In short
The ongoing opioid crisis in the United States raises concern about a possible shift of the issue towards Europe. Concomitantly, severe intoxications and deaths in Canada and Australia, among others, have been attributed to fentanyl-laced heroin. As heroin remains the most frequently consumed opioid in Europe, information on composition of retail heroin is of high value. Presence of adulterants, such as fentanyl, could pose a risk to public health. Knowledge on drug purity has proven to be valuable and should be investigated regularly. Current statistics, despite being valuable, do not provide a comprehensive and representative view of retail heroin. This project aims to provide up-to-date information on retail level heroin in Belgium.
Project description
The illegal nature of drug use means that injecting and high-risk opioid users are a hidden population that cannot be studied using standardised sampling and estimation methods. This project is a cross-sectional study, where we use a mixed method design in order to reach the objectives of the project. These include:
- to determine drug purity of retail heroin in Belgium
- to gather baseline data on the pharmacological properties of retail heroin in Belgium
- epidemiology on people who use heroin
We collected data via people who use drugs (PWUD) that visited one of the three participating grassroots organisations (Transit Brussels, MSOC Ghent or Spuitenruil Antwerp) between February and June 2023. Collaborations with these organisations, who are in direct contact with drug users and aim for building strong relationships with the persons, ensures face-to-face contact which improves data quality as well.
The study consists of two parts:
- A quantitative and qualitative analysis by gas chromatography combined with mass spectrometry and ultra high performance liquid chromatography of retail heroin samples to provide data on the drug purity of heroin. Next to the purity of the samples, pharmacological properties, such as the presence of adulterants were determined.
- A questionnaire elaborating on sociodemographic factors, purchase method and price, current heroin and poly-drug use and treatment. We also asked the participants about details of purchase and experienced unforeseen effects after consuming heroin.
Information on retail heroin has impact on several levels:
- If possible risks for public health are linked to retail heroin, policy needs to be adapted accordingly.
- Input on the substances circulating on the retail drug market, provides valuable information to adapt toxicological analysis and increase quality within toxicological laboratories.
- The opportunity to inform hospitals on circulating substances, supports in preparedness towards intoxicated patients presenting at emergency rooms.
- Having timely information on the Belgian drug market, more specifically heroin, improves daily operations of harm reduction services to support PWUD.
Results
Preliminary data (n=104) show that the average purity of heroin for the three participating cities lies between 11.66% and 14.10%. Impurities detected include, but are not limited to, codeine, morphine and 6-monoacetylmorphine. Few adulterants were found, including acetaminophen, diacetamate, caffeine, methacetine, cocaine, norcocaine and bromazepam. None of the samples showed the presence of fentanyl. Furthermore, only 6.7% of participants pointed out having experienced mild unexpected effects, including nausea, enhanced effect, itchiness and local irritation. Triangulation of the finished data will zoom in on relevant parameters, such as the relation between purity and price and inter-city differences in the composition of heroin.
