Research paper
Drug analysis of residual content of used syringes: A new approach for improving knowledge of injected drugs and drug user practices

https://doi.org/10.1016/j.drugpo.2014.09.010Get rights and content

Highlights

  • Analysis of the residual content of used syringes collected in automatic injection kit dispensers.

  • Qualitative differences in drug consumption are observed between the different sites of sampling.

  • New tool to detect new injection practices in the way to adapt prevention and harm reduction.

Abstract

Background

Since their inception, harm reduction services, including needle exchange programs, have aimed to improve and update knowledge about illicit drug consumption and injection practices in order to assess and regularly revise the effectiveness of preventive strategies.

Methods

In this paper we describe the development of a scientific approach to obtaining this type of information through analysis of the residual content of used syringes. This was done using a validated liquid chromatography method with mass spectrometry detection to identify different molecules. Used syringes were collected from automatic injection kit dispensers at 17 sites in Paris and the surrounding suburbs each month for one year.

Results

In total, 3489 syringes were collected. No compounds were detected in 245 syringes. Heroin was the most commonly observed compound (42%), followed by cocaine (41%), buprenorphine (29%) and 4-methylethylcathinone (23%). These analyses also showed the increased appearance of 4-methylethylcathinone between the summer and winter of 2012.

Conclusions

Despite the bias involved in this approach, the method can provide rapid data on patterns of drug consumption for specific time periods and for well-defined locations. This kind of analysis enables the detection of new substances being injected and thus enables harm reduction services to revise and adapt prevention strategies.

Introduction

Drug use is associated with numerous social and health risks. Microbiological cross-contamination risk through specific injection practices, for example, can facilitate the transmission of HIV, hepatitis B and C viruses, and bacteria and fungi inducing abscesses, endocarditis, septicemia, fungal ophthalmic mycosis (Kim, Juzych, & Eliott, 2002), tetanus (Hahné et al., 2006), botulism (Barry et al., 2009) and anthrax (Ringertz et al., 2000). Harm reduction programs have been established in many countries to reduce such health risks (Des Jarlais, 1998).

The first needle exchange programs (NEP) were opened in 1984 in The Netherlands to reduce the need for sharing and reuse of syringes by injection drug users (IDUs). By 1990, NEP were established in 15 European countries, including in France (Hedrich, Pirona, & Wiessing, 2008). Since that time, predominantly voluntary sector organisations have tried to improve their knowledge of injection practices in order to assess the effectiveness of their preventive strategies.

Evaluations of harm reduction programs mainly rely on self-reported data from program participants and this introduces an immediate bias. Many IDUs have never been in contact with support or treatment services and are considered to be a ‘hidden’ population (National Research Council, 2006). Methodological difficulties associated with evaluation studies include: differences between studies in the variables of interest, differences in the reporting periods for risk behaviours, operational definitions (e.g. “needle reuse”), but also the validity and reliability of data collection tools (Ksobiech, 2004) and the length of time it takes for such findings to be processed and published. These methodological problems limit the usefulness and representativeness of findings.

Likewise, it is difficult to gather up-to-date information on the qualitative composition of injected drugs in order to adapt or refine prevention recommendations for IDUs. Various substances can be injected: drugs bought on the illicit market, therapeutic compounds such as opiate substitutes provided with a prescription, or new psychoactive drugs purchased mainly from the Internet. In 2012, for example, more than 50 new molecules were synthesised and sold on the market (UNODC, 2013). A significant portion of these products contained insoluble compounds or unknown cutting agents that can lead to serious intravascular administration problems.

This ever-changing situation means that those working in harm reduction and prevention services need to be able to respond quickly to changes in IDU practices. This can be difficult and even targeted population surveys are unable to provide the relevant consumption information in the necessary timeframe.

The French “SAFE” association manages the biggest NEP in France through the installation and maintenance of street-based automatic injection kit dispensers (AIKD) which deliver injection kits and receive used syringes. In 2013, 185,000 of these kits were distributed from 33 AIKD in Paris and 83 in its suburbs. The AIKD deliver new kits 24 h a day, seven days a week. IDUs get a kit in return for a token, which they receive when they dispose of their used syringes in a special trash bin. Pharmacy or harm reduction services also provide tokens. The activity level of these units has risen by 8% per year since 2001. To optimise effect, the SAFE association needs up-to-date information to inform the geographic distribution of AIKD, to provide the necessary ‘tools’ to reduce microbial infections (e.g. filters and needles) and to give targeted prevention advice to IDUs.

We argue that a scientific approach to obtaining these data is to analyse the residual content of used syringes collected via the AIKD. This can provide more accurate and geographically sensitive information about drug compounds being used by IDUs as well as an opportunity to assess the extent of wear and tear of returned injecting equipment. In turn this information can help services to revise and refine their harm reduction advice.

Section snippets

Sampling strategy

Seventeen AIKD were chosen from sites in Paris and its suburbs to reflect different types of location (e.g. proximity to harm reduction services, crowded area such as train stations, high- vs. low-income area, business and touristic districts).

The intention was to collect syringe samples once a month for a year from SAFE staff who managed the maintenance of AIKD. Due to logistical problems, however, this was not always possible. The number of samples collected per site is presented in Table 1.

Results

A total of 131 samplings were performed, from 17 AIKD, corresponding to 3489 syringes analysed. No compounds were detected in 245 syringes and results obtained for the others – named positive syringes – are presented in Table 3 and Fig. 2, for each sampling site. The “others” class includes dextropropoxyphene, fentanyl, methylphenidate, alprazolam, clonazepam, diazepam, flunitrazepam, zolpidem, ketamine and trihexyphenidyle. When morphine was detected in presence of 6-monoacetylmorphine and/or

Conclusion

Analysis of the residual contents of used syringes collected from syringe dispensers had two aims: first, the identification of consumed compounds and secondly, an overview of consumption patterns at a particular time and at different sites in Paris and its suburbs.

The main advantage of this method is to rapidly acquire up-to-date, geographically sensitive, drug consumption data. This study has shown that opiates were the most commonly detected drugs (heroin: 42%) followed by cocaine (41%) then

Declaration of interest

None.

Acknowledgements

The authors would like to thank the Ville de Paris, the Regional council of Ile-de-France, the Interministerial Mission for Combating Drugs and Addictive Behaviours of Seine-Saint-Denis (MILDECA DDCS 93) and the French Directorate-general for Health for their financial supports.

We appreciate the help of Andrew Pearson for the English grammar correction.

Conflict of interest statement

The authors certify that there is no conflict of interest with any financial organisation regarding the material

References (9)

  • R.W. Kim et al.

    Ocular manifestations of injection drug use

    Infectious Disease Clinics of North America

    (2002)
  • S.H. Ringertz et al.

    Injectional anthrax in a heroin skin-popper

    Lancet

    (2000)
  • J. Barry et al.

    Botulism in injecting drug users, Dublin, Ireland, November–December 2008

    Euro Surveillance: Bulletin Européen Sur Les Maladies Transmissibles

    (2009)
  • D.C. Des Jarlais

    Single-use needles and syringes for the prevention of HIV infection among injection drug users

    Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology: Official Publication of the International Retrovirology Association

    (1998)
There are more references available in the full text version of this article.

Cited by (28)

  • 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)

    2021, International Journal of Drug Policy
    Citation Excerpt :

    In Paris, for example, cocaine and opioids were most commonly found near areas frequented by marginalized and impoverished users, whereas synthetic cathinones were detected near neighbourhoods frequented by more affluent and socially integrated users. In a 2014 study, cocaine was the only substance detected in syringes collected from the western site (Néfau et al., 2015). Synthetic cathinones were found in 98% of the syringes collected in 2017 from the same site, indicating a new local trend, demonstrating that the current method of syringe sampling can quickly detect temporal and spatial changes and inform services that may need to address them.

  • Novel detection methods and data triangulation for novel psychoactive substances (NPS)

    2021, Novel Psychoactive Substances: Classification, Pharmacology and Toxicology
  • Analytical findings in used syringes from a syringe exchange program

    2020, International Journal of Drug Policy
    Citation Excerpt :

    Cocaine was vastly reported in Switzerland (2018) and France (2015) (Lefrançois, Augsburger, & Esseiva, 2018; Néfau et al., 2015). In Hungary (2018), cathinones was the class of substances more frequently reported, which was also present in France (2015) and Metropoles in the European Union (2019) (European Monitoring Centre for Drugs and Drug Addiction, 2019; Néfau et al., 2015; Péterfi et al., 2018). Less frequently, buprenorphine (European Monitoring Centre for Drugs and Drug Addiction, 2019; Néfau et al., 2015), amphetamines (European Monitoring Centre for Drugs and Drug Addiction, 2019; Gjerde et al., 2020; Lefrancois, Belackova, et al., 2020) and benzodiazepines (Gjerde et al., 2020) were reported.

View all citing articles on Scopus
View full text