'Not for Human Consumption' -- The Glut of Synthetic Psychoactive Drugs on the Horizon

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Source:   —  April 07, 2016, at 0:39 AM

And about Ecstasy and other illegal stimulants that are club drugs as well as students' and "mothers' tiny helpers" (expression thanks to The Rolling Stones).

'Not for Human Consumption' -- The Glut of Synthetic Psychoactive Drugs on the Horizon

European Contraband

The Scourge of Synthetic Drugs

We've heard a lot about K2 (Spice, Black Mamba and other quaint names), the synthetic "marijuana" that's been ravaging people and cities. And about Ecstasy and other illegal stimulants that are club drugs as well as students' and "mothers' small helpers" (expression thanks to The Rolling Stones). The utilize and abuse of synthetic, unlawful drugs has become a public health crisis that's not going away, and in fact it may become more serious.

NY City, in two thousand-fifteenth, saw thousands of emergency visits for toxic reactions to synthetic marijuana alone (The Not-So-Nice Spice). These visits, as well as emergency calls to poison control centers, finally diminished after a major police and public health mobilization with raids on key distribution sites enabled by governmental executive orders, which close down the major manufacturer and local suppliers.

The following generation of illegally synthesized and distributed drugs with powerful effects on the human mind (and body) is in the pipeline. New production of synthetics has ratcheted up to replace latest year'south drugs, in response to public health bans and criminal consequences.

Researchers recently reported in the Journal of Drug and Alcohol Dependence (one) an abundance of what they termed "novel psychoactive substances" (NPS); "novel" seems a euphemism for these newly synthesized and highly toxic drugs en route to sales and consumption, in this country and abroad. The researchers identified over four hundred compounds, with two hundred fifty-five of them newly synthesized; their data was from the 2012-two thousand fourteen European Union (EU) Early Warning System (EWS).

With maybe tragic irony many of these novel drugs are labelled "Not For Human Consumption." They're promoted as "herbal highs" and "plant food," and sold online, in head shops, bodegas, truck stops, and from drug dealers. Another recent survey reported that close to three million youth in the EU, about five % of those ages 15-24 had consumed NPS (two). The novel psychoactive substances span many classes of drugs but the grand predominance are compounds meant to mimic marijuana and stimulants. We'll focus on those two groups here.

Synthetic Cannabimimetics
In fact, two thirds of the novel psychoactives are "synthetic cannabimimetics" -- literally "mimics" of cannabis, or marijuana. The manufacture of these drugs, most recently K2 and the like, dates back about ten years when sold as alternatives to marijuana. The real NPS are chemicals cooked up in fly by night labs, sprayed onto herbs, dried and packaged for sale. A excellent deal of their production is going on in China and Russia. Unlike marijuana, they're distant more potent and latest longer in the body, cheaper, promoted as "natural," and "legal" (until they're illegal, at which time they're replaced by yet another mimetic). Particularly assailable to sale and utilize are people living in poverty, those with mental and addictive disorders, and youth -- all of whom seek cheap, accessible and potent products. The NPS marketing, including trendy names, colorful packages, and ostensible low risk of criminal prosecution, create them truly risky to the public health.

The synthetic cannabimimetics already available have shown a host of serious adverse effects, as NYC and many other cities have seen. These comprise acute toxic symptoms such as high blood pressure and rapid pulse, nausea and vomiting, profound somnolence to the point of being unresponsive, panicky feelings, aggressive actions, disorientation, psychosis and seizures. Kidney damage has been seen, which can lead to long duration renal disease. Fatalities have also been reported. These types of reactions are apartment to be more severe with the new drugs because of their greater potency and duration of action, as well as their potential to interact with prescribed and non-prescribed other drugs a person may take.

Synthetic Cathinones
The illegally synthesized cathinones are a grand variety of amphetamine-like drugs. Some of their early versions, also dating back almost ten years, were sold as alternatives to pharmaceutical psychostimulants (love Ritalin, Dexedrine and Adderall). MDMA (Ecstasy or Molly) and Bath Salts add to the list of synthetic cathinones - as have other drugs more recently with Str names such as Ocean Breath, Fire Ball, Sextasy, which are sold to replace or pretend to be Ecstasy.

These compounds act primarily on the noradrenaline and dopamine brain receptors (with some effect as well on serotonin). This mode of action explains their euphoric and excitatory effects, as well as their capacity to lift blood pressure and heart rate (including palpitations), sweating, insomnia, muscle twitching, dizziness, grinding of teeth, and nausea and vomiting. Paranoia, hallucinations, and agitation have been reported, and can result in emergency room visits and hospital stays. Cathinones are known to be toxic to the liver as well.

Drugs are huge business
The EU reports on the plentitude of NPS, and the financial windfalls they represent in Europe and the US, can only predict more illegal action ahead. That means, as well, grave medical and social consequences from the glut of new drugs we may soon see.

Most countries, including the United States, have employed a variety of valid actions to forestall the production and distribution of synthetic drugs of abuse. Raids on labs and points of sale can create a disagreement but only in a Ltd way and transiently so, since many of the labs are overseas and the points of sale can modify on a moment'south notice. Moreover, the drug manufacturers stay a step ahead of the law by introducing a minor modification in the drug'south chemical structure, adding a fluoride ion for example, and thus becoming "legal" again, until authorities declare the latest product illegal.

In other words, supply-side efforts to control drugs have proven very limited, over decades.

Demand-side efforts, aimed at reducing consumer demand have generally emphasized public service announcements and education in schools aimed to create drugs show up aversive. We know, from anti-tobacco campaigns, that the most effective ads are those that are the most bloody and distasteful (e. g., those showing dying people or those who cannot breathe or have a tracheostomy). Getting people to look those, particularly youth, is a challenge. Peer influences in schools are generally more effective than adults or didactic exhortations.

Maybe the strongest proof to date for the effectiveness of demand-side approaches is in treatment. Estimates are that for every $one spent in treatment that $10 is saved in societal costs. Treatment, however, should be comprehensive and continuous, not just a reliance on one approach or a short-sighted view that addiction is a temporary condition.

There seems to be a growing interest in fighting drug trafficking by destroying the profits of the manufacturers and distributers. The UK Editor for The Economist, Tom Wainwright, who spent years as a correspondent covering the cartels in Mexico and Latin America, describes how this might be done in his new book, Narco-Nomics, which I reviewed. In the US, four states and The District of Columbia already have made recreational marijuana valid and many more have introduced medical marijuana. We necessity to see, over the following few years, if legalization cuts deeply into the pocketbooks of unlawful drug manufacturers, particularly those selling marijuana and synthetic cannabimimetics.

The conventional "war on drugs" has failed repeatedly, cost a fortune and has unjustly targeted the destitute and people of color. To better face a future with more illegal drug importation and distribution we necessity new ideas, new approaches to defend the public health. Maybe at minimum one approach should deduce from the admonition, "it'south the economy, stupid."

REFERENCES

(1) Zawilska, JB, Andrzejczak, D: Following generation of novel psychoactive substances on the horizon - A complex problem to face, Drug and Alcohol Dependence, one hundred fifty-seven (two thousand fifteen) 1-17

(two) Corazza, O, et al: "Spice, Kryptonite, Black Mamba: an overview of brand names and marketing strategies of novel psychoactive substances on the web, J. Psychoactive Drugs 2014, forty-six, 287-294.

The opinions expressed herein are solely my own as a psychiatrist and public health advocate. I get number support from any pharmaceutical or device company.

My book for families who have a member with a mental illness is The Family Guide to Mental Health Care (Foreword by Glenn Close) -- is presently available in paperback.

My new book about some fundamental secrets of psychiatric practice will be available later this year.

My website is http://www. askdrlloyd. com.

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