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Peer-reviewedCC BY-NC-ND 4.0Drug Testing and Analysis

Monitoring Injected Drug Use in Greece Through Syringe Residue Analysis: A Multicity Study Within the ESCAPE Network

  • Christina Matiaki1
  • Anastasios Trakakis2
  • Athanasios Theocharis2
  • Chara Parpala1
  • Chara Kotsailidou1
  • Alexandros Psarianos2
  • Emmanouil Chatzichristofis1
  • Eleni Zagelidu3
  • Panagiota Roussou1
  • Nikolaos Raikos1
  • Orthodoxia Mastrogianni3
  1. 1Laboratory of Forensic Medicine and Toxicology, Department of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
  2. 2National Organization for Prevention and Addiction Treatment (EOPAE) Athens Greece
  3. 3Laboratory of Forensic Medicine and Toxicology, Department of Medicine University of Thessaly Larissa Greece
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Abstract

This study presents findings from the European Syringe Collection and Analysis Project Enterprise (ESCAPE) conducted in Greece between 2022 and 2024. Used syringes were collected through harm reduction services and needle distribution and collection programs coordinated by EOPAE in Athens, Thessaloniki, and Patras, and analyzed using standardized ESCAPE extraction procedures followed by ultra‐high performance liquid chromatography–tandem mass spectrometry (UHPLC‐MS/MS). A total of 2122 syringes were included in the study. Substantial geographical variability in injected drug‐use patterns was identified across the participating cities. Athens demonstrated persistent opioid predominance accompanied by high cocaine co‐detection, extensive adulteration, and frequent multiple drug co‐detections. Methamphetamine was detected exclusively in Athens, demonstrating a transient increase during 2023. Thessaloniki exhibited a progressively cocaine‐dominant profile, with cocaine detections increasing markedly during the study period, while opioids remained consistently prevalent. In contrast, Patras demonstrated a distinct buprenorphine‐centered profile associated with comparatively lower adulteration prevalence and fewer multiple drug category co‐detections. Increasing detections of benzodiazepines, methadone, and pregabalin were observed across all cities during 2024. Fentanyl was detected in all participating cities during the final study year, although prevalence remained low. Adulterants, including caffeine and paracetamol, were highly prevalent in Athens and Thessaloniki but substantially less frequent in Patras. The present findings demonstrate substantial regional heterogeneity in injected drug‐use patterns within Greece and support syringe residue analysis as a rapid and highly informative surveillance approach capable of identifying temporal drug‐market changes, emerging synthetic opioids, adulteration patterns, and evolving patterns of injected drug use.

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Cite

BibTeXRIS
BibTeX
@article{matiaki2026monitoring,
  title = {{Monitoring Injected Drug Use in Greece Through Syringe Residue Analysis: A Multicity Study Within the ESCAPE Network}},
  author = {Christina Matiaki and Anastasios Trakakis and Athanasios Theocharis and Chara Parpala and Chara Kotsailidou and Alexandros Psarianos and Emmanouil Chatzichristofis and Eleni Zagelidu and Panagiota Roussou and Nikolaos Raikos and Orthodoxia Mastrogianni},
  journal = {Drug Testing and Analysis},
  year = {2026},
  month = aug,
  doi = {10.1002/dta.70138},
  url = {https://doi.org/10.1002/dta.70138},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Monitoring Injected Drug Use in Greece Through Syringe Residue Analysis: A Multicity Study Within the ESCAPE Network
AU  - Christina Matiaki
AU  - Anastasios Trakakis
AU  - Athanasios Theocharis
AU  - Chara Parpala
AU  - Chara Kotsailidou
AU  - Alexandros Psarianos
AU  - Emmanouil Chatzichristofis
AU  - Eleni Zagelidu
AU  - Panagiota Roussou
AU  - Nikolaos Raikos
AU  - Orthodoxia Mastrogianni
PY  - 2026
DA  - 2026/08/18
JO  - Drug Testing and Analysis
DO  - 10.1002/dta.70138
UR  - https://doi.org/10.1002/dta.70138
AB  - This study presents findings from the European Syringe Collection and Analysis Project Enterprise (ESCAPE) conducted in Greece between 2022 and 2024. Used syringes were collected through harm reduction services and needle distribution and collection programs coordinated by EOPAE in Athens, Thessaloniki, and Patras, and analyzed using standardized ESCAPE extraction procedures followed by ultra‐high performance liquid chromatography–tandem mass spectrometry (UHPLC‐MS/MS). A total of 2122 syringes were included in the study. Substantial geographical variability in injected drug‐use patterns was identified across the participating cities. Athens demonstrated persistent opioid predominance accompanied by high cocaine co‐detection, extensive adulteration, and frequent multiple drug co‐detections. Methamphetamine was detected exclusively in Athens, demonstrating a transient increase during 2023. Thessaloniki exhibited a progressively cocaine‐dominant profile, with cocaine detections increasing markedly during the study period, while opioids remained consistently prevalent. In contrast, Patras demonstrated a distinct buprenorphine‐centered profile associated with comparatively lower adulteration prevalence and fewer multiple drug category co‐detections. Increasing detections of benzodiazepines, methadone, and pregabalin were observed across all cities during 2024. Fentanyl was detected in all participating cities during the final study year, although prevalence remained low. Adulterants, including caffeine and paracetamol, were highly prevalent in Athens and Thessaloniki but substantially less frequent in Patras. The present findings demonstrate substantial regional heterogeneity in injected drug‐use patterns within Greece and support syringe residue analysis as a rapid and highly informative surveillance approach capable of identifying temporal drug‐market changes, emerging synthetic opioids, adulteration patterns, and evolving patterns of injected drug use.
SN  - 1942-7603
SN  - 1942-7611
ER  -