USED SYRINGES ANALYSIS : A NEW APPROACH TO BETTER KNOW THE INJECTED DRUG USES AND USERS
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1 USED SYRINGES ANALYSIS : A NEW APPROACH TO BETTER KNOW THE INJECTED DRUG USES AND USERS Thomas NEFAU a, Catherine DUPLESSY-GARSON a, Jean-Louis BARA a, Sara KAROLAK b, Vincent THIBAULT c,yves LEVI b a SAFE Association b Univ. Paris Sud/UMR CNRS 8079, Univ. Paris Sud c Virology Laboratory, Hôpital Pitié-Salpêtrière, Univ. Pierre et Marie Curie
2 Introduction problem drug users of them are low threshold structures clients 1 Those who answer to surveys o Declarative bias What about the hidden users? Little is known about the substances injected by drug users 1 OFDT, Drugs, key data. 6th edition, Saint-Denis, OFDT, 2015, 8 p. 2
3 CHEMICAL ANALYSIS Univ. Paris Sud/UMR CNRS 8079, Public Health & Environment Group
4 Substances illicit drugs & NPS 4
5 Substances misused medical drugs 5
6 Site locations Cergy Saint-Denis Aubervilliers Aulnays/s-Bois Colombes Bichat hospital Reims Mantes-La-Jolie Gare St-Lazare Gare du Nord Les Halles Colonel Fabien Chaumont Kennedy Bastille Javel Gare Montparnasse Chevaleret Gare de Lyon Melun Montargis 6
7 Samples preparation for chemical analysis used syringe methanol methanol + residues Recovering drug residues from used syringe 7
8 Samples preparation for chemical analysis clean syringe used syringe methanol methanol + residues recovering Recovering drug drug residues from from used used syringe sample filtration 7
9 Analytical method HPLC Tandem mass spectrometry TO SUM UP 4 sampling campaigns (2010, 2012, 2013, 2014) 32 sites 5562 samples 8
10 Results - example Kennedy station Date 25/03/2014 Syringes analyzed 30 Syringes with blood 6 Syringes with broken needle 0 Syringes with graduations erased 3 Syringes with particular signs 0 Substances Syringes 0 3 Composition 1 4-MEC 1 4 x-mmc 1 4-MEC / COC 7 4-MEC / x-mmc 1 4-MEC / MePHEN 1 4-MEC / MOR 2 1 x-mmc / COC 1 x-mmc / MePHEN 1 x-mmc / METHOX 1 x-mmc / METHYLONE 1 x-mmc / MePHEN / METHYLONE MEC / x-mmc / COC 2 4-MEC / x-mmc / METHOX 1 4-MEC / x-mmc / COC / METHOX 1 4-MEC / x-mmc / COC / MOR 4 4-MEC / x-mmc / MePHEN / 1 METHOX 4-MEC / x-mmc / METHOX / 5 1 METHYLONE / MOR 9
11 Results Aubervilliers Aulnay s/s-bois Reims % Kennedy Gare St-Lazare Gare du Nord Chaumont Melun Mantes-La-Jolie Javel Gare Montparnasse Gare de Lyon Montargis 11
12 Results
13 Results - example Kennedy station Date 25/03/2014 Syringes analyzed 30 Syringes with blood 6 Syringes with broken needle 0 Syringes with graduations erased 3 Syringes with particular signs 0 Substances Syringes Composition MEC 1 5 x-mmc 4-MEC / COC 4-MEC / x-mmc 4-MEC / MePHEN 4-MEC / MOR 2 14 x-mmc / COC x-mmc / MePHEN x-mmc / METHOX x-mmc / METHYLONE x-mmc / MePHEN / METHYLONE MEC / x-mmc / COC 4-MEC / x-mmc / METHOX 4-MEC / x-mmc / COC / METHOX 4-MEC / x-mmc / COC / MOR MEC / x-mmc / MePHEN / METHOX 4-MEC / x-mmc / METHOX / 5 1 METHYLONE / MOR 12
14 Results - reuse 13
15 Results - trends Aulnay s/s-bois Kennedy Javel 14
16 Aulnay s/s-bois Kennedy Javel Results - trends
17 Aulnay s/s-bois Kennedy Javel Results - trends
18 Aulnay s/s-bois Kennedy Javel Results - trends
19 VIROLOGICAL ANALYSIS Virology Laboratory, Hôpital Pitié-Salpêtrière, Assistance Publique, and Pierre et Marie Curie University
20 Samples preparation for virological analysis used syringe Viral RNA was extracted using the Abbott M2000sp (sample preparation) system. The purified RNA was analyzed using consecutively by: Real time HIV reagents for HIV, Real time HCV reagents for HCV RNA The limit of detection for HIV was 50 copies/ml and for HCV 12 IU/mL. Sterilized water Liquid was stored frozen at -20 C until further use. HBsAg was detected on the residual volume of collected rinsing water using the Abbott Architect system (HBsAg reagent). The lower limit of detection for HBsAg was 0.05 IU/mL. 16
21 Results - virology In % Budapest street (n=75) Gare de Lyon (n=70) Mantes-La-Jolie (n=71) Javel station (n=60) HCV (RNA) HIV (Ag-Ab) HBV (AgHBs) HBV seems to be a minor concern 17
22 Results - virology In % Budapest street (n=75) Gare de Lyon (n=70) Mantes-La-Jolie (n=71) Javel station (n=60) HCV (RNA) HIV (Ag-Ab) HBV (AgHBs) HIV was observed in a very small proportion of analyzed syringes 17
23 Results - virology In % Budapest street (n=75) Gare de Lyon (n=70) Mantes-La-Jolie (n=71) Javel station (n=60) HCV (RNA) HIV (Ag-Ab) HBV (AgHBs) HCV seems to be more problematic: - contaminated syringes were found in all sites - not a surprise given the estimated prevalence The site with the highest number of contaminated syringes is located far away from any harm reduction facilities. 17
24 Conclusion Limits: Different ways to get rid of syringes (collect in structure, pharmacy ) A person can throw away 20 syringes while 10 people can throw away 2 each The syringes may have been disposed of several weeks after use Degradation of molecules and viruses New tools to assess the drug consumptions and to estimate a HIV/HCV prevalence of a particular population of drug users Objective observations Analytical chemistry Virology tests 18
25 Thank you for your attention Drug analysis of residual content of used syringes: A new approach for improving knowledge of injected drugs and drug user practices. Int J Drug Policy. Volume 26, Issue 4, April 2015, Pages doi: /j.drugpo Hepatitis C transmission in injection drug users: could swabs be the main culprit? J Infect Dis Dec 15;204(12): thomas.nefau@ofdt.fr
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