Drug analysis of residues from used syringes collected at a syringe exchange programme in Gothenburg, Sweden

Abstract

To study drug content in syringes collected from a needle and syringe exchange programme in Gothenburg, Sweden. Needle and syringe exchange programmes (NEPs) are available in many cities both in Sweden and internationally for individuals who inject drugs. Their main objective is to prevent the spread of bloodborne viruses such as hepatitis C virus and HIV via needle and syringe sharing. Knowledge of which drugs are injected by the visitors of these programmes is of great importance for health promotion and drug prevention, such as planning and design of harm reduction measures, treatment of substance use disorders, adjustment of the hospital laboratories’ range of analyses and detection of unknown NPSs. There are a few international studies of drug content in used syringes, showing that the substances injected vary greatly both over time and regarding geographical region. So far, no corresponding studies have been carried out in Sweden. This study aimed to assess drug content in disposed syringes in the NEP in Sweden's second largest city, Gothenburg. A total of 2250 syringes were collected during one week in November 2021 of which 150 were randomly selected. The syringes were rinsed with methanol, and the extract was analysed for presence of drugs using liquid chromatography coupled to high-resolution mass spectrometry. To distinguish between main drugs and impurities in syringes containing more than one drug, a dose-adjusted comparison of the concentrations in the extract was performed. Drugs were detected in 149 out of 150 analysed syringes (99%), and 6% of these contained more than one drug. Amphetamine was the most common (81%) followed by buprenorphine (7%) and heroin (6%). Other findings consisted of sedatives (alprazolam and zopiclone, in total 5%), other stimulants apart from amphetamine (MDMA and methylphenidate, in total 2%), and androgenic anabolic steroids (trenbolone and testosterone, in total 4%). In addition, low levels of cocaine, lisdexamphetamine, MDA, methamphetamine, gabapentin and pregabalin were detected. Many syringes also contained suspected adulterants such as caffeine, phenacetin, phenazone and paracetamol and natural or synthetic by-products such as acetylcodeine, noscapine and N-formylamphetamine. In Gothenburg, the main drug detected in disposed syringes was amphetamine, in contrast to previous studies in other European cities where heroin and cocaine are the most commonly injected drugs. Knowledge of drug content in syringes from needle exchange programmes is useful to adapt local harm reduction and drug treatment services. However, further studies are needed to gain a deeper insight into drug injection patterns in Sweden.