Indonesia emerging psychoactive substances

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Indonesia emerging psychoactive substances

  1. 1. New & Emerging Psychoactive Substances Robert Ali
  2. 2. Emerging Psychoactive Substances Most NPS have little or no history of medical use Few comprehensive studies on toxicity most studies based on animals work , fatal poisonings in humans or clinical observations in intoxicated patients Toxicity, abuse liability and risks associated with long-term use unknown 2
  3. 3. 3
  4. 4. 4 “Legal Highs” Piperazines 2000’s BZP TFMPP MCPP Phenylethylamines 2005 2C-B derivatives Cathinones Mephedrone MPDV Synthetic Cannabinoids 2008 Spice Kronic
  5. 5. Piperazines  described as ‘failed pharmaceuticals’  no current human or veterinary pharmaceutical use  Have manufacturing applications  Synthetically manufactured  stimulants which gained popularity in early 2000’s as legal alternative to methamphetamine and MDMA  Now often sold as counterfeit MDMA  Consumed by swallowing 5
  6. 6. Piperazines  Stimulate release and prevent reuptake of DA, 5HT and NA  Mimics effects of ecstasy (MDMA)  Metabolized in the liver and COMT  Adverse events included hypertension, reduced consciousness, psychotic episode, hallucinations, tachycardia, hyperthermia, coma  dangerous with seizure disorders, psychiatric illness, or coronary disease  Could be toxic if combined with MDMA or amphetamines 6
  7. 7. Phenylethylamines Cathinones  EMCCDA cites 44 substances Hallucinogens EMCCDA cites 58 substances 2C-x D series PMA 7
  8. 8. Synthetic Cathinones “Bath Salts” Includes MDPV, 4-MMC, mephedrone, or methylone Sold on-line with little info on ingredients, dosage, etc. Advertised as ‘research chemicals’, ‘plant food’, ‘bath salts’ or ‘glass cleaner’ Taken orally or by inhaling, sometimes injected desired effects are increase in energy, empathy, openness, and libido Little known of detailed pharmacology 8
  9. 9. Mephedrone 4-methylmethcathinone (Miaow) effect profile similar to MDMA Effects short lived and dose dependent Repeated administration common 9
  10. 10. Mephedrone Severe adverse effects appear dose related but are rare at typical levels of use Interactions with other substances may be significant in risk profile student survey of mephedrone users, more than half reported adverse effects first fatality Sweden 2008 Most fatalities associated with the use of other substances 10
  11. 11. Mephedrone-related 11
  12. 12. Clinical Symptoms of Synthetic Cathinones Agitation 82% Combative/Violent behavior 57% Tachycardia 56% Hallucinations 40% Paranoia 36% Confusion 34% Myoclonus/Movement disorders 19% Hypertension 17% Chest pain 17% CPK elevations 9% SOURCE: Spiller et al. (2011). Clinical Toxicology, 49, 499-505.
  13. 13. 2C-x  Includes 2C-B and 2C-I  Synthesized Alexander Shulgin  variations on the mescaline molecule  Ingestion most common route of administration  Can be snorted or dissolved into a liquid and placed on blotter paper under the tongue  effects usually occurs within two hours, typically last 4 to 12 hours  psychoactive effects dose dependent  stimulant effect at lower doses  hallucinogenic and empathogenic effects at higher doses 13
  14. 14. 25B-NBOMe  Derivative of 2C-B (N-methoxybenzyl)  effects lasts about 12-16 hours  Potent 5HT2A receptor agonist  Google Trends shows interest in NBOMe by Australians began in April 2012 and continues to increase in 2013  high potency increases the likelihood of individuals overdosing  responsible for the deaths bizarre and irrational behaviour, paranoia, fear and confusion 14
  15. 15. Synthetic Cannabinoids 15
  16. 16. Synthetic Cannabinoids functionally similar to Δ 9- tetrahydrocannabinol (THC) But chemically unrelated structures bind to the cannabinoid receptors initially developed over past 40 years as therapeutic agents often for treatment of pain Little known about metabolism and toxicology 16
  17. 17. Synthetic Cannabinoids between 100 to 800 times more potent than THC usually available in powder form Typically 3 g of dried vegetable matter to which one or more cannabinoids added usually smoked oral use also reported often contain several chemicals in different concentrations 17
  18. 18. Timeline of Synthetic Cannabinoids and Spice Products SOURCE: Fattore & Fratta. (2011). Frontiers in Behavioral Neuroscience, 5(60), 1-12.
  19. 19. Cannabis vs. Cannabinoids: Effects Seen in Clinical Cases • Most symptoms similar to cannabis intoxication: – Tachycardia – Reddened eyes – Mild sedation – Anxiousness – Memory deficits – Hallucinations – Acute psychosis • Symptoms not typically seen after cannabis intoxication: – Nausea/vomiting – Agitation – Violent behavior – Hypertension – Seizures – Hypokalemia – Coma SOURCES: Hermanns-Clausen et al. (In Press), Addiction; Rosenbaum et al. (2012). Journal of Medical Toxicology; Forrester et al. (2011). Journal of Addictive Disease; Schneir et al. (2011). Journal of Emergency Medicine.
  20. 20. Rare Events reports of suicides associated with preceding use seizures tachyarrhythmias may be carcinogenic 20
  21. 21. Summary • Rapid explosion in manufacture and availabilty • High interest due to their properties and their legal status • Rapid evolving chemicals made by producers • Ingredients often not representative of claim • Fatalities haven’t really dented demand 21
  22. 22. Why do these drugs represent challenges for policy? 22
  23. 23. Why do these drugs represent challenges for policy?  Ethical issues  Technical issues  Legislative issues 23
  24. 24. Ethical Issues Harm relative to other drugs Greater levels of harm from tobacco, alcohol and illicit drugs A demand market may become established without action Unknown harms – is a preventive approach needed? Potential interest to organised crime Unintended consequences Legitimate uses Effects on drug markets 24
  25. 25. Technical Issues Identification, analysis and harms assessments - increased resources Displacement of law enforcement resources Treatment capabilities Risks from non-substance-specific impairments Driving High risk workplaces 25
  26. 26. Legislative Issues Speed of legislative response Using other legislative models? therapeutic goods, food safety and environmental protection legislative approaches Upstream implications – precursor chemicals Alternate sentencing 26
  27. 27. Types of control 27  Controls using existing consumer safety or medicines legislation  Extending, modifying or adapting existing laws and processes  Devising new legislation to tackle new substances
  28. 28. New Models: Ireland’s approach 28  Irish legislation makes it an offence to sell, import, export or advertise “psychoactive substances”  Psychoactive substances are defined broadly  exceptions for medicines, tobacco, alcoholic beverages, approved food, controlled drugs or other substances specified by Ministerial order
  29. 29. New Models: Ireland’s approach 29  Focus on community safety and seizure of suspicious substances  Has no possession offences  For community safety, some ability to seize small amounts may be required
  30. 30. Ireland’s approach 30  Able to distinguish products such as petrol, which may have psychoactive property if inhaled but is sold/supplied for other purposes from products which are sold/supplied for their psychoactive properties  has reduced shopfront sales and led to closure of ‘head shops’  online sales with postal distribution remain a problem
  31. 31. New Models: New Zealand’s approach 31  Similar to Irish scheme  Adds new permit scheme to regulate manufacture and sale of ‘low-risk’ psychoactive substances  Sponsor pays for a harm assessment for new psychoactive substance and attempts to prove the product is safe  If substance assessed as low risk of harm it will be granted a permit for sale, subject to conditions
  32. 32. New Zealand’s approach 32  Scheme modelled on existing schemes applied to therapeutic goods  may result in substances being approved for sale for no other purpose than recreational psychoactive use  may reduce the introduction of more harmful drugs onto an uncontrolled black market, and allow point of sale and other controls to be placed on relatively safe substances
  33. 33. Reverse Onus of Proof Principle 33  Putting the burden of proof for safety on the seller, rather than on government  Making unknown psychoactive substances prohibited unless the seller can prove that they are in fact a substance which is permitted under a law, or is otherwise subject to an exception (eg. it is safe)
  34. 34. Issues for Australia 34  Commonwealth can only legislate to ban importation  Complementary legislation to ban sale, manufacture or advertising of new psychoactive substances needs cooperation of Commonwealth, State and Territory Governments  Administration of the scheme requires cooperation of both law enforcement and health agencies in every jurisdiction, as well as support of industry
  35. 35. The details… 35  Should possession offences be included in diversion programs?  Precautionary seizures for possession amounts?  How to frame legislation so the state is not left with an onus to prove psychoactivity?
  36. 36. The details… 36  Public awareness and education about the nature and risks of new psychoactive substances?  Better coordination between jurisdictions to address inconsistencies between the controls in different countries
  37. 37. Next steps? 37  Continue extending existing drug legislation?  Introducing “Reverse onus of proof” system?  Basic safety net approach (Ireland)?  New approval scheme for psychoactive substances (New Zealand)?
  38. 38. Summary Variety of synthetic drugs and research chemicals Many have stimulant and hallucinogenic properties Long term harms not clear Many showing evidence of dependence forming potential Best legislative framework still evolving 38

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