The rising wave of cathinone use in people attending harm reduction facilities: a French repeated cross-sectional study (2019–2023)

In Europe, cocaine use has recently been on the rise among people who use drugs (PWUD). In parallel, cathinones, another type of psychostimulant that were once associated within the unique context of chemsex, are now spreading to broader patterns of use. Here, we examined trends in reported drug use, including cathinones, among PWUD attending the main harm reduction center in Lyon, France, between 2019 and 2023. We conducted a year-by-year comparison of standardized assessments completed at entry and updated annually for all PWUD attending the harm reduction center. These assessments collected sociodemographic characteristics (i.e., age, sex, nationality, family, housing, and occupational status), and the types of drugs reported as used. We performed logistic regression models to compare the prevalence of each substance, used as the dependent variable, with year and sociodemographic characteristics of PWUD as independent variables. Adjusted odds ratios and their 95% confidence intervals (aOR [95% CI]) were reported. A total of 1,652 PWUD were analyzed. Between 2019 and 2023, the proportion of PWUD reporting cathinone use increased from 1.1% to 10.9%, and from 53.2% to 73.2% for cocaine (p < 0.001 for both). In parallel, the proportion of PWUD reporting alcohol use decreased from 29.5% to 12.8%, and from 72.1% to 39.9% for opioids (p < 0.001 for both). After adjusting for age, sex, and socioeconomic factors, and using 2019 as the reference year, we found significant increases in reported cathinone use in 2022 (aOR [95% CI] = 4.84 [1.35–31.05]) and 2023 (aOR [95% CI] = 4.90 [1.40-31.06]), along with significant decreases in opioid use in 2022 (aOR [95% CI] = 0.50 [0.28–0.88]) and 2023 (aOR [95%CI] = 0.39 [0.22–0.66]). The changes observed for alcohol and cocaine were no longer significant. We observed a significant increase in the proportion of PWUD reporting cathinone use at harm reduction centers. This trend highlights the need for improved training for caregivers and adaptations in the services provided for these substances within these facilities. Further research is needed to gain a deeper understanding of the profiles of more vulnerable cathinone users and their motivations for use.