As part of the Forensic Medicine Department at the LNS, the Analytical Toxicology – Pharmaceutical Chemistry service’s main task is to identify and quantify illegal drugs of abuse. Using high-end technology, the unit provides valuable information for possible criminal investigations and educational campaigns. The team works hand in hand with the police, customs, the Ministry of Health, the Ministry of Consumer Protection. Together, they put their work and expertise at the service of Luxembourg and its people. In 2021, a new phenomenon on the drug scene caught the LNS’ eye: heating heroin without the use of water prior to injection, commonly known as the “Turkish Method”.
Abrigado notices popularity of the “turkish” preparation method
Social workers at Abrigado, the drug consumption centre in Luxembourg City, noticed that many of the experienced heroin users had taken a preference to a new so-called “Turkish” preparation method over the standard heroin cooking method – even though it was associated with more harmful side effects. Abrigado flagged their observations with the experts of the LNS analytical toxicology – pharmaceutical chemistry service during one of their regular meetings. How does this preparation method differ from the standard method? The LNS team decided to get to the bottom of it and to conduct a detailed chemical study.
“It pops better…
…and smells and tastes better, almost like coffee”, consumers reported during interviews with the Abrigado health care personal. It appears that heroin users turn to the “Turkish” method to obtain more intense effects, as well as for the ritualised preparation and/or for the presumed elimination of contaminants and adulterants in the samples, the investigators found out.
In Western Europe, heroin is usually sold as the free base on the black market. However, in order to obtain a water-soluble product that can be injected intravenously, it is necessary to add an acid. The relaxing and euphoric effect of the drug are caused by the heroin and its degradation products 6-monoacetylmorphine (MAM) and morphine. This process is a metabolic pathway but can be chemically accelerated during the preparation of the drug by heating.
Comparing the standard and “Turkish” methods
During the standard cooking method, the heroin powder is most frequently mixed with ascorbic or citric acid. Water or physiological saline solution is added whilst applying heat to dissolve the powder. This does not result in any significant changes in colour. In contrast, the “Turkish” technique consists of heating heroin powder and ascorbic acid without the addition of water to obtain a dark liquid slurry. Only then, saline water is added, and the mixture is briefly heated again for optimal dissolution. The resulting solution is then drawn up in a syringe for intravenous injection.
During the LNS study, the concentrations of heroin, its degradation products 6-monoacetylmorphine and morphine as well as the common cutting agents paracetamol and caffeine were compared in unprocessed material and after heroin processing according to standard and “Turkish” procedures. In “Turkish” preparation method, a lower DAM concentration was detected compared to the initial product, and significantly more MAM was produced.
Higher amount of MAM responsible for intense high from the “Turkish” method
“The high concentration of MAM seems to be the cause of the increased effect of heroin when using the “Turkish” preparation procedure”, suspects Dr sc. Serge Schneider, head of the service, “as it crosses the blood-brain barrier almost as quickly as heroin.” It was however also observed that, compared to the standard method, the “Turkish” technique leads to more severe clinical side effects, such as abscesses and serious epidermal necrosis. “Therefore, it is very important that healthcare workers raise awareness amongst consumers about the hazardous effects of this specific preparation method.”
Ongoing fight against drug abuse
The project illustrates the LNS’ continuous efforts to fight against drug abuse in 2021. In 2019, Serge Schneider’s team analysed wastewater samples in order to gain information about the prevalence of drug abuse in Luxembourg. Other, still ongoing projects, are the “Drug Checking” and “Konsumraum” projects at the Abrigado and Esch/Alzette facilities respectively, whereby consumers voluntarily give a small amount of their sample for analysis. This enables the quality of samples of drugs used by consumers at the facilities to be compared with those seized by customs/police. Another ongoing initiative, “PiPaPo”, was designed to evaluate the quality of drugs consumed at music festivals in the Grand-Duchy. Drug users voluntarily hand in a small amount of their substances (mainly ecstasy, amphetamines, cocaine) for analysis. The project is still underway, even though the COVID-19 crisis has largely put the programme on hold.
Increase in synthetic cannabinoids
Serge Schneider highlights an observation made since the last 2 to 3 years: there is significantly more hemp (low THC concentration cannabis cultivars) on the drug market than before and this hemp is spiked with synthetic cannabinoids and sold as cannabis (high THC concentration). “The increase in the prevalence of synthetic cannabinoids is worrying”, states Schneider. “These products are far from being dominant, accounting for only about 3/100 samples, however previous figures used to range around 1/1000.” Whenever these so-called designer drugs are discovered, a report is sent to the Ministry of Health which then may result in a public warning being issued. By this means, the LNS team and its partners contribute to the protection of the population against dangerous drugs or drug mixtures which remain the primary concern for these public institutions.