Changes in patterns of injecting drug use in Hungary: a shift to synthetic cathinones

Abstract

The spread of synthetic cathinone injecting is a new phenomenon observed in recent years in Hungary. Until 2010, when the first anecdotal reports on cathinone injecting appeared, injecting was associated with the use of heroin and amphetamine. In this paper we review available evidence of the changes in the drug market and a concurrent shift in patterns of injecting drug use that have been taking place in Hungary since 2010. Remarkable changes have been observed in police seizures data since 2010. While new psychoactive substances have appeared, the availability of heroin has dropped significantly. A qualitative study in 2011 revealed that these market changes correlate with changes in patterns of injecting drug use: decreasing heroin use and the appearance of mephedrone injecting were reported by treatment and needle and syringe programme (NSP) personnel. These changes are detectable in other routine epidemiological data collection systems in the following years as well (i.e. treatment, drug-related deaths, NSP clientele). Heroin-related treatment demand dropped, as did heroin-related mortality. Parallel to this, a growing number of clients appeared in treatment and in NSPs who were primarily injecting cathinones. The shift to cathinones can be observed in amphetamine and heroin injectors as well. Monitoring changes in patterns of injecting drug use are especially important because of the vulnerability of this drug-user population and the consequences of this high-risk route of drug administration. The realignment observed in Hungary is to be further investigated with regard to its determinants, changes in risk behaviour, and in treatment needs.

Is the recent emergence of mephedrone injecting in the United Kingdom associated with elevated risk behaviours and blood borne virus infection?

“…The rapid emergence of the injection of synthetic cathinones, often as substitute for or in addition to other drugs, has also been reported in several central European countries [9][10][11]. However, the extent of mephedrone injecting varied markedly across the UK, from around one in 25 in London and the south of England, through around one in 14 elsewhere in England, to one in five in both Wales and Northern Ireland.…”

“…Considering the higher levels of injecting risk behaviours and infections among those injecting mephedrone, our findings indicate that the emergence of mephedrone injection in the UK has the potential to increase the transmission of infections among PWID, particularly if its use is sustained or becomes more widespread. The rapid emergence of the injection of synthetic cathinones has already been implicated in increases in viral hepatitis and HIV transmission in a number of other European countries [10,11,32].…”

“…The use of drugs marketed as 'mephedrone' under street names such as 'drone', 'm-cat' and 'meow meow', have increased since its use was first reported around 2007. The subsequent emergence of the injection of synthetic cathinones, including mephedrone, has caused particular concerns in Europe [9], with the injection of these drugs having been associated with increases in human immunodeficiency virus (HIV) infections and risk behaviours among people who inject drugs (PWID) in several central European countries [10,11]. The use, and in particular the injection, of mephedrone by some populations of men who have sex with men (MSM), particularly during sex, has also recently been reported in Europe and elsewhere [12][13][14], often in settings where unsafe sex and sharing of injecting equipment occur [12,13].…”

Emerging Risks Due to New Injecting Patterns in Hungary During Austerity Times

“…Partly as a result of law enforcement activities (EMCDDA, 2013a(EMCDDA, , 2013bGriffiths, Mounteney, & Laniel, 2012) between 2010 and 2011, a drastic decrease was observed in the number and quantity of heroin seizures in Europe (EMCDDA, 2013a). Nonetheless, several member states -including Hungary -that traditionally had relatively large proportion of heroin users among PWID -were experiencing not only a decrease but a serious heroin "drought" between late 2010 and early 2011 (EMCDDA, 2013a;Griffiths, et al, 2012;Péterfi, Tarján, Horváth, Csesztregi, & Nyírády, 2014). In parallel with the heroin shortage, the rapid emergence of new psychoactive substances (NPS) became a serious concern all over the continent regarding both supply and demand, including a large expansion of the synthetic cathinone drug market (EMCDDA & Europol, 2013;Hillebrand, Olszewski, & Sedefov, 2010;UNODC, 2013;Van Hout & Bingham, 2012).…”

“…In parallel with the heroin shortage, the rapid emergence of new psychoactive substances (NPS) became a serious concern all over the continent regarding both supply and demand, including a large expansion of the synthetic cathinone drug market (EMCDDA & Europol, 2013;Hillebrand, Olszewski, & Sedefov, 2010;UNODC, 2013;Van Hout & Bingham, 2012). According to the number of cases notified to EU Early Warning System (EMCDDA, 2013a;Péterfi, et al, 2014), the emergence of new synthetic cathinones reached its peak in 2010 and slowed down only slightly during 2011 and 2012.…”