Dr Dr Raimondo Raimondo Bruno School of Psychology Universit it y f o T asmania

Transcription

1 Dr Raimondo Bruno School of Psychology University it of Tasmania

2 Down the rabbit hole...

3 Over the counter...

4

5 Over the internet... As of March, this one site (of very many) had 35 different research chemicals listed, including: Substituted cathinones Cannabinoid agonists MDMA analogues Ketamine analogues Information provided looks Information provided looks scientific and helpful but contains substantial errors

6 Mephedrone / israelis Likely the main source of the mephedrone hd mentioned by Tas consumers neo doves Sudden flurry of new generations of products in response to legal changes 4 th generation was not well received Quite unclear in their product labelling lli and descriptions (e.g.: Brand New Product TC True C 'shower invigorator' This is a luxury product for the most wonderful 'showering' experience. It comes in capsule or powder form, it is recommended that you open capsule and put powder into 'shower head' small amounts can be used to extend your 'shower'. It will invigorate you and make you feel on top of the world by releasing the product all over your body through the 'shower head'. It can also be used in your 'bath' as you would with other Neorganics 'bath' products.

7 Rules: provide documentation; full chemical structure & CAS; trademarked brands(!); NMR spectrographs provided; overweight; re ship if lost; create *custom projects*

8 Use of emerging gpy psychoactive substances among the frequent ecstasy users (n=693) Drug Class Ever Used (%) Psychedelics Used 6/12 (%) Med Freq (6/12) Used just once (%) 2CI Psychedelic Phenethylamine (1 3) 71 2CB Psychedelic Phenethylamine (1 20) 58 2CE Psychedelic Phenethylamine (1 10) 64 DOI Psychedelic Phenethylamine (1 6) 75 Mescaline Psychedelic c Phenethylamine et ya e (1 14) 81 5MEO DMT Psychedelic Tryptamine (1 2) 66 DMT Psychedelic Tryptamine (1 14) 50 Any psychedelic Stimulants BZP Stimulant (1 24) 47 MDPV Stimulant (1 5) 50 Mephedrone Stimulant (1 100) 30 Any stimulant Source: National EDRS 2010

9 Key Emerging Psychoactives Noted in Tasmanian EDRS Cohorts (to 2010) Drug 2010 % Mephedrone 47 Stimulant, entactogen Summary DMT 7 Psychedelic tryptamine (duration ) 2C E 7 Psychedelic phenethylamine (duration+) 2C I 4 Psychedelic (empathogenic) phenethylamine Methylone (bk MDMA) 4 Stimulant / Entactogenic substituted cathinone DOI 3 Psychedelic phenethylamine (duration+++) Others: BZP; Salvia; DXM; MDPV; LSA; Mescaline; 2C T 7; Methcathinone; 5 MeO DMT

10 EPS use in Tasmanian EDRS samples Mephedrone 2C X (I,E,B) % of sam mple

11 Mephedrone & relatives y Mephedrone: 4 methylmethcathinone, 4 methylephedrone Stimulant (S) & Entactogen (E) Array of other py psychoactive substituted cathinones: Ethcathinone (S) Buphedrone (S) Metamfepramone (S) Amfepramone (S) Buproprion (Zyban!) 4 Methyethcathinone (S) NRG 1/2 3 Fluoromethcathinone (S) Flephedrone (4 FMC) (S) 4 bromomethcathinone (SS/NRI) 3,4 Methylenedioxycathinone (bk MDA)(E,S) Methylone/bk MDMA (Arlone;E,S) Butylone (E, P, S) Pentylone P l (bk MBDP) (NRG 1/3) /) α Pyrrolidinopropiophenone (S) 4 Methoxy αpyrrolidinopropiophenone p p p (MOPPP) (S) Pyrovalerone (Centroton, Thymergix)(NDRI) (S) Methylenedioxypyrovalerone Mthl l (MDPV) (NDRI)(Ivory Wave)(S) Naphyrone (o 2482)(NRG 1) (S/N/D/ RI) (S)

12 Mephedrone History 1929 Saem de Burnaga Sanchez synthesised (Bulletin de la SociétéChimiquei de France) 2003 Kinetic on The Hive website synthesised 2004 Neorganics (Israel): Neodoves (to 2008, when banned) 2007 First picked up by psychonaut system, seized in France 2008 First reports in Aus (Cairns); identified in Tasmania 2009 Mixmag survey UK 4 th most popular drug (after cannabis, cocaine, ecstasy) Bust of NeoBase site (Tasmania) 2010 Identified in ALL EU member states February decent seizure in Tasmania; almost 50% of Hobart REU recent use Banned in UK in April; across EU in December Late 2010, UK: still available from dealers, price increase, quality decreased, still used

13 20 March, 2010 I d been in central London buying a birthday card when I noticed a row of small packets on the counter by the till...the the front was decorated in bright green and orange and it had pictures of flowers and the words Buzz Gro. In tiny letters below it said: watersoluble all purpose plant feed. Out of curiosity I asked the cashier... What do you do with it? He rolled his eyes at me: Snort it, put it in a drink or wrap it in paper and swallow it, he said with disinterest. What are the side effects? I asked. He...simply shrugged while he continued to chew his gum. No mention that nobody knows the long term effects, the correct dose to take, what to expect from it or the risks. Surely it can t be that bad if I can buy it in a shop, I reasoned to myself. [...implicit suggestion that because it s legal it must be safe...] At first, I felt nothing except a slight burning sensation in my nose. A few minutes later, we were all sitting round in a euphoric haze, smiling benignly but with an incomprehensible, overwhelming desire to dance. It was nearly impossible to keep still. Then things became very vivid iid and real and everything everyone said suddenly became very important. Before we knew it we were piling into a cab, laughing and giggling uncontrollably and going to a club. The effects lasted for about another two hours. Then, as suddenly as they had appeared, they vanished. I was left standing in the club with a pounding headache, wondering what on earth had possessed me to go out. I can now understand why people re dose as soon as the effects wear off because the contrast between being intoxicated and not is sharp and sudden.

14 Acute Subjective Effects of Mephedrone Typical stimulant profile Frequent sympathomommetic physical effects Prosocial profile Relatively infrequent adverse psychological effects Winstock & Marsden, 2010: National Addiction Centre, London; telephone interviews, urines of n=100, mid 2010

15 Davey, Corazza, Schifano, Deluca (2010) Mass information: mephedrone, myths & the new generation of legal highs Drugs & Alcohol Today, 10,

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17 How people p usually took mephedrone First use: >80% first snorted ~0.1g line Minority swallow or drop Average: 6 doses (~0.6g) over next 8 hours most +alcohol, ¼ 1/3 also +cannabis, +ecstasy Current use: Most snort ~0.1g 01g line, redose 30 60mins Typical session: 14 hrs (SD: 16hr) Typical dose/session: mean 1.1g (range 0.1 9g) TAS EDRS 2010: 64% lifetime; 47% past 6/12, snorted Winstock & Marsden, 2010: National Addiction Centre, London; telephone interviews, urines of n=100, mid 2010

18 Withdrawal / Comedown effects Winstock & Marsden, 2010: National Addiction Centre, London; telephone interviews, urines of n=100, mid 2010

19 Winstock & Marsden, 2010: National Addiction Centre, London; telephone interviews, urines of n=100, mid 2010

20 Source: TAS EDRS Why Mephedrone? Mephedrone: easier availability; lower price (~$30/cap vs ~$35/pill);?mixed purity

21 UK: Forensic Science Service (analysis of seizures) Largely meta Chlorophenylpiperazine h l (mcpp) (previously common in NZ, strong 5 HT agonist, it SSRI) Dutch Information & Monitoring System

22 0 = no influence on use 10 = maximum influence possible Winstock & Marsden, 2010: National Addiction Centre, London; telephone interviews, urines of n=100, mid 2010

23 Acute Toxic Effects Most common: Sympathomimetic features Agitation* Tachycardia *(36% of presentations, 8% severe) Dilated pupils Hypertension Uncommon: Severe clinical features Chest pains Seizure (7% of presentations) Marked hypertension (14% of presentations) Arrhythmia At least two cases where mephedrone was sole cause of death; 37+ where present + 4+ RTA See; Wood 2010a, b case series of (72, 9) presentations between

24 Symptoms of dependence Much greater effects than ecstasy Winstock & Marsden, 2010: National Addiction Centre, London; telephone interviews, urines of n=100, mid 2010

25 Using khat as a neurobiological model Catha edulis (khat) tree leaves Effects: optimism, i mild euphoria, excitation, talkativeness, increased energy & self esteem Cathine & cathinone are core components Increase DA (?inducing release &/or inhibiting re uptake) Esp in striatum Similar to AM but ~1/2 potency In chronic AM use see: Downregulation D2 receptors in striatum Reduced functioning in PFC & OFC (control goal directed actions)

26 Based on inferences from amphetamine research Information processing speed Sustained attention Complex working memory Memory (learning rather than consolidation due to strategic issues & reflecting striatal DA function) Executive functions Flexibility, inhibiting irrelevant info, abstraction Strategic planning Decision making Short vs long term Inhibition hb Impulsive (?) Underlines = continue ~months into abstinence

27 Cognitive deficits associated with methamphetamine (dependence) cog flexiblity (switch); strategic planning inhibitory control (SST; go nogo; stroop) sustained attention Riskier decision making, short term focus memory and learning Scott et al, 2007 Meta analysis

28 Cohen s d = 1.8

29 Demographics of EPS consumers (National EDRS, 2010, n=693) No EPS Stimulant EPS Psychedelic (n=497) (n=104) EPS (n=92) Male *** Age (<21) 37 58*** 45 Jurisdiction (small/isolated) 40 61*** 42 Ecstasy use Sexual preference (%GLBT) Did not complete year Unemployed In drug treatment Age first used < *** Used ecstasy weekly Usually take 2+ tablets

30 Drug use of EPS consumers (National EDRS, 2010, n=693) No EPS Stimulant EPS Psychedelic (n=497) (n=104) EPS (n=92) Use party drugs weekly * 41* Alcohol l daily * Tobacco daily *** Cannabis daily dil *** Methamphetamine last 6/ ** Cocaine last 6/ Psychedelics last 6/ ** 75*** Ketamine last 6/ * 19* GHB last 6/ ** Amyl nitrate / nitrous last 6/ ** 66***

31 Risks & Harms amongst EPS consumers (National EDRS, 2010, n=693) Last 6 months No EPS Stimulant EPS Psychedelic (n=497) (n=104) EPS (n=92) Mental health problem ** Stimulant overdose Depressant overdose Accessed health h services due to drugs Access psychotherapy due to drugs * Binge stimulant t use (48hr+) 30 41* 49*** Use cause repeated social problems * DSM IV Substance Abuse Drive under influence drugs Unprotected sex casual partner 38 49* 40 Income from crime in past month ***

32 Harm reduction suggestions for EPS Don t use Especially if existing conditions (inc pregnancy!) & psychotropic medications Don t think that the online sellers actually know what they are doing, despite the scientific presentation Don t the first be to use The new line ; a new delivery; or amongst your group If you do use Avoid other drugs (inc alcohol), especially stimulants Minimise psychobiological distress (inc binges) Don t use regularly, and cap the amount per session Bombing > Shelving/Shafting > Snorting > Injecting Think safe sex Don t be afraid to access help early if things aren t good

33 Incoming! l) N methyl 1 (thiophen 2 yl) yl) propan 2 amine Substituted methamphetamine 1 ethynyl 1 cyclohexanol Alcohol family,?g like? 1 (benzofuran 6 yl)propan 2 amine Phenethylamine analog Stimulant/entactogen 2 (1H indol 3 yl) 1 methyl ethylamine Substituted tryptamine (? Monoamine releaser) 5,6 Methylenedioxy 2 aminoindane woof woof (heavily) substuted phenethylamine Monoamine reuptake inhibiter; weaker effects than MDMA 2 (3 methoxphenyl) 2 (ethylamino) cyclohexanone MXE; MKET Ketamine analog Dissociative anesthetic

34 Where to hunt for information