Drogas viejas y “nuevas” Christopher Yates! Servicio de Urgencias/ Unidad de Toxicología Hospital Son Espases!

! !

Introducción •  Qué son?! •  Donde las encuentro?! •  Qué puedo encontrar allí?! •  Cuáles son sus efectos deseados?! •  Cuáles son sus impactos sobre la salud?! !

Contexto

Annual prevalence

Source: A. Pabst and others, “Substanzkonsum und substanzbezogene Störungen: Ergebnisse des Epidemiologischen Suchtsurveys 2009”, Sucht — Zeitschrift für Wissenschaft und Praxis, vol. 56, No. 5 (2010), pp. 327-336; L. Kraus and others, “Kurzbericht Epidemiologischer Suchtsurvey 2009: Tabellenband — Prävalenz der Medikamenteneinnahme und problematischen Medikamentengebrauchs nach Geschlecht und Alter im Jahr 2009” (Munich, Institut für Therapieforschung, 2010).

B. Spain

Source: tion, St europa. informa naire.

6.0 3.0

2011

2009

2007/08

2005/06

0.0

2003

Poca información acerca de nuevas drogas de abuso/drogas “smart”

9.0

2001

Encuestas de usuarios acerca de uso de drogas

Annual prevalence (%)

12.0

Cannabis

Cocaine

ATS

"Ecstasy"

Tranquillizers

Opioids

Table

Denm

Irelan

Source: European Monitoring Centre for Drugs and Drug Addiction, Statistical Bulletin 2012 (available from www.emcdda.europa. eu/stats12); United Nations Office on Drugs and Crime, information provided by Spain in the annual report questionnaire.

Spain

32 European Monitoring Centre for Drugs and Drug Addiction, Annual Report 2012: The State of the Drugs Problem in Europe.

UNODC Centre

Engla

Table 1.

Trend of new psychoactive substance seizures, 2009 to mid-2012a

Contexto 2009

2010

2011

First half of 2012

Synthetic cannabinoids

!

!

!

!

Synthetic cathinones

!

!

!

#

Ketamine

#

#

#

#

Phenethylamines

#

!

#

#

Piperazines

!

#

#

"

Plant-based substances

!

!

!

#

Miscellaneous

$

!

!

!

New psychoactive substance group

Source: United Nations Office on Drugs and Crime, The Challenge of New Psychoactive Substances (Vienna, March 2013). a Based on information from 42 countries. Respondents were asked to provide information on a yearly basis on observed seizure trends (“increasing”, “stable”, “decreasing”) for the above-mentioned NPS groups. When the number of respondents reporting “increasing” trends exceeded the number of respondents reporting “declining” or “stable” trends, an overall increase is shown in the table. Similarly, when the number of reported “declining” trends exceeded the “increasing” or “stable” trends an overall decline is shown. Where the largest number of respondents reported “stable” trends, an overall stable trend is shown. != Increasing, "= Decreasing, # = Stable, $ unknown.

The most closely monitored region with regard to the emergence of NPS so far has been Europe, notably the European Union. EMCDDA, in cooperation with Europol, created the European early warning system for NPS. Whenever a NPS is detected in a country, information on its manufacture, trafficking and use is sent by the State to Europol and EMCDDA. The early warning system comprises the 27 European Union countries, as well as Norway and the two European Union candidate countries, Croatia and Turkey. Through the early warning system, a total of 236 substances were identified over the period 2005-2012, equivalent to more than 90 per cent of all substances found

73

163 Specific new psychoactive substances identified by national laboratories 150

49 Laboratories were asked to provide 114 detailed information on An analysis of 100the specific substances they examined. 73 41 the responses revealed that laboratories in 40 countries 24mid-2012. This exceeds identified a total of36 251 49 NPS to 50 13 21 of currently controlled psychoactive subthe total14 number 15 7 stances at the international level (234). 0 2012

2011

2010

2009

The number of newly identified NPS rose from 166 by 200972 to 251 NPS by mid-2012. Thus, the total number of identified NPS rose by more than 50 per cent at the Total identified new psychoactive global level between 2009 and mid-2012. 2008

Europe

200

2007

substances at the regional level

Some sub250 differences can be observed for plant-based 236 stances. Seizure trends for these drugs rose until 2011 and then started to stabilize.

2006

Aumento de sustancias identificadas Spread of new psychoactive

no furtherofincreases were reported for ketamine. Fig.contrast, 8. Evolution new psychoactive The overall trends forreported piperazines and early phenethylamines substances to the appear to have been rather stable over warning system, 2005-2011 the same period.

2005

Among Internet searches for the chemical groups of the main NPS, the strongest interest by far has been in synthetic cannabinoids, i.e. the main psychoactive substances contained in Spice. This has clearly increased over the period 2008-2012. Interest in piperazines started to emerge at the global level as of 2008 and peaked in 2009 before declining in subsequent years. Interest in phenethylamines remained relatively constant. Interest in tryptamines, in contrast, appears to have lost momentum in recent years. Interest in synthetic cathinones increased in 2010, and again in 2012, to the extent that it was higher than for the other NPS groups in that year, except the synthetic cannabinoids.

substances since 2005 The bulk of the 251 NPS identified overidentified the period 2009 New psychoactive substances to mid-2012 were synthetic in reporting year cannabinoids (24 per cent of the total), phenethylamines (23 per cent) and synthetic New psychoactive substances identified cathinones (17 cent), followed prior toper reporting year by tryptamines (10 per

cent). These four groups accounted for almost three quarSource: European Monitoring Centre for Drugs and Drug AddictersEuropean (74 per Police cent)Office, of all EU NPS and reported tion and Drugidentified Markets Report: A Stra- to tegic UNODC. Analysis (Luxembourg, Publications Office of the European Union, 2013).

The main substances in each category were identified on the basis of the number of times they were mentioned by in 2011, 41 in 2010, 24 in 200983 and, on average, 5 per Member States. The NPS most 84 frequently reported (more

Fig. 4. Number of new psychoactive substances identified

2. NEW PSYCHOACTIVE SUBSTANCES

Number of new psychoactive substances

74

Number of newly identified new psychoactive substances at the global level: 2009 to mid-2012 (cumulative)

300

206 200

251 8

243

250

166

37

40

150 100

102

50 0 2009

2010

2011

2012

New psychoactive substances identified for the first time in current year New psychoactive substances identified in previous years

Source: United Nations Office on Drugs and Crime questionnaire on new psychoactive substances, 2012.

s JWH-018 and JWH-073 among the synthetic cannabinoids s Mephedrone, MDPV and methylone among the synthetic cathinones

Contexto

C. The recent emergence and spread of new psychoactive substances

Map 2.

Experience with legal substances that imitate the effects of illicit drugs in the European Union among persons aged 15-24, 2011

1 3.3

6.2 8.8 3.8 5.2 8.2 16.3 3.4

9 3.7

4

4

6.8

3.1 3.6 5.2

Prevalence of use of new psychoactive substances

1.9

6.6

3.3

Ç Ç Ç

Ç

Ç

Ç

Ç

Ç Ç

Ç

ÇÇ

ÇÇ Ç

Ç Ç Ç Ç

Ç ÇÇ

Ç

Ç

Ç

ÇÇ

Ç

< 1.5%

Ç ÇÇ Ç Ç Ç Ç

ÇÇ

Ç

Ç

Ç ÇÇ

ÇÇ Ç Ç

3.4

ÇÇ

Ç

1.6 - 2.9% 3- 4.9%

Ç

ÇÇ ÇÇ

ÇÇ Ç

Ç

0.8

5.8

4.9 1.6

5- 7.9% > 8% 0.3 1.6

Source: Gallup Organization, Youth Attitudes on Drugs: Analytical Report, Flash Eurobarometer series No. 330 (European Commission, July 2011).

Users of legal substances that imitate the effects of illicit drugs showed lower risk perceptions with regard to the negative health effects of illicit drugs than the general pop-

with legal substances that imitate the effects of illicit drugs, while the proportion was negligible among non-users of cannabis (0.8 per cent).93

79

Cocaína • 

La forma soluble, clorhidrato de cocaína se puede insuflar, inyectar, ingerir pero se degrada con pirólisis.!

• 

Mediante la disolución de clorhidrato de cocaína en una base fuerte se obtiene cocaína base o crack!

Cocaína Ruta!

Comienzo de acción (min)!

Pico de acción (min)!

Duración de acción (min)!

intravenoso!

Ketamina, PCP!

GHB •  Gammahidroxibutirato (llamado écstasis líquido)! •  No tiene relación con el éxtasis, no es una anfetamina! •  Es un sedante usado todavía para tratamiento de la narcolepsia!

GHB •  Abusos! -  Uso en fiestas rave! -  Ambiente gay! -  Culturistas! -  Sumisión química!

GHB Toxíndrome TA!

FC!

FR!

Tª!

Estado mental!

Pupilas!

Peristalsis!

Diaforesis!

↓!

↓!

↓!

-/↓!

↓!

↓!

-/↓!

-!

• Inicio de acción rápida. Duración muy corta (vida media 30 minutos)" • Tiene un rango terapéutico pequeño. Con dosis pequeñas presentan desinhibición, euforia que pasa a inconsciencia y coma profundo."

• Puede haber muerte por apnea" • Pueden presentar mioclonía "

GHB Manejo •  Habitualmente no lo requieren pero a veces es necesario intubar! •  Medidas de soporte (posición lateral de seguridad, fluidos, oxígeno)! •  No está indicada la descontaminación ni hay antídoto! •  Suelen despertarse al cabo de minutos, pocas horas y marcharse asintomáticos!

Ketamina •  Uso como anestésico en medicina y veterinaria! •  Generalmente esnifada en ambientes fiestas rave y en el ambiente homosexual! •  Susceptible de uso para sumisión química!

Ketamina •  Efectos de corta duración con inhalación (20-30 minutos)! •  Puede manifestar toxíndrome similar al simpaticomimético! •  Los que son traídos a Urgencias lo suelen ser por alteraciones neuropsiquiátricos!

Ketamina •  Es un anestésico disociativo que produce amnesia, hipnosis y analgesia sin pérdida de conciencia! •  Sensación de flotar, de estar fuera del cuerpo, viajar en un túnel, y alteraciones del tamaño de los objetos y otras alucinaciones! •  Reacción de emergencia: confusión, alucinaciones y sueños vivaces!

Ketamina •  Medidas de soporte según estado clínico! •  Habitualmente benzodiacepinas y reposición de líquido será suficiente!