In the second phase of the Syringe Analysis Programme, the HSE in partnership with Merchants Quay Ireland collected 165 used syringes from the Dublin and Midland regions during September and October 2022. The residual drugs were extracted from these syringes and the data used to compare drug trends from the two regions. The Syringe Analysis Programme is the first of its kind in Ireland, whereby community services and a laboratory collaborate to conduct analysis. This enables the HSE to identify temporal and geographical trends annually as part of their emerging drug trend monitoring.

 Main findings:

• 165 used syringes were collected from Merchants Quay Ireland in the Dublin (100 syringes) and Midlands Regions of Offaly, Longford and Laois (65 syringes) which were submitted to the HSE National Drug Treatment Centre for analysis through September – October 2022
• Analysis performed by LC-MS (Liquid Chromatography-Mass Spectrometry) for 235 different types of drugs and metabolites to identify both the contents of the syringes and the contents of the blood within the syringes
• Seven different drug classes/categories were detected in total contained within the syringes which were amphetamines, benzodiazepines, cocaine, opioids, cathinones, ketamine and other medicines
• 26 different substances and metabolites were detected in syringes (note, metabolites are not named in this report)
• A number of syringes contained a number of drugs and metabolites with as many as 15 detected in one single syringe
• Concern on representation of the drug market. As there were repeat donations of syringes by a limited pool of individuals in some collection centres in 2022, there are concerns of how representative the results are of drug market trends. The 2023 study will attempt to source syringes from a more diverse range of drug users
• Heroin remained the most common drug in syringes. Similar to the 2021 findings, heroin was the most common drug found within syringes (90.0% Dublin and 78.5% Midlands)
• Cocaine continues to be the second most common drug found in syringes. Cocaine was the second most common drug within syringes (71.0% Dublin and 50.8% Midlands), however there was a reduction in the presence of cocaine in Dublin and Midlands syringes when compared with 2021 findings (86.5% Dublin and 89.1% Midlands)
• There has been a reduction in some drugs detected. A number of substances identified in the 2021 collection were not present in the 2022 review such as methamphetamine and oxycodone
• There was a decrease in the presence of pregabalin in Dublin (24.7% in 2021 to 3.0% in 2022) and a decrease in the Midlands (34.5% in 2021 to 15.4% in 2022)
• There was a decrease in the presence of methadone detected in the syringes. Findings decreased in Dublin (61.8% in 2021 to 33.0% in 2022) and in the Midlands Region (50.9% in 2021 to16.9% in 2022). It is important to note that the presence of methadone is most likely due to the presence of blood in the syringes as opposed to a trend of injecting methadone
• An increase in flurazepan in the Midlands Region. There was an increase in the detection of the benzodiazepine flurazepam in the Midlands Region (12.7% in 2021 to 20% in 2022) which had been documented as a local injecting trend in the 2021 results
• Trends detected from blood in samples. There was an increase in the presence of MDMA in the Dublin Region (1.1% in 2021 to 7.0% in 2022) which is likely linked with the substance presence in blood contained within the syringes and not from injecting practices
• The most common ‘cutting agents’ remained similar across the two years of the study which were caffeine (84.2%) and paracetamol (81.2%). The percentage of these adulterants identified in substances was similar to the 2021 results (caffeine 83.3% and paracetamol 88.2%)