European Hair Drug Analisys Network – A pioneer study to investigate the use of NPS and NSO
Background: New Psychoactive Substances (NPS) and synthetic opioids (NSO) use is increasing, posing a risk to public health and a challenge for international drug policies. While NPS may be used to avoid judicial sanctions or try new products and effects, the risk of unaware intake exists. Research showed that stimulants can be replaced or adulterated with NPS; heroin can contain synthetic opioids and nitazenes, causing overdoses and deaths. Since most drugs are stable in the keratin matrix and can be identified months after their use, hair analysis was used to monitor NPS consumption. The project, coordinated by the EMCDDA, combined a survey and hair analysis to assess emerging trends and patterns of drug/NPS use in different European countries. Italian results are here presented.
Methodology: Only people who declared the use of drugs in the last 6 months and who gave an informed consent were selected. Participants filled in a questionnaire, declaring their use of drugs in the previous 30 days and in the last 6 months (recent use), more than 6 months (past use) or never., Motivations, settings and patterns of use were also explored. Hair samples were analyzed for old drugs and more than 150 NPS/NSO with UHPLC–MS/MS.
Results: 200 questionnaires/samples were collected in party setting and harm reduction services. Hair samples were analyzed in their entire length when they were long up to 6 cm, and divided in two segments when longer than 6 cm. 285 hair segments were analyzed. 2 different groups were identified: people attending party settings (PS) and people who use drugs heavily (PUDH). Gender and age were specular in both groups, with a prevalence of women and people under 35 in PS, while in PUDH men and people over 35 were prevalent. 72% of PS were employed compared to the 30% of PUDH; 47% of PS had a bachelor’s degree, while 59% of PUDH had a primary school degree. Questionnaires revealed alcohol (98% PS, 74% PUDH) and cocaine (75% PS, 71% PUDH) as the most used drugs, followed by cannabis (74%) and party drugs (51%) in PS, and heroin (68%), cannabis and crack (57% each) in PUDH. From hair analysis, the most used drugs were cocaine (68%), cannabis (50%), MDMA and ketamine (32% each) and heroin (26%). Synthetic cathinones and opioids were rarely identified. Mephedrone, buphedrone and euthylone resulted in PS who declared a recent use (n=3) and a past use (n=9) of MDMA and amphetamine; 2 persons turned positive to recent use of mephedrone despite not having it declared. Ketamine, MDMA and tramadol were often identified in samples of people who had not declared their use.
Conclusions: The study drew new information on NPS/NSO diffusion by the combination of a survey and up-to-date hair analytical screening. Cocaine, MDMA and ketamine were widely found; particularly people tested positive for ketamine, MDMA, mephedrone and tramadol despite not reporting their use. Harm reduction and drug checking services are needed to avoid unaware use of NPS/NSO.
