How can I buy cocaine online in Oslo

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How can I buy cocaine online in Oslo

These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. The analysis of municipal wastewaters for drugs and their metabolic products to estimate community consumption is a developing field, involving scientists working in different research areas, including analytical chemistry, physiology, biochemistry, sewage engineering, spatial epidemiology and statistics, and conventional drug epidemiology. This page presents the findings from studies conducted since Data from all studies can be explored through an interactive tool, and a detailed analysis of the findings of the most recent study, in , is presented. See our wastewater analysis hub page for more resources on this topic. Please note that due to the large amount of data involved processed on this page, it may take some moments before all content appears. In this section you can explore the data from the most recent study in , as well as from previous studies. Each study reveals a picture of distinct geographical and temporal patterns of drug use across European cities. Clicking on a symbol in the graph or the map will show more detailed information for a given wastewater treatment plant. You can also select a site from the drop-down menu. Preparing the data The data explorer is designed to work with most modern browsers but if this message is still visible after 1 minute, we recommend trying again with another browser. The findings of the largest European project to date in the emerging science of wastewater analysis are presented in this section. The results provide a valuable snapshot of the drug flow through the cities involved, revealing marked geographical variations. Wastewater analysis is a rapidly developing scientific discipline with the potential for monitoring real-time data on geographical and temporal trends in illicit drug use. Originally used in the s to monitor the environmental impact of liquid household waste, the method has since been used to estimate illicit drug consumption in different cities Daughton, ; van Nuijs et al. It involves sampling a source of wastewater, such as a sewage influent to a wastewater treatment plant. This allows scientists to estimate the quantity of drugs consumed by a community by measuring the levels of illicit drugs and their metabolites excreted in urine Zuccato et al. In , a Europe-wide network Sewage analysis CORe group — Europe SCORE was established with the aim of standardising the approaches used for wastewater analysis and coordinating international studies through the establishment of a common protocol of action. The first activity of the SCORE group was a Europe-wide investigation, performed in in 19 European cities, which allowed the first ever wastewater study of regional differences in illicit drug use in Europe Thomas et al. That study included the first intercalibration exercise for the evaluation of the quality of the analytical data and allowed a comprehensive characterisation of the major uncertainties of the approach Castiglioni et al. A standard protocol and a common quality control exercise were used in all locations, which made it possible to directly compare illicit drug loads in Europe over a one-week period during 10 consecutive years van Nuijs et al. Raw hour composite samples were collected during a single week between March and May in the majority of the cities. These samples were analysed for the urinary biomarkers i. In addition, the samples were analysed for the main urinary metabolites i. The specific metabolite of heroin, 6-monoacetylmorphine, has been found to be unstable in wastewater. Consequently, the only alternative is to use morphine, although it is not a specific biomarker and can also be excreted as a result of therapeutic use. The project findings revealed distinct geographical and temporal patterns of drug use across European cities see the data explorer. The annual SCORE wastewater sampling presented here, from 88 cities, showed that, overall, the loads of the different stimulant drugs detected in wastewater in varied considerably across study locations, although all illicit drugs investigated were found in almost every city that participated. For the first time, data from outside Europe is also shown and compared against European cities. The BE loads observed in wastewater indicate that cocaine use remains highest in western and southern European cities, in particular in cities in Belgium, the Netherlands and Spain. Low levels were found in the majority of the eastern European cities, although the most recent data continues to show signs of increase. The loads of amphetamine detected in wastewater varied considerably across study locations, with the highest levels being reported in cities in the north and east of Europe, as in previous years. Amphetamine was found at much lower levels in cities in the south of Europe, although with the most recent data showing some signs of increase. The observed methamphetamine loads in the other locations were very low, although most recent data show signals of increases in central European cities. For the second time, ketamine loads are being published. The highest mass loads were found in the wastewater in cities in Belgium, France, the Netherlands, and Spain. The study highlighted differences between these cities within the same country, which may be explained in part by the different social and demographic characteristics of the cities universities, nightlife areas and age distribution of the population. Interestingly, in the majority of countries with multiple study locations, no marked differences were found when comparing large cities to smaller locations for all substances. In addition to geographical patterns, wastewater analysis can detect fluctuations in weekly patterns of illicit drug use. More than three quarters of cities show higher loads of amphetamine, BE, ketamine and MDMA in wastewater during the weekend Friday to Monday than during weekdays. Seventy-three cities have participated in at least five of the annual wastewater monitoring campaigns since This allows for time trend analysis of drug consumption based on wastewater testing. Cannabis is Europe's most commonly used illicit drug, with an estimated However, both the level of use and trends in use reported in recent national data appear heterogeneous. In wastewater, cannabis use is estimated by measuring its main metabolite, THC-COOH, which is the only suitable biomarker found so far. Although it is excreted in a low percentage and more research is still needed Causanilles et al. In , there were diverging trends with 20 cities out of 51 reporting an increase in THC-COOH loads in wastewater samples, and 15 a decrease. Low levels were found in the majority of the eastern European cities, but the most recent data continues to show signs of increases. When comparing to study locations outside the European Union, cities in Brazil, Switzerland and in the United States show similar levels of use as the cities in Europe with the highest loads. A relatively stable picture of cocaine use was observed between and in most cities. The data revealed further increases in cocaine residues in most cities when compared to data, with 49 out of 72 cities reporting an increase, while 13 cities reported no change and 10 cities reported a decrease. An overall increase is seen for all 10 cities with data for both and These 7 cities were selected owing to the availability of annual data from to Contrary to previous years, in most countries with multiple study locations, no marked differences were found when comparing large cities to smaller locations. More than three quarters of cities show higher loads of BE in wastewater during the weekend Friday to Monday than during weekdays, which may reflect a pattern of more recreational use. A recent European project on wastewater found crack cocaine residues in all 13 participating cities and for all sampling days, with the highest loads reported in Amsterdam and Antwerp. Where data is available, when comparing to study locations outside the European Union, only cities in Switzerland show similar levels of use as the cities in Europe with the highest loads, while all the other location show low levels of MDMA use. General population surveys in many countries showed that MDMA prevalence was declining from peak levels attained in the early to mids. In recent years, however, the picture has remained mixed with no clear trends. Where prevalence is high, this may reflect MDMA no longer being a niche or subcultural drug limited to dance clubs and parties, but now being used by a broader range of young people in mainstream nightlife settings, including bars and house parties. Looking at longer-term trends in wastewater analysis, in most cases the loads increased between , and have fluctuated after this. In , possibly due to the fact that in the majority of countries nightlife was largely closed for long periods, almost half of the cities 24 of 49 reported a decrease with 18 reporting an increase. In , 38 out of 58 cities, reported a decrease. In , 28 out of 62 cities reported an increase and 27 a decrease. Of the 69 cities that have data on MDMA residues in municipal wastewater for and , 42 reported an increase mostly in northern Europe , 11 a stable situation and 16 a decrease mostly in cities in southern and central Europe. Of the 9 cities with data for both and , 9 had higher MDMA loads in than in As for cocaine, and contrary to previous years, in most countries with multiple study locations, no marked differences were found when comparing large cities to smaller locations. More than three quarters of cities showed higher loads of MDMA in wastewater during the weekend Friday to Monday than during weekdays, reflecting the predominant use of ecstasy in recreational settings. Amphetamine and methamphetamine, two closely related stimulants, are both consumed in Europe, although amphetamine is much more commonly used. Methamphetamine consumption has historically been restricted to Czechia and, more recently, Slovakia, although recent years have seen increases in use in other countries. The loads of amphetamine detected in wastewater varied considerably across study locations, with the highest levels reported in cities in the north and east of Europe. Amphetamine was found at much lower levels in cities in the south of Europe, although the most recent data shows some signs of increase. To examine the data, use the data explorer , also available on this page. Underlying data is available in source data. The observed methamphetamine loads in the other locations were very low to negligible, although most recent data show signals of increases in central European cities. Overall, the data related to amphetamine and methamphetamine from the 11 monitoring campaigns showed no major changes in the general patterns of use observed, although since increases were observed in several cities for both substances in regions where use has traditionally been low to negligible. Of the 65 cities with data on amphetamine residues in municipal wastewater for and , 26 reported an increase, 13 a stable situation and 26 a decrease. Of the 67 cities that have data on methamphetamine residues in municipal wastewater for and , 15 reported an increase, 13 a stable situation and 39 a decrease. In , methamphetamine use was found to be distributed more evenly over the whole week than in previous years, possibly reflecting the use of these drugs being associated with more regular consumption by a cohort of high-risk users. For amphetamine, more than three quarters of cities show higher loads during the weekend Friday to Monday than during weekdays. In , low levels of ketamine residues in municipal wastewater were reported by 49 cities, although with signals of increases. Of the 22 cities that have data on ketamine residues for and , 12 reported an increase, 8 a stable situation and 2 a decrease. The highest mass loads were detected in cities in Belgium, France, the Netherlands, and Spain. More than three quarters of cities showed higher loads of ketamine in wastewater during the weekend Friday to Monday than during weekdays, reflecting the predominant use of ketamine in recreational settings. Wastewater analysis offers an interesting complementary data source for monitoring the quantities of illicit drugs used at the population level, but it cannot provide information on prevalence and frequency of use, main classes of users and purity of the drugs. Additional challenges arise from uncertainties associated with the behaviour of the selected biomarkers in the sewer, different back-calculation methods and different approaches to estimate the size of the population being tested Castiglioni et al. The caveats in selecting the analytical targets for heroin, for example, make monitoring this drug in wastewater more complicated compared to other substances Been et al. Also, the purity of street products fluctuates unpredictably over time and in different locations. Furthermore, translating the total consumed amounts into the corresponding number of average doses is complicated, as drugs can be taken by different routes and in amounts that vary widely, and purity levels fluctuate Zuccato et al. Efforts are being made to enhance wastewater monitoring approaches. For example, work has been undertaken on overcoming a major source of uncertainty related to estimating the number of people present in a sewer catchment at the time of sample collection. This involved using data from mobile devices to better estimate the dynamic population size for wastewater-based epidemiology Thomas et al. Wastewater-based epidemiology has established itself as an important tool for monitoring illicit drug use and future directions for wastewater research have been explored EMCDDA, First, wastewater analysis has been proposed as a tool to address some of the challenges related to the dynamic new psychoactive substances NPS market. This includes the large number of individual NPS, the relatively low prevalence of use and the fact that many of the users are actually unaware of exactly which substances they are using. A technique has been established to identify NPS that involves the collection and analysis of pooled urine from stand-alone portable urinals from nightclubs, city centres and music festivals, thereby providing timely data on exactly which NPS are currently in use at a particular location Archer et al. The project applied innovative analytical chemical and epidemiological methods and a robust risk-assessment procedure to improve the identification of NPS, to assess risks, and to estimate the extent and patterns of use in specific groups e. Second, in addition to estimating illicit drug use, wastewater-based epidemiology has been successfully applied in recent years to providing detailed information on the use and misuse of alcohol Boogaerts et al. Furthermore, wastewater analysis can potentially provide information on health and illness indicators within a community Kasprzyk-Hordern et al. Third, the potential for wastewater-based epidemiology to be used as an outcome measurement tool, in particular in the evaluation of the effectiveness of interventions that target drug supply e. Close collaboration between the different stakeholders involved, including epidemiologists, wastewater experts and legal authorities, is highly recommended in order to start examining these potential wastewater-based epidemiology applications EMCDDA, High levels of MDMA were recorded during the whole monitoring period in one city in the Netherlands, suggesting continuous discharges of unconsumed MDMA from sources within the wastewater catchment area, indicating drug production was taking place in this region. Fourth, by back-calculating the daily sewer loads of target residues, wastewater analysis can provide total consumption estimates, and specific efforts are now being directed towards finding the best procedures for estimating annual averages. It is envisaged that findings from wastewater analysis can help to further develop work in this area. Finally, new methods such as enantiomeric profiling have been developed to determine if mass loads of drugs in wastewater originated from consumption or from the disposal of unused drugs or production waste. It is now important to assess the possible utility of wastewater analysis to report on drug supply dynamics, including synthetic drug production Emke et al. For example, recent malfunctioning of a small wastewater treatment plant in the Netherlands was caused by direct discharges in the sewage system of chemical waste from a drug production site. Further analysis revealed the actual synthesis process used to manufacture the corresponding drugs. The study confirmed that the chemical waste from the illegal manufacturing of stimulants will result in a specific chemical fingerprint that can be tracked in wastewater and used for forensic purposes. Such profiles can be used to identify drug production or synthesis waste disposal in the wastewater catchment area Emke et al. Wastewater analysis has demonstrated its potential as a useful complement to established monitoring tools in the drugs area. It has some clear advantages over other approaches as it is not subject to response and non-response bias and can better identify the true spectrum of drugs being consumed, as users are often unaware of the actual mix of substances they take. This tool also has the potential to provide timely information in short timeframes on geographical and temporal trends. In order to check the quality and accuracy of data, further comparisons between wastewater analysis and data obtained through other indicators are needed. As a method, wastewater analysis has moved from being an experimental technique to being a new method in the epidemiological toolkit. Its rapid ability to detect new trends can help target public health programmes and policy initiatives at specific groups of people and the different drugs they are using. In addition to the glossary below, see also Frequently-asked questions on wastewater-based epidemiology and drugs. Traces of drugs consumed will end up in the sewer network either unchanged or as a mixture of metabolites. Metabolites, the end products of metabolism, are the substances produced when the body breaks drugs down. Wastewater analysis is based on the fact that we excrete traces in our urine of almost everything we consume, including illicit drugs. The target drug residue is what remains in the wastewater after excretion and is used to quantify the consumption of illicit drugs in the population. Analytical chemists look for urinary biomarkers measurable characteristics to calculate population drug use in wastewater samples, which can be the parent drug i. Enantiomeric profiling is an analytical chemistry technique used to determine if studied drugs in wastewater originate from consumption or direct disposal eq. It is based on the fact that chiral molecules if only one chiral centre is present exist as two enantiomers opposite forms which are non-superimposable mirror images of each other. As the enantiomeric ratio will change after human metabolism, the enantiomeric fraction can be used to determine whether the studied drugs in wastewater originate from consumption. In order to estimate levels of drug use from wastewater, researchers attempt first to identify and quantify drug residues, and then to back-calculate the amount of the illicit drugs used by the population served by the sewage treatment plants Castiglioni et al. This approach involves several steps see figure. Initially, composite samples of untreated wastewater are collected from the sewers in a defined geographical area. The samples are then analysed to determine the concentrations of the target drug residues. A correction factor for each drug is taken into account as part of the calculation. In a last step, the result is divided by the population served by the wastewater treatment plant, which shows the amount of a substance consumed per day per 1 inhabitants. Population estimates can be calculated using different biological parameters, census data, number of house connections, or the design capacity, but the overall variability of different estimates is generally very high. Although primarily used to study trends in illicit drug consumption in the general population, wastewater analysis has also been applied to small communities, including workplaces, schools Zuccato et al. Using this method in small communities can involve ethical risks Prichard et al. In the SCORE group published ethical guidelines for wastewater-based epidemiology and related fields Prichard et al. The objective of these guidelines is to outline the main potential ethical risks for wastewater research and to propose strategies to mitigate those risks. Archer, J. Bade, R. Baz-Lomba, J. Been, F. Bijlsma, L. Boogaerts, T. Castiglioni, S. Causanilles, A. Daughton, C. Emke, E. Hall, W. Kasprzyk-Hordern, B. Kinyua, J. Krizman-Matasic, I. Lai, F. Mardal, M. Mastroianni, N. Prichard, J. Reid, M. Senta, I. Thomaidis, N. Thomas, K. Yang, Z. Zuccato, E. Show source tables. You can download the source data for drugs in wastewater in cities from our our data catalogue or use the links below to directly download the CSV files. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. Breadcrumb Home Publications Wastewater analysis and drugs — a European multi-city study. On this page. Wastewater analysis and drugs — a European multi-city study. PDF is being prepared. This make take up to a minute. Once the PDF is ready it will appear in this tab. Sorry, the download of the PDF failed. Introduction The analysis of municipal wastewaters for drugs and their metabolic products to estimate community consumption is a developing field, involving scientists working in different research areas, including analytical chemistry, physiology, biochemistry, sewage engineering, spatial epidemiology and statistics, and conventional drug epidemiology. Page last updated: 20 March World view Europe South America Oceania. Complete source data for all wastewater measurments, all cities, all years CSV format Wastewater treatment centres information table CSV format Changes in the mean weekly measurements by targeted substance, from wastewater analyses in selected European cities between and CSV format Aggregated trends in cocaine residues in 7 EU cities, to CSV format.

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How can I buy cocaine online in Oslo

Official websites use. Share sensitive information only on official, secure websites. E-mail: rmhage ous-hf. This article is distributed under the terms of the Creative Commons Attribution 4. 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. 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. The material was collected every third month from June to June and analysed for 64 substances using highly specific analytical methods ultra—high performance liquid chromatography tandem mass spectrometry. Heroin Other opioids, stimulants or benzodiazepines were rarely detected 6. Fentanyl was detected in only one syringe. Heroin was the most reported drug Injection of methadone, buprenorphine and dissolved tablets was self-reported more frequently than determined in drug residue findings. 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. Keywords: Illicit drugs, people who inject drugs, injecting paraphernalia, used syringes, needle exchange, chemical analysis, liquid chromatography—mass spectrometry, survey. People who inject drugs PWID present a 10—20 times higher mortality rate than the general population. Fatal overdoses are the most common cause of premature death \[ 1 \]. Causes for overdosing include a lack of accurate information regarding the type and purity of drugs bought on the illicit market, drug users overestimating their drug tolerance and a combined intake of heroin or other opioids with alcohol, benzodiazepines or stimulants. In Norway, overdose deaths account for a higher proportion of deaths among 15—44 years old Therefore, reducing the number of drug-induced deaths has long been high on the political agenda. In order to design and implement prevention strategies better, improved knowledge regarding what drugs and drug combinations are being used by PWID is warranted. Recent developments have further expedited the need for comprehensive knowledge \[ 3 \]. In addition to the injection of traditional opioids such as heroin and morphine, increased availability of synthetic opioids, such as fentanyl and fentanyl analogues, on the illicit drug market has contributed to a dramatic increase in the number of overdose deaths in the USA, Canada, Sweden and other European states \[ 4 \]. Fentanyl is a potent analgesic drug used clinically. It is 50— times more potent than morphine. For acute medical treatment, fentanyl is administered by injection or infusion. On the illegal market, fentanyl may be sold as a powder, dropped onto blotter paper and added to eye droppers and nasal sprays \[ 5 \]. Fentanyls are also mixed with other drugs sold illegally. For example, heroin may be laced with fentanyls \[ 6 \], and counterfeit tablets labelled Xanax containing fentanyl instead of alprazolam have been available on the illicit drug market in several countries \[ 7 \]. Some fentanyl analogues are extremely potent. For example, carfentanil is 10, times more potent than morphine, and a small grain 0. A high number of carfentanil seizures have been reported in the Baltic states i. Estonia, Latvia and Lithuania \[ 9 \]. These countries are crucial for Scandinavian trade, tourism and employment immigration, with close ties indicating the potential for the illegal entry of fentanyls from these countries. Carfentanil and other potent fentanyls have already caused overdose deaths in Scandinavia \[ 10 , 11 \]. Increased knowledge of the extent and types of fentanyls present on the illegal market, whether sold as such or disguised as other drugs, could reduce overdose risks by PWID when informed, and analysis of drug residues in used syringes and needles can be one strategy to close the information gap. Typically, information on drug use among PWIDs has been based on interviews with convenience samples of users. However, people might under-report or may not be aware of the actual content of purchased drugs. One example is para-methoxymethamphetamine PMMA sold as amphetamine or Ecstasy 3,4-metylendioksymetamphetamine in Norway in Approximately 30 people died from PMMA poisoning in a short period \[ 12 \]. In addition to the risk of premature death, drug injections may cause other harmful health effects. Injections carry the risk of abscesses and blood-borne diseases, such as hepatitis C and human immunodeficiency virus. Interviews with PWID further indicate that injection of dissolved tablets is common, either alone or combined with opioids or stimulants, to increase the desired drug effect \[ 13 \]. Tablets often contain poorly soluble ingredients. Injecting tablet particles may cause serious harm, including infections and obstruction of small blood vessels, which in turn may lead to acute limb ischaemia inadequate blood flow and, in worst cases, amputations. In addition, accumulation in lung tissue has been reported to form granulomas and non-functioning scar tissue or fibrosis \[ 14 , 15 \]. Improved information on tablet injection will help design better programmes to reduce health risks among PWIDs. Norway has one of the highest rates of drug-induced deaths in Europe. The average number of deaths induced by psychoactive drug use was per year during — \[ 16 \], which corresponds to approximately 75 per million population aged 15—64 years. The average overdose mortality rate in Europe in was approximately 23 deaths per million people aged 15—64 years \[ 3 \]. However, the numbers are not necessarily comparable because countries may vary in the extent to which they are able to identify drug-induced deaths correctly and in their definitions of these deaths. Four out of five overdose deaths in Norway were caused by opioids, very often by means of intravenous injection. Autopsies have revealed that most often, the concomitant use of alcohol or benzodiazepines is involved, in addition to opioids \[ 17 \]. The elevated prevalence of drug-induced deaths emphasises the particular importance of improved and timely information, which would also afford complementary data to self-reports. Analysis of drug residues in used syringes is a relatively new approach for obtaining objective data on injected drugs. Data collection is non-invasive, and the method has the potential to capture changes in the illicit market for injectable drugs and provide an opportunity to identify new psychoactive substances. The methodology has previously been used in some European countries, the USA and Australia \[ 18 — 25 \]. Our study adds to the current literature by a presenting analytical results from drug residues collected in Oslo; b testing for 64 substances, including 24 fentanyls and six other opioids and c not confining analyses to drug residues from used syringe barrels only but also from used needles; and d comparing drug test results to self-reported information from PWID. Therefore, samples were collected at the syringe distribution site and two low-threshold health services. A minimum of 50 syringes or needles were collected from each location. The collection of the used syringe barrels was prioritised, if available, because the concentrations of residual drugs are higher in used barrels than in the needles and therefore easier to detect and identify. In previous studies assessing drug residues, only remains found in the used syringe barrels were analysed \[ 18 — 25 \]. In Norway, it is substantially more challenging to find used syringe barrels than needles for analysis, as syringes in their entirety barrels and needles are returned to distribution points to a lesser extent. Conversely, used needles are often returned. Specially designed small disposal boxes containing up to 23 needles are used for this purpose see Supplemental Figure S1. Each collected syringe barrel and one needle from each needle disposal box were selected for drug testing. Trace analysis for 64 drug types was performed using ultra—high performance liquid chromatography tandem mass spectrometric detection, a sensitive and specific analytical technique. The details are described in the Supplemental Material. Survey data were obtained from interviews with PWID conducted outside the main needle exchange programme NEP facility in Oslo city centre in , and The interviews were part of an ongoing study that began in Participants were approached after they had collected the injecting equipment from the NEP facility. Each interview was conducted out of earshot from others and took approximately 15 minutes to complete. Among those who declined to participate, the most common reasons for refusal were that they did not have sufficient time or were experiencing withdrawal symptoms. No names or other personal information were collected. Participants were asked what type of drugs and their frequency of injection in the four weeks leading up to the interview. Detailed information regarding the survey has been previously published \[ 26 \]. The syringes and needles used were randomly collected from the disposal bins and could not be linked to individuals. The data protection official at Oslo University Hospital was informed regarding the collection and analysis of used syringes and needles. A total of syringes or needles were selected for analysis. It was impossible to analyse 16 of the syringes and needles, either because the needles were clogged or because the extracts contained too much blood that would contaminate the instrument. No drug was found in extracts from 33 used syringes or needles. The total drug findings are presented in Table I. Heroin was detected in Other drugs were detected in 6. Comparison of findings in used syringes — with self-reported drug injections — Drug combinations are presented in Table II. The most common combination was heroin and amphetamines, sometimes combined with additional drugs We did not detect any regular ratio between amphetamines and heroin. The second most common combination was heroin and a benzodiazepine clonazepam or alprazolam , sometimes combined with additional drugs 2. Self-reported information on drug injections performed during the past four weeks prior to the interview was obtained from PWID. Data were compared with drug findings in the injection equipment used, elaborated in Table I. The most commonly reported drug injected was heroin, followed by amphetamine. Approximately half reported daily or almost daily injections of heroin, whereas a quarter reported daily or almost daily injections of amphetamine. Few participants reported injections of morphine, cocaine or other drugs. The analysis of 64 substances, including 24 fentanyls, in drug residues detected that heroin and amphetamines were the most commonly injected drugs in Oslo. Few drug users had injected other opioids, other stimulants or benzodiazepines. Fentanyl was detected once, while other highly toxic fentanyls were not detected. Almost a third of the samples indicated combined use of amphetamines and heroin. This is worrying because such combinations may increase the risk of fatal overdose. By combining those drugs, users want to experience an intense rush while hoping to reduce some negative effects of both substances. It might, however, be difficult for the user to tell when an overdose point is approaching. Also, amphetamines may cause arrhythmias, heart failure or stroke. To date, surveys among PWID have not on a regular basis asked about injection of drug mixtures. This should be considered in future studies. Combining heroin with stimulants is also common in other parts of the world, but more often with cocaine than amphetamines \[ 27 \]. In Oslo, cocaine was rarely detected in used syringes. The users seemingly preferred injecting amphetamines as stimulants. This finding could be explained by the fact that amphetamines are cheaper and demonstrate longer-lasting effects. Heroin was also the most commonly reported drug, followed by amphetamines. Despite distinct methodological approaches and a lack of complete overlap in time points and data-collection locations, the concurrence shown in Table I suggests that both self-report and analysis of used injection paraphernalia reflect the same pattern of drug injection in Oslo. Analysis of drug residues complemented survey information by revealing that almost a third had injected mixtures of heroin with amphetamines. Autopsy results from drug-induced deaths confirm that heroin is often combined with other drugs. This may suggest that people who combine heroin with other drugs often seem to administer amphetamines by injection and benzodiazepines by oral administration. Drug residue analysis also complemented the self-reported information regarding the injection of fentanyls. Drug users were not explicitly asked about these opioids and might not have complete information regarding the injected drugs. Accordingly, analysis of drug residues could provide timely information to users and health authorities regarding the local availability of these high-risk drugs. In the present study, fentanyl was detected in one syringe only, in combination with heroin. Heroin is sometimes laced with fentanyl to enhance its potency. However, we lack information to confirm whether this was the reason fentanyl was detected. No other fentanyls were detected. Our findings thus suggest that injecting fentanyl and fentanyl derivatives is a rare event among PWID in Norway. Importantly, however, fentanyls may be administered by alternate routes. Therefore, analysis of fentanyls in used syringes may not reflect the total incidence of use among problem drug users. Our two data sources regarding drug injection also revealed some interesting differences. The self-reported rates of daily or almost daily injections of morphine, methadone, buprenorphine and crushed tablets were higher than those in used syringes or needles. Analysis of residual drugs found that only alprazolam and clonazepam tablets were crushed, dissolved and injected, corroborating with information in drug user forums on the Internet. These substances are more potent than diazepam and oxazepam. Injecting the most potent benzodiazepines reduces the amount of particulate matter injected, thus reducing the risk of tissue damage. In addition, self-reported data on the types of drugs injected at the supervised drug consumption facilities indicate that benzodiazepines were rarely injected. From April to December , only 2. PWID must be encouraged to take tablets orally instead of intravenously because of the dangers associated with injecting crushed and dissolved tablets. The needles proved valuable for the analytical testing of drug residues. A sufficiently large amount of drug residues could be detected in most cases. No drug traces were found in the 33 syringes or needles used. The most likely reason is that the equipment had been rinsed after use, had not been used or was used to inject substances that were not included in the analytical programme, such as anabolic steroids, other psychoactive substances seldom used by PWID in Oslo or only adulterants. Findings from other drug residue studies highlight the need to conduct local studies to determine relevant data regarding drug usage for designing targeted prevention programmes. Accumulating evidence has revealed considerably different drug preferences among PWID across examined cities: injections of heroin and cocaine were most common in Glasgow UK , Cologne Germany , Lausanne Switzerland and New York USA ; injections of heroin and cathinones were most common in Budapest Hungary and Paris France ; injection of buprenorphine and amphetamines were most common in Helsinki Finland ; injection of methadone and carfentanil were most common in Vilnius Lithuania ; whereas in Sydney, heroin and amphetamines were most commonly injected, as observed in Oslo \[ 21 — 24 \]. Differences between cities may be explained by factors such as drug availability, prices and drug use in cultures in the PWID community, and these need to be reflected in locally adjusted harm reduction and prevention measures. The syringes and needles used in this study were selected from four sites in Oslo during — Still, the selection may not be representative for all injections of illegal drugs by PWID during the study period. Users who do not visit these collection sites may have other drug preferences, and people may inject different drugs when using the supervised injection room than elsewhere. Some findings of drug traces might be due to contamination by reuse of syringes, by contact with other used syringes or needles in the containers for used paraphernalia or by the presence of drugs in residual blood in the syringes or needles. The analytical test results represent only the drugs administered by injection. Most users may have administered other drugs orally. Data on self-reported drug injections were collected over a longer time frame — close to the NEP facility and the supervised drug consumption facilities and may therefore not represent the same cohorts as those who delivered used syringes. Also, drug use surveys may not provide accurate data because of recall bias, under-reporting or incorrect information about purchased drugs. The users did not report the injection of drug mixtures or only reported the main substance. Analysis of drug residues in used syringes and needles is a non-invasive, rapid and accurate means to obtain detailed and timely information regarding the types of substances injected and their relative frequency of use. Thus, they could supplement traditional survey information. The vast majority of PWID in Oslo seems to inject heroin or amphetamines, often in combination, whereas other opioids including fentanyls , other stimulants or benzodiazepines may be injected more rarely. Supplemental material, sj-docxsjp Supplemental material: Supplemental material for this article is available online. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Scand J Public Health. Which illicit drugs are injected in Oslo? Find articles by Hallvard Gjerde. Find articles by Anne Line Bretteville-Jensen. Find articles by Lihn Bache-Andreassen. Find articles by Kristin Hanoa. Find articles by Gerd-Wenche Brochmann. Find articles by Vigdis Vindenes. Open in a new tab. A study based on analysis of drug residues in used injection equipment and self-reported information. Click here for additional data file. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Tablets a. MDMA b. Heroin, amphetamines and other drugs a , b , c. Heroin and benzodiazepine b. Heroin and other opioids a. Amphetamines and other opioids a. Amphetamines, other opioids a and benzodiazepines b. Amphetamines and other stimulants c.

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