Substances detected in used syringes of injecting drug users across 7 cities in Europe in 2017 and 2018: The European Syringe Collection and Analysis Project Enterprise (ESCAPE).

BACKGROUND AND AIMS: Injecting drug use is a matter of public health concern, associated with risks of overdoses, addiction and increased risk of bloodborne viral transmissions. Self-reported data on substances injected can be inaccurate or subject to bias or drug users might be oblivious to their injected substances or adulterations. Gathering of robust analytical information on the actual composition of substances injected might provide better information about the drugs that are being used. Therefore, this study aimed to analyse the residual content of discarded syringes collected across 7 European cities, collectively called the European Syringe Collection and Analysis Project Enterprise (ESCAPE). METHODS: Used syringes were collected at street automatic injection kit dispensers or at harm-reduction services in Amsterdam, Budapest, Cologne, Glasgow, Helsinki, Lausanne and Paris. Two sampling periods were executed thus far, in 2017 and 2018. Qualitative chemical analysis of the content of used syringes was performed combining gas chromatographic (GC) and ultra(high)performance liquid chromatographic ((U)HPLC) analytical techniques with detection by mass spectrometry (MS). RESULTS: Substances detected most frequently across both campaigns were cocaine, heroin, buprenorphine, amphetamines and synthetic cathinones. In Amsterdam, Cologne, Lausanne and Glasgow heroin and cocaine were the psychoactive substances most often detected, often in conjunction with each other. Helsinki showed a high presence of buprenorphine and amphetamines. In Budapest and Paris, synthetic cathinones were frequently detected. Less synthetic cathinones and cocaine was detected in 2018, whereas buprenorphine was detected almost twice as much. Inner-city variations were found, probably reflecting the types of people who inject drugs (PWID) in different areas of the city. CONCLUSION: Overall, laboratory-confirmed local data on injected substances showed resemblance to national surveys done among PWID. However, the ESCAPE data also showed some interesting differences, showing it can be used for local interventions and complementing existing monitoring data.

Drug residues in syringes and other injecting paraphernalia in Hungary.

The appearance and spread of new psychoactive substances (NPS) is a phenomenon seen throughout Europe since 2008. Synthetic cathinones, a group of NPS, have been self-reported as the drug injected by the vast majority of people who inject drugs (PWID) in Hungary. This study aims at updating our knowledge of what exactly are the compounds injected by PWID. This multi-site study analysed residues from used injecting drug paraphernalia collected from PWID via low-threshold services and from public places in Budapest, Debrecen, Miskolc, Szeged, Békéscsaba and Pécs between March 2015 and February 2016. The paper describes the results of the chemical analysis of 2985 analytical samples created out of the 22 005 objects collected in this period. Active agents and their occurrences (compound cases) were identified using GC-MS. The study detected 161 different compounds, mostly synthetic cathinones (29%), non-psychoactive compounds (14%), amines (12%), non-psychoactive medications (12%) and other substances (32%). Of the 12 762 compound cases, 50% were cathinones, 18% substitution medications, 9% non-controlled psychoactive substances and 24% other substances. Among compound cases, the most frequent cathinones were pentedrone (21%) and α-PHP (12%). Among substitution medications, most were methadone (93%), and non-controlled psychoactive substances were caffeine (74%) and nicotine (21%). Overall, the most prevalent substances were methadone (16%), pentedrone (10%) and caffeine (7%) with considerable variation detected among participating cities. Our results are consistent with previous self-reported data showing a high prevalence of synthetic cathinone injection among PWID in Hungary. We also detected a large-scale misuse of methadone by PWID.

Diverted medications and new psychoactive substances-A chemical network analysis of discarded injecting paraphernalia in Hungary.

BACKGROUND: Until about 2010, people who inject drugs (PWIDs) injected almost exclusively heroin and amphetamines in Hungary. After 2010, self-reported studies have indicated a dominance of new psychoactive substances on the drug market for injectable drugs. METHODS: Between March 2015 and February 2016, we collected used and discarded injecting paraphernalia. We utilized chemical analysis to assess and UCINet to visualize the connections between the most prevalent main substances and their respective co-occurring additional components at 7 locations in Hungary. RESULTS: The samples (n=2977) contained a mean of 4.5 components (SD=3.1, range: 1-18); 422 contained only one component. We found that the most common main components were the diverted substitution medication methadone (32%) and cathinones: pentedrone (18%), mephedrone (13%), alpha-PHP (8%), and alpha-PEP (5%). While these main substances also occurred among the top co-occurring additional components, caffeine and benzoic acid (a preservative) also frequently co-occurred. CONCLUSION: A large number of co-occurring additional components indicate either common reuse of injecting paraphernalia or the common addition of additives or both. While caffeine may indeed be an adulterant, the high prevalence of benzoic acid may be difficult to explain. The preference of methadone despite the availability of a wide array of drugs may indicate a preference for opioids during the current heroin drought and/or a true demand for opioid substitution therapy.

Asociación entre la búsqueda de novedades y el polimorfismo Val 158Met del gen de la catecol-O-metiltransferasa en pacientes dependientes de opiáceos / Association between novelty seeking of opiate-dependent patients and the catechol-O-methyltransferase Val 158Met polymorphism

Fundamento. Los genes candidatos del sistema dopaminérgico se han descrito como elementos clave en la conformación del temperamento del ser humano. La enzima catecol-O-metiltransferasa (COMT) desempeña un papel decisivo en la inactivación de la dopamina, y recientemente, en estudios efectuados en adultos sanos, al igual que en individuos dependientes de la metaanfetamina, en el cuestionario Temperament and Character Inventory el polimorfismo de un solo nucleótido Val158Met (rs4680) del gen COMT se ha asociado a la dimensión temperamental de búsqueda de novedades (BN). Método. El objetivo del presente estudio fue examinar la asociación entre las dimensiones temperamentales del cuestionario Temperament and Character Inventory y la variación Val158Met del gen COMT en una muestra húngara de 117 pacientes dependientes de la heroína y 124 individuos de control, no dependientes. Resultados. El análisis de casos-controles no demostró diferencias significativas en las distribuciones de alelo o genotipo. Sin embargo, la estrategia dimensional reveló una asociación entre el polimorfismo Val158Met del gen COMT y la dimensión temperamental de búsqueda de novedades (p=0,01): tanto en los individuos de control como en los dependientes de opiáceos con genotipos Met/Met se demostraron puntuaciones más altas para BN comparado con aquellos con el alelo Val. Las puntuaciones obtenidas para BN también fueron significativamente más altas entre dependientes de opiáceos; sin embargo, no se detectó ninguna interacción entre el estado del grupo y el genotipo del gen COMT. Conclusión. Para pacientes dependientes de la heroína e individuos de control, con independencia de la situación del grupo, se ha demostrado la asociación del polimorfismo del gen COMT y la dimensión temperamental de búsqueda de novedades (AU)

Background. Candidate genes of the dopaminergic system have been reported as key elements in shaping human temperament. Catechol-O-methyltransferase (COMT) plays a vital role in dopamine inactivation, and the Val158Met single nucleotide polymorphism (rs4680) in its gene has been recently associated with the Novelty Seeking (NS) temperament scale of the Temperament and Character Inventory in studies of healthy adults, as well as methamphetamine abusers. Method. Our goal was to examine the association between temperament dimensions of the Temperament and Character Inventory and the COMT Val158Met variation in a Hungarian sample of 117 heroin-dependent patients and 124 nondependent controls. Results. Case-control analysis did not show any significant difference in allele or genotype distributions. However, dimensional approach revealed an association between the COMT Val158Met and NS (P=.01): both controls and opiate users with Met/Met genotypes showed higher NS scores compared to those with the Val allele. The NS scores are also significantly higher among opiate users; however, no interaction was found between group status and COMT genotype. Conclusion. Association of the COMT polymorphism and NS temperament scale has been shown for heroin-dependent patients and controls regardless of group status (AU)

[Changes in psychosocial symptoms of opiate users over six months with buprenorphine/naloxone substitution therapy]. / Buprenorphin/naloxon szubsztitúció alatt álló ópiátfüggök pszichoszociális tüneteinek változásai hathónapos terápia során.

AIMS: The main target of our research was to measure the changes in psychological symptoms (anxiety, depression, craving) of patients receiving buprenorphine-naloxone substitution treatment for six months, and the evaluation of the changes using the clients' dependency parameters (ASI). METHODS: The level of dependency was investigated using the Addicton Severity Index (ASI). The psychiatric symptoms related to Axis I and II disorders were examined using the Structured Clinical Interview for DSM-IV, SCID I and SCID II. The degree of craving was measured using the Heroin Craving Questionnaire, the assessment of the symptoms of depression using BDI and HAM-D, recorded by the medical attendant of the patient. To survey the extent of anxiety, we used STAI-S, and HAM-A. All patients receiving Suboxone therapy in Hungary between November 2007 and April 2008 were included in the study (n=80). During this time, Suboxone therapy was available in 6 locations. RESULTS: We found significant improvement in almost all observed fields of behavioural and symptomatic dimensions during the first month. The only exception was the dimension of subsistence/livelihood of ASI, the changes were only at the tendency level. During the next five months of therapy, there was no further sign of improvement or decline in the observed fields, the only exception was again the subsistence/livelihood dimension of the ASI. CONCLUSIONS: Our results indicate that buprenorphine/naloxone treatment is a promising possibility for patients in need of opiate-substitution treatment.

Association between Novelty Seeking of opiate-dependent patients and the catechol-O-methyltransferase Val(158)Met polymorphism.

BACKGROUND: Candidate genes of the dopaminergic system have been reported as key elements in shaping human temperament. Catechol-O-methyltransferase (COMT) plays a vital role in dopamine inactivation, and the Val(158)Met single nucleotide polymorphism (rs4680) in its gene has been recently associated with the Novelty Seeking (NS) temperament scale of the Temperament and Character Inventory in studies of healthy adults, as well as methamphetamine abusers. METHOD: Our goal was to examine the association between temperament dimensions of the Temperament and Character Inventory and the COMT Val(158)Met variation in a Hungarian sample of 117 heroin-dependent patients and 124 nondependent controls. RESULTS: Case-control analysis did not show any significant difference in allele or genotype distributions. However, dimensional approach revealed an association between the COMT Val(158)Met and NS (P = .01): both controls and opiate users with Met/Met genotypes showed higher NS scores compared to those with the Val allele. The NS scores are also significantly higher among opiate users; however, no interaction was found between group status and COMT genotype. CONCLUSION: Association of the COMT polymorphism and NS temperament scale has been shown for heroin-dependent patients and controls regardless of group status.

Early experience with Suboxone maintenance therapy in Hungary.

BACKGROUND: Suboxone (Buprenorphine/naloxone) is a novel drug used in opiate substitution therapy. In Hungary, it was introduced in November 2007. Suboxone is a product for sublingual administration containing the partial mu-receptor agonist buprenorphine and antagonist naloxone in a 4:1 ratio. OBJECTIVE: Objectives of our study were to monitor and evaluate the effects of Suboxone treatment. METHOD: 6 outpatient centers participated in the study, 3 from Budapest and 3 from smaller cities in Hungary. At these centers, all patients entering Suboxone maintenance therapy between November 2007 and March 2008, altogether 80 persons (55 males, 35 females, mean age = 30.2 years, SD=5.48) were included in the study sample. During the 6-month period of treatment, data were collected 4 times; when entering treatment, 1 month, 3 months, and 6 months after entering treatment. Applied measures were the Addiction Severity Index, SCID-I, SCID-II, Hamilton Depression Scale, Hamilton Anxiety Scale, STAI-S State Anxiety Inventory, Beck Depression Inventory, Heroin Craving Questionnaire, WHO Well-being Inventory, Perceived Stress Scale, ADHD retrospective questionnaire, TCI short version, and Ways of Coping questionnaire. RESULTS: Nearly fourth of the altogether 80 heroin dependent patients (18 persons, 22.5%) dropped out of treatment during the first month (the majority, 12 persons [15%] during the first week) or chose methadone substitution instead. Following this period however, dropout rate decreased and the six-month treatment period was completed by 32 patients (40%). During the first month of treatment significant positive changes were experienced in all studied psychological and behavioral dimensions that proved to be stabile throughout the studied period. CONCLUSIONS: According to the early experience with Suboxone treatment, it is a well tolerable and successfully applicable drug in the substitution therapy of opiate addicts. A critical phase seems to be the first one or two weeks of treatment. Dropout rate is high during this early period, while after a successful conversion clients presumably remain in therapy for a long period. At the beginning of administration special emphasis must be put on informing patients, especially concerning withdrawal symptoms that might be present during the first week, which highly contributes to better retention in treatment.

[The potential role of childhood ADHD in the development of heroin dependence at a young age]. / A gyermekkori figyelemhiányos hiperaktivitási zavar lehetséges szerepe a fiatalkori heroinfüggôség kialakulásában.

Several studies suggested a possible link between substance use disorder and attention deficit hyperactivity syndrome (ADHD). The ADHD Rating Scale (ADHD-RS) completed by parents is a tool for diagnosing ADHD in childhood. We adapted this questionnaire for a self-report retrospective scale to estimate the presence of childhood ADHD symptoms in adults. This retrospective questionnaire was completed by 121 heroin dependent patients and 85 age- and sex-matched healthy controls. The ADHD Rating Scale Retrospective Questionnaire is a novel tool for assessing ADHD symptoms that demonstrated high validity. Our results showed strong gender difference in the prevalence of ADHD symptoms, since male subjects obtained higher mean scores of both attention-deficit and hyperactivity scales than females in both the control and the heroin dependent population. Besides, mean score of both scales were higher in the clinical population as a higher portion of substance abusers reported symptoms of childhood ADHD than controls. These results support the hypothesis that untreated childhood ADHD could be a risk factor for developing substance use disorder.