Substances detected in used syringes of injecting drug users across 7 cities in Europe in 2017 and 2018: The European Syringe Collection and Analysis Project Enterprise (ESCAPE)

How to improve the surveillance of the Taliban ban's impact on European drug markets

In April 2023, the Taliban banned poppy cultivation and the trade of all narcotics. This caused a 95% reduction in opium production. Usually, that would be good news. But there is a substantial worry: synthetic opioids might fill the void left by heroin. This is concerning because these drugs have led to health emergencies in areas where they are prevalent. This paper highlights the limitations of the current drug surveillance system in Europe and proposes improvements. It argues that reliance on secondary data is insufficient. Instead, we need to interview a sentinel group of people who inject drugs and adjust city-level sentinel systems, such as wastewater analysis, to specifically track the spread of synthetic opioids. Without these proactive steps, we risk only noticing a transition from heroin to synthetic opioids after it has occurred, with its harmful impacts already in place.

Community-based respondent-driven sampling as a strategy for drug use surveillance in a large French urban area

BACKGROUND

Understanding drug use and behavior within the PWUD population is crucial to adapt harm reduction and prevention strategies, and provide improved addiction and medical treatment. However, in most countries such as France, the knowledge of drug use behaviors is likely biased as it originates from addiction centers which are attended by only an unknown proportion of PWUD. The objectives of this study were to describe drug use behavior in a population of active PWUD in the urban area of Montpellier, South of France.

METHODS

We implemented a community-based respondent-driven sampling survey (RDSS), a validated strategy to obtain a representative sample of a population, to recruit PWUD in the city. Adult individuals reporting frequent psychoactive drug use other than cannabis, with confirmation by urine test, were eligible. Beside HCV and HIV testing, trained peers interviewed participants on their drug consumption and behavior using standardized questionnaires. Fifteen seeds launched the RDSS.

RESULTS

During the 11 weeks of the RDSS, 554 actives PWUD were consecutively included. They were mostly men (78.8%), had a median age of 39 years, and only 25.6% had a stable living place. On average, participants consumed 4.7 (± 3.1) different drugs, and 42.6% smoked free-base cocaine. Unexpectedly, heroin and methamphetamine were consumed by 46.8% and 21.5% of participants, respectively. Among the 194 participants injecting drugs, 33% declared sharing their equipment.

CONCLUSION

This RDSS highlighted a high consumption of heroin, crack and methamphetamine in this PWUD population. These unexpected results can be explained by low attendance to addiction centers, the source of drug use reports. Despite free care and risk reduction equipment in the city, sharing was very frequent among injectors, challenging the current program of harm reduction.

Monitoring for fentanyl within Australian supervised injecting facilities: Findings from feasibility testing of novel methods and collaborative workshops

BACKGROUND

Australia is yet to see widespread fentanyl-contaminated heroin, despite the established presence of fentanyl in other countries. International mortality trends alongside a local cluster of fentanyl-related deaths prompted interest in developing methods to monitor for fentanyl and other potentially harmful novel psychoactive substances (NPS) in Australia.

METHODS

We tested novel methods to monitor for fentanyl and other NPS. From 2017-2021, clients from supervised injecting facilities (SIFs) in Melbourne and Sydney, Australia, contributed urine screens (UDS) with BTNX Rapid Response™ fentanyl test strips (FTS) paired with surveys, and injecting equipment associated with opioid overdoses for laboratory analysis. A single site piloted drug checking using FTS with laboratory confirmation. Two workshops were conducted with SIF staff, content experts and people with lived experience to determine how results can inform practices within SIFs.

RESULTS

Of the 911 UDS with FTS conducted, less than 1% (n=8) yielded positive results that were not explained by self-reported pharmaceutical fentanyl use, with two laboratory confirmed fentanyl positive results. Injecting equipment from 59 overdoses was tested and neither fentanyl nor other NPS were identified. Drug checking with FTS (n=34) indicated the presence of fentanyl on three tests. Two specimens were subsequently sent for laboratory testing and classified as false positives as the presence of fentanyl was not confirmed. Workshop participants (n=21) felt routine monitoring with FTS currently had limited value. A process for using pre-defined signals to trigger surveillance was developed.

CONCLUSION

The high false positive rates with FTS, relative to the small number of positive results and potential for them to undermine confidence in FTS emphasised the need for confirmatory testing. The role of routine surveillance was unclear within the current low-fentanyl context, however, a process was developed to upscale testing should signals of increased fentanyl prevalence in the Australian heroin market emerge.

A culturally appropriate method for validating self-reported drug administration among indigenous people who use injection drugs

Compared with other racial/ethnic groups in the United States (US), American Indians/Alaska Natives have one of the fastest climbing rates of drug overdose deaths involving stimulants. Validating the substances self-reported by Indigenous people who use injection drugs (IPWIDs) can present logistical and cultural challenges. While the collection of biospecimens (e.g., urine, blood, hair follicle) can be one way to cross-validate the substances self-reported by IPWIDs, the collection of biospecimens has been historically problematic when conducting substance use research with Indigenous North Americans. In our National Institutes of Health (NIH)-supported pilot research conducted with IPWIDs, we have documented low willingness to provide a biospecimen to a research team. This article demonstrates an alternative method for validating self-reported substances injected by IPWIDs that does not require the extraction of biospecimens from Indigenous bodies and spaces. The method described includes:•Collecting used, unwashed syringes from IPWIDs at the time of behavioral assessment,•Sampling the used syringe by washing the syringe needle/barrel with methanol,•Analyzing the samples with gas chromatography mass spectrometry (GC-MS) and liquid chromatography coupled to triple-quadrupole mass spectrometry (LC-QQQ-MS). This method offers a more culturally appropriate alternative to validate substances self-reported by IPWIDs during behavioral assessments.

Analysis of illicit stimulant use triangulating wastewater, general population survey and web survey data

Background: We analysed illicit stimulant use in Finland by comparing three separate datasets collected at the same time. Methods: The data used were wastewater analysis (2014 and 2018), population-based drug surveys (2014 and 2018) and European Web Survey on Drugs (2018, Finnish data). Proportions, prevalence levels and trends of stimulant use as well as their consumption were measured. Factors associated with stimulant use were assessed for past-year stimulant or amphetamine use as an outcome measure in regression analyses. Results: Both population-based drug survey and wastewater data showed that stimulant use has increased in Finland between 2014 and 2018. Disadvantaged socio-demographic background and other substance use were associated with past-year stimulant use, with no geographical variation in Finland. The socio-demographics of those reporting amphetamine use differed between population-based drug survey and web survey. In the web survey, infrequent and occasional users of amphetamine were quite alike, whereas frequent users were more likely to be unemployed or use injection as the route of administration. Conclusion: Analysis of three different data revealed findings that would have been missed and conclusions that could not have been made by using only one dataset. Putting findings from different methods into dialogue raises new questions and opens new interpretations. This analysis emphasises the importance of the prevention of frequent use and associated harm, as well as the impact of versatile drug treatment and harm reduction services on it.

Polydrug Definition and Assessment: The State of the Art

Polydrug use is a very common phenomenon and represents an important public health problem. The definition of the term has varied since its inception, and consequently so have forms of self-report evaluation. The aim of this review is to offer an overview of how the concept has evolved and its forms of evaluation through self-reporting. A search of the term polydrug was conducted on the PubMed portal up to August 2022, with a total of 2076 publications detected containing the word polydrug in their title, abstract or keywords. This includes publications that represent an advance in the definition and assessment of this construct through self-reports, which may be useful for researchers carrying out future studies in the field. The importance of distinguishing between concurrent and simultaneous polydrug use and the need to employ comparable measures in parameters for the frequency, magnitude and combination of psychoactive substances involved in polydrug use are two of the main recommendations emerging from this review.

Infections in people who inject drugs on the acute medical take

People who inject drugs are disproportionately affected by acute/chronic bacterial and viral infections that are a cause of significant morbidity. Clinical presentations to the acute medical take vary from skin and soft tissue infections to complications of bacteraemias, and can be challenging with difficulties in adherence, pain management, early self-discharges and loss to follow-up.This review summarises the most recent UK epidemiology of injecting drug use and infection as well as clinical presentation and management.

Trace Residue Identification, Characterization and Longitudinal Monitoring of the Novel Synthetic Opioid β-U10, from Discarded Drug Paraphernalia

Empirical data regarding dynamic alterations in illicit drug supply markets in response to the COVID-19 pandemic, including the potential for introduction of novel drug substances and/or increased poly-drug combination use at the 'street' level, i.e., directly proximal to the point of consumption, is currently lacking. Here, a high-throughput strategy employing ambient ionization-mass spectrometry is described for the trace residue identification, characterization and longitudinal monitoring of illicit drug substances found within >6,600 discarded drug paraphernalia (DDP) samples collected during a pilot study of an early warning system for illicit drug use in Melbourne, Australia from August 2020-February 2021, while significant COVID-19 lockdown conditions were imposed. The utility of this approach is demonstrated for the de novo identification and structural characterization of β-U10, a previously unreported naphthamide analogue within the 'U-series' of synthetic opioid drugs, including differentiation from its α-U10 isomer without need for sample preparation or chromatographic separation prior to analysis. Notably, β-U10 was observed with 23 other drug substances, most commonly in temporally distinct clusters with heroin, etizolam and diphenhydramine, and in a total of 182 different poly-drug combinations. Longitudinal monitoring of the number and weekly 'average signal intensity' (ASI) values of identified substances, developed here as a semi-quantitative proxy indicator of changes in availability, relative purity and compositions of street level drug samples, revealed that increases in the number of identifications and ASI for β-U10 and etizolam coincided with a 50% decrease in the number of positive detections and an order of magnitude decrease in the ASI for heroin.