New multi-city syringe study uncovers latest patterns of injecting drug use

The latest patterns of injecting drug use in a selection of European cities are explored today in a new study from the EMCDDA. The report presents the results of an innovative project investigating the substances used by people who inject drugs, by chemically analysing the content of used syringes (1).

The findings, from the agency’s ESCAPE project, are based on two data-collection campaigns carried out in 2018 and 2019. Syringes were collected from street disposal bins (2) and at harm reduction services in eight sentinel European cities: Amsterdam (2019), Budapest (2018–19), Cologne (2018–19), Helsinki (2018–19), Lausanne (2018–19), Oslo (2019), Paris (2018–19) and Vilnius (2019).

In this new analysis, the contents of 988 (2018) and 1 330 (2019) used syringes were tested for over 120 drugs (3). Overall, people who inject drugs were seen to use a wide range of substances and the strong differences observed between cities reflect the diversity and complexity of the European drug situation.

The report highlights two injecting patterns which are a particular cause for concern, namely:

  • High prevalence of stimulant drugs in the analysed syringes (e.g. cocaine, amphetamines and synthetic cathinones). Stimulant injection can be associated with increased risk of blood-borne virus outbreaks (e.g. HIV, HCV) and requires careful monitoring.
  • Detection of the highly potent opioid carfentanil in a third of syringes from Vilnius (Lithuania), often mixed with methadone. Although the detection of fentanyl and its derivatives was rare in the other participating cities, the very high overdose risk associated with these substances calls for vigilance.

Around a third of all syringes were found to contain residues of two or more drugs, highlighting the fact that people who inject drugs often inject more than one psychoactive substance (or are re-using or sharing injecting material). The most frequent combination of drugs was a mix of a stimulant and an opioid. Benzodiazepines were often found in syringes that also contained traces of opioids.

By providing local data on patterns of injecting and substances used, the ESCAPE approach can be instrumental in informing local prevention, treatment and harm-reduction strategies. Importantly, it increases understanding of injection practices among people who are not in contact with services, as well as those already receiving interventions.

A follow-up analysis, involving 10 European sentinel cities, is currently under way. It will help to assess the impact of the COVID-19 pandemic on injecting drug use in the selected cities.

An analysis of drugs in used syringes from sentinel European cities — Results from the ESCAPE project, 2018 and 2019, EMCDDA Technical report. Available in English.