title: Veni, vidi, vici: The appearance and dominance of new psychoactive substances among new participants at the largest needle exchange program in Hungary between 2006 and 2014.
abstract: BACKGROUND
  There has been an almost exponential growth in the number of new psychoactive substances (NPS) on the drug markets in Europe during the past decade. While most users of NPS use them by routes other than injecting, percutaneous use of NPS is associated with very frequent injecting episodes and paraphernalia sharing.
  
  
  METHODS
  We assessed to what extent new clients between 2006 and 2014 (N=3680) at Blue Point, Hungary's largest needle exchange program, exhibited a shift during these years in the drugs they primarily injected.
  
  
  RESULTS
  Until 2010, 99% of clients injected either heroin or amphetamines. After 2010, however, there was a "replacement chain" of new substances, with one appearing and disappearing after the other: between 2010 and 2014, NPS under five names appeared and gained dominant prevalence (from 0% to 80%), and gradually replaced first the two "traditional" drugs amphetamine and heroin (which diminished to 17% together in 2014) and later each other. We also saw an increase in the proportion of female and older clients.
  
  
  CONCLUSIONS
  While our findings are restricted to injected NPS, they suggest that NPS affect the vast majority of the population of people who inject drugs not only in terms of drug use patterns, but maybe also in terms of demographics. Given that over 80% of people who inject drugs use NPS and injecting NPS is associated with increased injecting risks, harm reduction services should be made more available to avoid an epidemic of blood-borne infections.
authors.affiliation: Eötvös Loránd University, Institute of Psychology, Budapest, Hungary; Semmelweis University, Faculty of Health Sciences, Budapest, Hungary; Blue Point Drug Counselling and Outpatient Centre, Budapest, Hungary.
authors.forename: József
authors.initials: J
authors.lastname: Rácz
authors.affiliation: Semmelweis University, Faculty of Health Sciences, Budapest, Hungary; Blue Point Drug Counselling and Outpatient Centre, Budapest, Hungary.
authors.forename: Róbert
authors.initials: R
authors.lastname: Csák
authors.affiliation: Eötvös Loránd University, Institute of Psychology, Budapest, Hungary.
authors.forename: Krisztina Tímea
authors.initials: KT
authors.lastname: Tóth
authors.affiliation: Eötvös Loránd University, Institute of Psychology, Budapest, Hungary.
authors.forename: Eszter
authors.initials: E
authors.lastname: Tóth
authors.affiliation: Eötvös Loránd University, Institute of Psychology, Budapest, Hungary.
authors.forename: Klaudia
authors.initials: K
authors.lastname: Rozmán
authors.affiliation: Semmelweis University, Faculty of Health Sciences, Budapest, Hungary; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: vgyarmat@jhsph.edu.
authors.forename: V Anna
authors.initials: VA
authors.lastname: Gyarmathy
mesh_terms: D000293:Adolescent; D000328:Adult; D000661:Amphetamine / Q000009:adverse effects; D005260:Female; D003932:Heroin / Q000009:adverse effects; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D018671:Needle-Exchange Programs / Q000639:trends*; D015995:Prevalence; D011619:Psychotropic Drugs / Q000009:adverse effects*; D015819:Substance Abuse, Intravenous / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs; D003932:Heroin; D000661:Amphetamine
keywords: Hungary; Needle exchange program; New psychoactive substances; People who inject drugs; Time series