indonesia emerging psychoactive substances
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New & Emerging Psychoactive Substances
Robert Ali
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Emerging Psychoactive Substances
Most NPS have little or no history of medical use
Few comprehensive studies on toxicitymost 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
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“Legal Highs”
Piperazines2000’s
BZPTFMPPMCPP
Phenylethylamines2005
2C-B derivatives Cathinones
MephedroneMPDV
Synthetic Cannabinoids
2008
SpiceKronic
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
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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
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Phenylethylamines
Cathinones EMCCDA cites 44 substances
HallucinogensEMCCDA cites 58 substances
2C-xD series PMA
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 injecteddesired effects are increase in energy, empathy,
openness, and libidoLittle known of detailed pharmacology
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Mephedrone
4-methylmethcathinone (Miaow) effect profile similar to MDMAEffects short lived and dose dependentRepeated administration common
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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
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Mephedrone-related
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.
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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
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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
Synthetic Cannabinoids
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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 agentsoften for treatment of pain
Little known about metabolism and toxicology
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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 addedusually smokedoral use also reportedoften contain several chemicals in different
concentrations 17
Timeline of Synthetic Cannabinoids and Spice Products
SOURCE: Fattore & Fratta. (2011). Frontiers in Behavioral Neuroscience, 5(60), 1-12.
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.
Rare Events
reports of suicides associated with preceding use
seizures tachyarrhythmiasmay be carcinogenic
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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
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Why do these drugs represent challenges for policy?
Why do these drugs represent challenges for policy?
Ethical issues
Technical issues
Legislative issues
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Ethical IssuesHarm 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 consequencesLegitimate uses
Effects on drug markets 24
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
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
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Types of control
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Controls using existing consumer safety or medicines legislation
Extending, modifying or adapting existing laws and processes
Devising new legislation to tackle new substances
New Models: Ireland’s approach
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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
New Models: Ireland’s approach
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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
Ireland’s approach
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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
New Models: New Zealand’s approach
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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
New Zealand’s approach
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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
Reverse Onus of Proof Principle
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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)
Issues for Australia
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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
The details…
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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?
The details…
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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
Next steps?
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Continue extending existing drug legislation?
Introducing “Reverse onus of proof” system?
Basic safety net approach (Ireland)? New approval scheme for psychoactive
substances (New Zealand)?
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Summary
Variety of synthetic drugs and research chemicals
Many have stimulant and hallucinogenic properties
Long term harms not clearMany showing evidence of dependence
forming potential Best legislative framework still evolving