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Characterizing Adulterant and Polysubstance Use Research Priorities through Syringe Residue Analysis in Kentucky
Medrxiv : the Preprint Server for Health Sciences
|August 1, 2026
Summary
Rising polysubstance use, including fentanyl and meth, is detailed in syringe residues. Common combinations like diphenhydramine and fentanyl highlight urgent needs for targeted research and interventions.
Area of Science:
- Drug Use and Addiction
- Forensic Chemistry
- Public Health
Background:
- Polysubstance use is increasing, leading to higher overdose rates and treatment difficulties.
- The detection of adulterants like xylazine in street drugs complicates the drug supply landscape.
- Harm reduction programs offer a unique avenue for analyzing drug use patterns through syringe residue analysis.
Purpose of the Study:
- To characterize prevalent polysubstance combinations by analyzing residues from used syringes.
- To inform translational and preclinical research on polysubstance use patterns.
- To identify frequent recreational drugs, adulterants, and their combinations.
Main Methods:
- Residues from 3,168 used syringes collected from harm reduction organizations in Jefferson County, KY (Jan-Dec 2025) were analyzed.
- Gas chromatography-mass spectrometry (GC-MS) was employed to identify and quantify substances.
- Compounds were classified as recreational drugs, adulterants, or byproducts/precursors, with the latter excluded from frequency analysis.
Main Results:
- 79.61% of syringes tested positive for substances.
- The most frequent recreational drugs were methamphetamine (54.99%), fentanyl (48.37%), and heroin (25.89%).
- Common adulterants included diphenhydramine (40.48%), dimethyl sulfone (29.69%), and lidocaine (29.18%).
- Frequent combinations included diphenhydramine+fentanyl (26.57%) and fentanyl+heroin (19.19%).
- Common trios were diphenhydramine+lidocaine+fentanyl (14.63%) and diphenhydramine+fentanyl+heroin (12.97%).
Conclusions:
- Findings reveal evolving patterns of multiple-opioid and opioid-stimulant polysubstance use.
- These insights are crucial for strengthening clinical, preclinical, and translational research on polysubstance use.
- The study accelerates investigations into the biobehavioral mechanisms and consequences of emerging drug use patterns, aiding novel therapeutic development.
