Abstract
People who inject drugs (PWID) have a high risk of premature death due to fatal overdoses. Newly emerged fentanyls, much more potent than heroin and other opioids, may increase this risk further. Therefore, precise information on injected drugs is critical to improving prevention strategies. This study aimed to analyse drug residues in used injection equipment in order to determine drug and drug combinations and compare and complement findings with self-reported information. Used syringes and needles (n=766) were collected at the supervised drug consumption facilities, the needle exchange service and two low-threshold health services for problem drug users in Oslo, Norway. The material was collected every third month from June 2019 to June 2020 and analysed for 64 substances using highly specific analytical methods (ultra-high performance liquid chromatography tandem mass spectrometry). Additionally, a street-recruited sample of PWID was interviewed from 2017 to 2019 regarding their drug injection habits (n=572). Heroin (65.5%) or amphetamines (59.8%), often in combination (30.5%), were commonly detected in drug residues. Other opioids, stimulants or benzodiazepines were rarely detected (6.1%). Fentanyl was detected in only one syringe. Heroin was the most reported drug (77.6% during the past four weeks, 48.3% daily/almost daily), followed by amphetamines (57.5% during the past four weeks, 23.1% daily or almost daily). Injection of methadone, buprenorphine and dissolved tablets was self-reported more frequently than determined in drug residue findings. Analysis of the injection equipment proved useful as a non-invasive, rapid and accurate means to obtain detailed information on injected drugs in Oslo and supplement traditional PWID survey information.
Highlights
People who inject drugs (PWID) present a 10–20 times higher mortality rate than the general population
Syringes and needles were collected in Oslo in June, September and December 2019 and in March 2020 at the city’s supervised drug consumption facilities and the distribution site for needles and syringes, which are operated by the Oslo city authorities, and at a low-threshold health service for problem drug users operated by a non-governmental organisation
No drug was found in extracts from 33 used syringes or needles
Summary
People who inject drugs (PWID) present a 10–20 times higher mortality rate than the general population. Fatal overdoses are the most common cause of premature death [1]. Causes for overdosing include a lack of accurate information regarding the type and purity of drugs bought on the illicit market, drug users overestimating their drug tolerance and a combined intake of heroin or other opioids with alcohol, benzodiazepines or stimulants. In order to design and implement prevention strategies better, improved knowledge regarding what drugs and drug combinations are being used by PWID is warranted. People who inject drugs (PWID) have a high risk of premature death due to fatal overdoses. Aims: This study aimed to analyse drug residues in used injection equipment in order to determine drug and drug combinations and compare and complement findings with selfreported information. Results: Heroin (65.5%) or amphetamines (59.8%), often in combination (30.5%), were commonly detected in drug residues. Conclusions: Analysis of the injection equipment proved useful as a non-invasive, rapid and accurate means to obtain detailed information on injected drugs in Oslo and supplement traditional PWID survey information
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