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.

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 website's online map to view data by year and detected substance. 

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 11 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.
• 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. 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.

See also, Statistical bulletin 2023 — syringe residues