Heroin adultarated with synthetic cannabinoids in the Paris region in 2023 : a multi-case review

Background
The Paris region (PR) is particularly exposed to drug-related risks. Physical and dematerialized markets are diversifying, increasing access to a growing number of drugs, including new psychoactive substances (NPS). In Seine-Saint-Denis, heroin is accessible via a well-established trafficking network. In 2023, 3 unprecedented waves of accidents linked to heroin adulterated with synthetic cannabinoids (SC) were observed with psychiatric and somatic symptoms sometimes requiring hospitalization. Thanks to a responsive regional network, the composition of the products was identified in less than 24 hours by ATPidf. Collective information (for people who use drugs (PWUD) and professionals) was also put in place via a regional health monitoring network.To our knowledge, for the second time in the world, SC was being sold as heroin and/or used as a heroin adulterant.
Methods
PWUD have access to drug analysis via a network of sample 30 drop-off points (30, results within 48 hours). A mobile laboratory operating monthly in the town of Aulnay-sous-bois provides real time analysis with on site results. Sampling and feedback interviews, carried out by a trained staff enable people to reduce the risks associated with their drug use. ATPidf analyses are carried out by a specialized staff, using tools assessed by the toxicology laboratories of Raymond Poincare hospital in Garches and Lille Hospital laboratories (reference medical biology laboratories for NPS). The chosen methods have low detection limits (around 1% m/m in powders): TLC and HPLC-DAD, which can at least detect the presence of unusual substances, if not identify them, and even quantify the molecules of interest. In monitoring situations, counter-analyses are carried out to confirm results, and sometimes to provide hospital laboratories with reactive possibilities for confirming cases of intoxication following consumption of these products in biological samples. Monitoring information is transmitted to the French Observatory of Drugs and Addictive Tendencies and the PR Regional Health Agency.
Results
14 samples were analyzed by ATPidf for harm reduction (HR) purposes. 3 different SC, ADB BUTINACA, MDMB-4en-PINACA and MDMB BUTINACA, were found in samples sold as heroin, 2 identified by TLC by ATPidf (ADB-BUTINACA and MDMB-4en-PINACA) and all confirmed by the toxicology laboratories of Raymond Poincare hospital by GC/MS and LC-MS/MS.
Conclusions
The heroin market was severely disrupted in 2023 in the PR (presence of SC, decrease in potency). The geopolitical context, particularly in Afghanistan, has led to fears of new overdoses in France and worldwide. The development of reliable analytical tools adapted to this market (discrimination of molecules in a complex mixture, detection at low limits of detection) seems more necessary than ever in a perspective of HR and monitoring. TLC enables SC to be detected and identified, even in complex mixtures at low levels (below 5%).