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

The latest patterns of injecting drug use in a selection of European cities are presented today in a new analysis from the EMCDDA. The findings are from the agency’s ESCAPE project (1), which investigates the substances used by people who inject drugs (PWID) by chemically analysing the content of used syringes. In the latest ESCAPE data-collection round (2022), the contents of 1 845 used syringes were analysed via a sentinel network of harm-reduction sites in 10 EU cities, plus Oslo, Odessa and Tunis (2). The results show that the drugs being injected in Europe are highly diverse, with a total of 54 psychoactive substances identified.

The latest analysis highlights a number of injecting patterns that are cause for concern: a
large proportion of the drugs found this time were stimulants and potent synthetic opioids continue to be detected.

While heroin remained the most commonly found drug in the analysed syringes in five cities out of the 10 EU cities and Oslo, traces of stimulants (cocaine, synthetic cathinones, amphetamines) were found in a high proportion of syringes tested in all but one city (Vilnius). Cocaine was detected in over half of the syringes from Thessaloniki, Athens, Dublin and Cologne.

The potent synthetic opioid carfentanil was frequently found in syringes from Vilnius (92%) and also Riga (29%). And another synthetic opioid, isotonitazene (from the benzimidazole group), was detected in 26% and 10% of syringes from Riga and Tallinn respectively.

The data also show that a third of the syringes analysed contained residues of two or more drug categories, suggesting that people who use drugs often inject more than one substance or that syringes are re-used. The most frequent combination was a mix of a stimulant and an opioid.

The wide range of substances detected across the participating cities reflects local drug markets and sub-populations of PWID. While the findings are not necessarily representative of the national situation, they do offer useful city-level information on injecting drug use patterns that can inform local drug policymaking.

These local patterns of injecting carry specific health risks which have implications for local interventions. For example, the injecting of stimulants — including cocaine and synthetic cathinones — has recently been associated with local HIV outbreaks in Europe (see Drug-related infectious diseases – the current situation in Europe (European Drug Report 2023)). Highly potent opioids, such as fentanyl and its derivatives, as well as benzimidazole opioids (isotonitazene, metonitazene), can cause the rapid onset of life-threatening respiratory depression leading to fatal overdoses.

Knowledge of what substances are being injected is important to guide prevention strategies and plan the provision of harm reduction and treatment interventions. The ESCAPE approach can increase understanding of injection practices among people who are not in contact with services, as well as those already receiving interventions.

New interactive features — data explorer tool

A new data explorer tool, launched today, allows access to ESCAPE data from 2017 to 2022. Through an interactive map, users can explore results by year, by city and by reported drug. This interactive feature has been designed to be accessible and user-friendly and to perform better on mobile and desktop devices. In line with the EMCDDA’s commitment to open data, all of the source tables behind the tool can be easily downloaded by researchers, data journalists or anyone interested in using the data in their work.

Statistical Bulletin 2023

For the first time this year, the dataset of the ESCAPE project is available in the Statistical Bulletin 2023. Published annually, this is one of the EMCDDA’s key outputs and complements the analysis presented in the European Drug Report 2023.