Most recent data from the European Syringe Collection and Analysis Project Enterprise (ESCAPE): data explorer, analysis and key findings

Background and introduction

While evidence from drug treatment centres suggests that injecting drug use is declining among heroin clients in the European Union, the risk of overdose death and infectious diseases associated with this mode of administration remains high. The injection of stimulants — including cocaine and synthetic cathinones — has been linked to increased risk of HIV and hepatitis B and C virus (HBV/HCV) transmission, through increased frequency of use and sharing of injecting paraphernalia. Knowledge of what substances are being injected is important to guide prevention strategies and plan the provision of harm reduction interventions.

Page last updated: 11 September 2023

Objective

ESCAPE — the European Syringe Collection and Analysis Project Enterprise — aims to identify the range of substances being used by people who inject drugs in a sentinel network of cities in the EU and neighbouring countries and to monitor changes in patterns of use over time. It provides city-level data that can complement other information and indicators on drug consumption and potential emerging health threats in the region.

Method

The methods of the ESCAPE network are detailed in the ESCAPE generic protocol. Since 2017, study teams at the city level collect on a yearly basis a target of 150 used syringes from low-threshold harm reduction services. After appropriate extraction of their content, the samples are analysed in the participating laboratories, using either targeted or non-targeted screening methods. The primary indicator shown in the data explorer is the percentage of syringes testing positive, by drug category, by city, by year. The denominator is the number of syringes testing positive for at least one drug category. The drug categories are listed in the generic protocol. Other indicators of interest include the percentage of syringes containing 2 or more drug categories, and the most frequent combinations detected.

Explore the data

Use the filters at the top of the map to view data by year and detected substance. Click on a bubble or select a location from the City drop-down list to view details about a location and the selected drug. Note that when no data is available for a given combination of filters (substance, year, location), the button will be greyed out.

Key 2022 findings

• There is a wide diversity of substances detected in used syringes across participating cities, reflecting local markets and different sub-populations of users.
• While heroin was still the most commonly detected drug in analysed syringes in 5 out of the 12 participating cities from EMCDDA Member States, traces of stimulants (cocaine, synthetic cathinones, amphetamines) were found in a high proportion of syringes tested in all but one city (Vilnius).
• Cocaine, the availability of which has increased in Europe in recent years, was detected in >50% of syringes from Thessaloniki, Athens, Dublin and Cologne.
• Synthetic cathinones were commonly detected in Paris (81%), Budapest (34%), Helsinki (23%) and Tallinn (19%). 
• Injection of diverted opioid agonist medications, such as buprenorphine (>30 % of syringes in Helsinki, Prague and Thessaloniki) and methadone (>30 % of syringes in Dublin, Vilnius and Riga), was common in some cities. Morphine was detected in 35% of syringes from Paris. Benzodiazepines were also detected (more than 5 % of syringes in Helsinki, Dublin and Tallinn), to a lesser extent.
• Carfentanil was commonly found in syringes from Vilnius (92%) and Riga (29%). Another potent synthetic opioid, isotonitazene, was detected in 10% and 26% of syringes from Tallinn and Riga respectively. 
• Xylazine, a potent veterinary tranquilliser, was detected in 13 % of syringes from Riga, where it was found in the presence of isotonitazene, metonitazene or carfentanil.
• A third of syringes contained residues of two or more drug categories, which may indicate that people who inject drugs often inject more than one substance or that syringes are reused. The most frequent combination is a mix of a stimulant and an opioid.

Potential associated health risks

• Cocaine and synthetic cathinones injecting has been recently associated with local HIV outbreaks in Europe.
• There are multiple long-term risks linked to injecting dissolved medicine tablets, including vascular damage and bacterial infection.
• As very potent opioids, fentanyl and its derivatives, as well as  benzimidazole opioids (isotonitazene, metonitazene) can cause rapid onset of life-threatening respiratory depression leading to fatal overdoses.
• Polydrug use and the co-injection of cocaine and heroin amplifies the negative cardiovascular effects of cocaine, while cocaine can mask the sedative effects of opioids, increasing the risk of delayed overdose.
• Reusing or sharing of needles are associated with soft tissue infections and blood-borne infections.   

Main limitations

• The results are based on a sample of syringes only, and reflect local specificities of the drug markets and sub-populations of users accessing the participating harm reduction services: they are not necessarily representative of the national situation.
• The high proportion of syringes containing residues of stimulants could reflect a higher frequency of injecting among stimulant users than among non-stimulant users, rather than a higher prevalence of stimulant use than other drug use among people who inject drugs (selection bias).
• Drugs found in syringes may originate from blood drawn into the syringe during an injection, that is, from drugs consumed prior to the injection, possibly through other modes of administration (measurement bias).
• It is not possible to distinguish a syringe containing residues of multiple drugs that had been used once from a syringe that had been reused by one or several users.

Source tables

The source data behind the data explorer on this page may be found below. ESCAPE data and additional methodological information may also be found in the Syringe residues section of annual Statistical Bulletin.

Show source tables