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Indonesia emerging psychoactive substances

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  • 1. New & Emerging Psychoactive Substances Robert Ali
  • 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
  • 4. 4 “Legal Highs” Piperazines 2000’s BZP TFMPP MCPP Phenylethylamines 2005 2C-B derivatives Cathinones Mephedrone MPDV Synthetic Cannabinoids 2008 Spice Kronic
  • 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. 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. Phenylethylamines Cathinones  EMCCDA cites 44 substances Hallucinogens EMCCDA cites 58 substances 2C-x D series PMA 7
  • 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. Mephedrone 4-methylmethcathinone (Miaow) effect profile similar to MDMA Effects short lived and dose dependent Repeated administration common 9
  • 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. Mephedrone-related 11
  • 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. 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. 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. Synthetic Cannabinoids 15
  • 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. 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. Timeline of Synthetic Cannabinoids and Spice Products SOURCE: Fattore & Fratta. (2011). Frontiers in Behavioral Neuroscience, 5(60), 1-12.
  • 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. Rare Events reports of suicides associated with preceding use seizures tachyarrhythmias may be carcinogenic 20
  • 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. Why do these drugs represent challenges for policy? 22
  • 23. Why do these drugs represent challenges for policy?  Ethical issues  Technical issues  Legislative issues 23
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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