation pattern and/or through retention time (when a standard was available).

The most frequently detected compounds in the syringes were cocaine and 6-acetylmorphine which is indicative of cocaine and heroin combined consumption. In addition, other substances related with such consumption such as benzoylecgonine and morphine presented a high detection frequency. It is remarkable that caffeine is the adulterant with the highest frequency of appearance followed by other related drugs, such as noscapine and papaverine.

Differences in detection frequencies among cities, gender and even in different sampling points of the same locality were found for some substances. For example, a high detection frequency was observed for piracetam in the city of Madrid with respect to other locations.

Acknowledgements: This work was funded by the Spanish National Drugs Plan PNSD (2022I003) and Instituto de Salud Carlos III/ NextGenerationEU/PRTR (RD 21 0009 0012 and RD 21 0009 0001). Thanks to the institutions that collaborated in sampling: Fundación Salud y Comunidad (Ángeles Gutierrez), Arquisocial (Patricia Jimenez, Jorge Álvarez), MadridSalud (Antonio Sáez), Grup ABD, Àmbit Prevenció Fundaciò, Equipo comunitario CDR Robador, IMIM (Sandra Aguelo, Isabel Novell, Yandri Quimis y Sofia Anador), ASPB (Anna Lago, Marc Moya, Maria Barranqueras, Ester Aranda), Sidálava (Blanca Bastida), Bizkaisida (Cristina Marbella, Saioa Iglesias), Médicos del Mundo (Andrea Náñez), Fundación Érguete (Adela Uriz), UMAD (Maria Carou)

References:

[1] T.M. Brunt, et al., International Journal of Drug Policy, 2021, 95, 103130

[2] European Syringe Collection and Analysis Enterprise: Generic Protocol, European Monitoring Centre for Drugs and Drug Addiction, February 2021.