Which illicit drugs are injected in Oslo? A study based on analysis of drug residues in used injection equipment and self-reported information

Abstract

Background 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. 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 self-reported information. Methods 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). Results 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. 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.

Increases in drug overdose deaths in Norway and the United States during the COVID-19 pandemic

“…In the US, the prevalence of highly potent illicitly manufactured fentanyls increased sharply during the pandemic [ 15 ]. Fentanyls have not been commonly used by PWUD in Norway [ 16 , 17 ], but heroin of higher purity was noted during 2020 [ 5 ]. In both cases, this is likely to be an acute instance of the ‘iron law’ of prohibition and drug markets.…”

Concentrations of psychoactive substances in blood samples from non‐fatal and fatal opioid overdoses

“…Higher drug intake will produce higher concentrations than lower doses of the same drug, but there can be large inter‐individual differences due to pharmacokinetic factors such as genetic polymorphisms 21 that alter the bioavailability and metabolism. Recent studies showed that Norwegian drug abusers inject other drugs besides heroin, such as amphetamines 22,23 . The outcomes after amphetamine toxicity depend on the number of organs affected, the dose ingested, administration of any potent decongestants and patient comorbidities 24 .…”

“…Recent studies showed that Norwegian drug abusers inject other drugs besides heroin, such as amphetamines. 22,23 The outcomes after amphetamine toxicity depend on the number of organs affected, the dose ingested, administration of any potent decongestants and patient comorbidities. 24 Amphetamines might reduce the respiratory depressant effect of opioids, 25 and our study shows that identification of mechanisms by which amphetamines interfere with the probability of overdosing is needed and of great importance in overdose prevention.…”

How Do Persons Who Inject Drugs Experience Care From Nurses in Hospital Settings? A Qualitative Study

“…Injection drug use is defined as taking drugs subcutaneously, intramuscularly, or intravenously ( Gjerde et al, 2023 ). In global terms, the most common injected drugs are opiates and stimulants ( Degenhardt et al, 2017 ; European Monitoring Centre for Drugs and Drug Addiction, 2023 ; Gjerde et al, 2023 ).…”

“…Injection drug use is defined as taking drugs subcutaneously, intramuscularly, or intravenously ( Gjerde et al, 2023 ). In global terms, the most common injected drugs are opiates and stimulants ( Degenhardt et al, 2017 ; European Monitoring Centre for Drugs and Drug Addiction, 2023 ; Gjerde et al, 2023 ). In the Norwegian context, the most common injected drugs are heroin (opiate) and amphetamines (stimulants) ( Gjerde et al, 2023 ) and several studies show that over 70% of people who inject drugs are males ( Gjersing & Helle, 2021 ; Opheim et al, 2024 ).…”