Detected substance abuse among injecting drug users through analysis of used syringes in Tunisia

Injecting drug use poses significant public health risks due to unsafe practices such as syringe sharing, reuse, and risky sexual behaviors, which increase the transmission of bloodborne viruses. In Tunisia, limited data on injecting drug use hinders the development of informed health and harm reduction policies. A syringe collection campaign was conducted in Tunis in November 2022. The used syringes were provided by the Tunisian Association for Information and Orientation on AIDS and Addiction (ATIOST), a harm-reduction service. These syringes had been distributed to people who inject drugs (PWID) as part of a mobile syringe exchange program. The objective of the study was to analyze the contents of the used syringes to gain further insights into drug use patterns among PWID. The residual substances in the syringes were examined using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), in accordance with the standardized protocol of the European Syringe Collection and Analysis Project Enterprise (ESCAPE). A total of 261 syringes from five collection sites were analyzed. Among these, 87 % contained at least one psychoactive substance, while 32 % contained more than two psychoactive substances. The most frequently identified psychoactive substances were buprenorphine (50.28 %), amphetamine (11.65 %) and tramadol (9.66 %). No substances were detected in 34 syringes. This method provides rapid data on drug use trends in specific regions and timeframes, revealing differences that can inform tailored prevention and harm reduction strategies. Such analyses are valuable for comparative studies across countries in the European Neighbourhood Policy (ENP-South) region. [Display omitted] •261 syringes analyzed; 87 % contained at least one psychoactive substance.•Buprenorphine (50.28 %) was the most detected, followed by tramadol and amphetamines.•New psychoactive substances like fentanyl and synthetic cathinones were found.•32 % of syringes had multiple substances indicating risky behavior and syringe sharing.•Results guide harm reduction efforts and enhance drug monitoring approaches.