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Mephedrone: Still available and twice the price
... responded by banning the trafficking and production of mephedrone (4-MMC). As expected, this did not stifle the demand for the specific stimulative effects of the new drug (McElrath & O'Neill, 2011;Winstock, Mitcheson, & Marsden, 2010). Developers of new synthetic substances soon put a whole range of mephedrone 'substitutes' on the market. ...
... Based on the results of studies on cocaine use and the increased use and seizures of mephedrone in the EU (Annual Report, Winstock et al., 2010), DrogArt conducted in 2011 a small-scale study on the characteristics of the use of mephedrone (Nacionalno Poročilo, 2011), as new information collected on the ground began to complement available data on the use in the context of nightlife. Outreach workers and informants working at nightlife venues reported an increase in the use of mephedrone. ...
... Before the ban, users bought mephedrone on the Internet or in head shops. After the ban went into effect, they started buying from dealers (McElrath & O'Neill, 2011;Winstock et al., 2010). In Slovenia, friends and dealers continued to be the main source of synthetic cathinones after the ban of mephedrone, which had disappeared from the Slovenian market within a month following the ban. ...
The study presents the characteristics of the use of new psychoactive substances (NPS), the perceived problems experienced by users, and the reasons for cessation or cutting down. The research focused mainly on synthetic cathinones and the use of 3-MMC in Slovenia.
In order to research the characteristics of NPS use, we used a questionnaire which had been developed to determine the characteristics of the use of ATS and cocaine in the context of nightlife and was elaborated in our study on the use of mephedrone. The final non-representative sample included 249 users of NPS from Slovenia, who had completed an on-line survey over a period of 5 months in 2014. Part of the sampling was conducted on the ground and with the help of peer-groups. DrogArt's outreach workers and correspondents visited open public places, clubs, and discotheques to encourage users to participate in the survey.
Most users of NPS in Slovenia have tried NPS from the groups of synthetic cathinones and amphetamines. Most respondents included in the sample (67.9%) have tried 3-MMC, while 43.0% have tried methylone and 37.3% have tried mephedrone (4-MMC). Users attributed greater risks to the use of new drugs and preferred the effects of traditional drugs to those of new drugs. The most frequently reported problems were depression (55.2% of users), concentration difficulties (44.0%), damage to the mucous membrane of the nose and to the throat (39.8%), feelings of fear and anxiety (39.4%), and tingling in the arms or legs (34.4%). The main reasons for cutting down or discontinuing the use of NPS were 'fear of the health consequences', 'actual health consequences', and 'growing weary of using'. Among users of NPS, 7% have sought help, while 9.1% have considered doing so. The results also highlight differences between the NPS drug markets in Slovenia and the United Kingdom.
In 2014, the most frequently used NPS in Slovenia were synthetic cathinones such as 3-MMC. Users experienced various problems related to the use of NPS. However, they are familiar with recommendations on harm reduction and want additional information on the harmful effects of the use of NPS. Based on the obtained results, we can develop specific interventions in the area of harm reduction.
Copyright © 2015 Elsevier B.V. All rights reserved.
... In terms of bath salt use, the USA lagged behind Europe, Australia, and other parts of the world. Mephedrone, marketed as a bath salt, became increasingly popular in the UK during -2009. Winstock et al. (2010 found that over 40 % of 2,295 visitors to a popular UK dance music website had used mephedrone. An overwhelming majority of these users had used it in the last month. This study also assessed MDPV use, but found it to be much rarer (1.9 %) in the sample. explored use in a more representative sample of young adults (one thousand Scottish ...
... Though the UK and many nearby countries regulated mephedrone in 2010, its use continued. Winstock et al. (2010) reported that 63 % of their UK sample of mephedrone users continued to use, but complained that the price had more than doubled as a result of the ban. Alternatively, Carhart-Harris et al.'s (2011) research suggests that the majority of these users at least reduced their use as a result of the ban. ...
... Ideally, voters and politicians should make the "right" decision for the "right" reasons, but implementing the "right" policy for the "wrong" reason is likely far better than taking no action at all or enacting problematic legislation. While regulation may not eliminate use, it would likely cause an increase in price (Winstock et al. 2010) and decrease in frequency of use (Carhart-Harris et al. 2011) as was reported in the UK. ...
In order to offer more insight into the novel and emerging drug phenomenon, a series of case studies are presented in the following pages that intricately explore the recreational use, media coverage, and regulation of three emerging psychoactive substances with diverse effects and unique histories. First, a short-acting dissociative plant in the mint family, Salvia divinorum, is described as an example of an extant drug that somewhat suddenly became linked to recreational use after the natural product was chemically enhanced, mass produced, and packaged for retail sale by a handful of organizations. This drug is also an excellent example of state-led drug regulation as opposed to federal oversight. Second, the chapter examines the appearance of psychoactive synthetic stimulants marketed as “bath salts.” This category of substances received significant media attention and was quickly scheduled at the federal level in most countries. Finally, we present the recreational use of a recently synthesized research chemical that has yet to become a widespread drug of abuse. Bromo-DragonFly is a powerful and long-acting hallucinogen when taken recreationally.
... The ACMD (2011) recommends that the government implements strategies to decrease the request for NPS by including NPS in substance misuse education in schools and developing prevention initiatives. Mephedrone is often advertised as bath salts, plant food, insecticides, novelty items, chicken feed additives or research chemicals, with products being sold with names such as 'Meow Meow', 'Meph', 'TopCat' and '4-MMC' (Winstock et al., 2010a(Winstock et al., , 2010b. Warnings that the contents are not for human consumption are added to packaging in an attempt to escape legal and civil sanctions. ...
... The desired psychological and behavioural effects reported by users include feelings of intense euphoria, increased energy, heightened concentration, moderate sexual arousal, intense stimulation and alertness, empathy/feelings of closeness, sociability and talkativeness, intensification of sensory experiences and perceptual distortions (Winstock et al., 2011). These are similar to a range of NPS, with either stimulant (Schifano et al., 2005) and/or hallucinogenic (Ricci et al., 2011) properties; mephedrone may be associated with a number of both physical and psychopathological side effects especially reported in persons with psychiatric, cardiac or neurological issues, who may have a higher risk of side effects (Winstock et al., 2010a(Winstock et al., , 2010b. The most common adverse effects reported in mephedrone users who require medical care include gastrointestinal symptoms (loss of appetite, dry mouth, nausea and vomiting), neurological signs (tremors, tense jaws, bruxism, headache, dizziness and seizures), cardiovascular effects (tachycardia, elevated blood pressure, respiratory difficulties, chest pain and peripheral vasoconstriction; Schifano et al., 2011) and psychiatric symptoms (anxiety, aggression, agitation, confusion, dysphoria, depression, irritability, time distortions, long-lasting hallucinations, paranoid delusions, short-term psychosis, short-term mania, insomnia and nightmares and impaired short-term and working memory). ...
Mephedrone is a stimulant drug chemically related to amphetamine, with effects similar to those of amphetamine and cocaine. This study aims to analyse fatalities following ingestion of mephedrone in the UK amongst 16- to 24-year-olds in 2009-2013, providing an update on data presented at the 2nd International Conference on Novel Psychoactive Substances.
A literature search was undertaken to identify published information on pharmacology, toxicity and fatalities associated with mephedrone. Fatalities involving mephedrone were extracted from the National Programme on Substance Abuse Deaths database, which receives information on drug-related deaths from coroners in the UK and Islands and other data suppliers. Selection criteria are as follows: deceased aged 16-24 years at time of death and mephedrone directly implicated in the cause of death and/or mentioned in the coroner's verdict.
Thirty cases met the study criteria, and when known, all were of White ethnicity, most (85%) had a history of drug use and 73% were male. Two-thirds (63%) were accidental poisonings. Mephedrone was used with other substances in most cases (87%); other substances were implicated in 60% of deaths.
Mephedrone use can have potentially fatal consequences, especially in combination with other substances. Deaths from its use in the 16-24 years' age group continue to occur in the UK, despite it being a controlled drug. Health professionals and potential consumers should be alert to this risk. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
... These stimulants often include cathinone derivatives [5], e.g., MDPV (3,4-methylenedioxypyrovalerone) and mephedrone (4-methylmethcathinone), which are intended to mirror the effects of cathinone, a compound found in the Khat plant. Although few studies have investigated users" experiences with MDPV, a growing number of European and Australian studies have explored the use of mephedrone [2,[6][7][8][9][10][11][12][13], a substance that emerged as a legal psychoactive substance in several European countries beginning in 2007-2008 [14]. ...
... Prior to its control in Europe, mephedrone was available through streetbased headshops, other retail outlets, internet-based suppliers, friends/ acquaintances, and/or street dealers [7,10,11,15]. Despite its now illegal status in several European countries, the use of mephedrone has continued [16] and the supply of the drug has tended to shift to street-based dealers following legislative bans [7,12]. Online provision has continued and the number of internet-based "shops" that supply new psychoactive substances has increased since 2011, with some speculation that the rise is due in part to an increase in internet suppliers in the United States [3]. ...
... This product is not intended to diagnose, treat, cure, or prevent any disease" (Food and Drug Administration 2013). The merchandise produced by this shadow industry typically reaches the end consumer via tobacco outlets, head shops, tattoo parlors, gas stations, convenience stores, and the Internet prior to bans Jerry et al. 2012), and via street dealers and the Internet after bans (Winstock et al. 2010). The role of the shadow industry in expanding emerging drug use is covered in more detail in Chap. ...
... As a result, street dealers may increasingly handle these products before it reaches end users; dealers are known to use cutting agents, which may include toxic substances. The increase in impurities and decrease in the awareness of content is likely to lead to negative consequences for users (Winstock et al. 2010). However, those regulating emerging drugs hope to see a net decrease in drug harm due to fewer users through restricting access. ...
Over the past two decades in particular, there has been increasing concern over a subset of psychoactive substances new on the drug scene. While some have received a substantial amount of media coverage in recent years, many of these substances are unheard of by the vast populous; in fact, only a niche group of drug users may know of their existence previous to their eventual exposure to the public. There is, however, a good base for understanding these emerging drugs as presented in this chapter. A framework is presented to better grapple with emerging drug trends given this knowledge base. This provides a solid foundation to expand on previous research while minimizing the temptation of including anecdotal and circumstantial evidence when drawing conclusions on emerging drug trends.
... However, it has been shown that manufacturers quickly react to the changes in legislation by replacing the newly banned NPS with new substances that have not yet been banned [6,7]. Users have also been shown to change their behaviour and rapidly switch to non-banned substances [8][9][10]. ...
... The number of MDPV cases both in DUID and in PM investigations decreased markedly after it was put under control of the Narcotics Act. Users' choice of recreational drugs has been reported to be motivated by, among other things, the legal status of the substances, their reputation for lack of harm and by the recommendations of the internet community about the quality of the Bhigh^ [8]. The banning of MDPV presumably Average length of driving ban (months) 10 9 Imposed to a fine (%) ...
In this study, we sought to determine what impact the banning of 3, 4- methylenedioxypyrovalerone (MDPV) had on the incidence of MDPV-positive findings and on user profiles in driving under the influence of drugs (DUID) and postmortem (PM) investigations in Finland. All MDPV-positive cases and a selection of corresponding court cases between 2009 and 2012 were examined. The median serum concentration of MDPV in DUID cases was 0.030 mg/L and in PM blood 0.12 mg/L. The number of MDPV-positive cases decreased both in DUID and PM investigations after the drug was banned. The decrease in the mean monthly numbers of MDPV-positive DUID cases was 51.1%. In court cases, MDPV was rarely mentioned until banned and frequently mentioned thereafter. Of the convicted, 37% were without a fixed abode, 98% had other charges besides that of DUID, and 13% appeared in the study material more than once. In MDPV-positive PM cases, the proportion of suicides was very high (24%). Research on new psychoactive substances is required not only to support banning decisions but more importantly to be able to provide a scientific assessment of the risks of these new substances to the public and potential users.
... In the case of NPS much less is known about the effects of scheduling, but it is possible that the "legal" marketing of these substances (i.e. that they are sold openly on the web) will make classification have a more direct effect on the supply. There are some indications that this is indeed so (Anderson et al., 2010;Advisory, 2011;Carhart-Harris et al., 2011;Stogner et al., 2012;Loeffler and Craig, 2013) but there are also reports of users whose use seem to be relatively unaffected by the legal status (Winstock et al., 2010;Wood et al., 2012). Interestingly, a few reports support the notion that scheduling removes the substance from the web, at least from websites on the 'surface web', but might remain available via more 'traditional' routes such as street dealers (Winstock et al., 2010;Advisory, 2011) and possibly from "dark net" websites as well. ...
... There are some indications that this is indeed so (Anderson et al., 2010;Advisory, 2011;Carhart-Harris et al., 2011;Stogner et al., 2012;Loeffler and Craig, 2013) but there are also reports of users whose use seem to be relatively unaffected by the legal status (Winstock et al., 2010;Wood et al., 2012). Interestingly, a few reports support the notion that scheduling removes the substance from the web, at least from websites on the 'surface web', but might remain available via more 'traditional' routes such as street dealers (Winstock et al., 2010;Advisory, 2011) and possibly from "dark net" websites as well. ...
... This drug has also been classified in some other countries as a measure for the control of its availability. However, after regulatory measures restricting possession, sale, and manufacture of synthetic cathinones passed in the UK, the number of users who purchased the drug from dealers increased considerably and at the same time its price became almost twice as high as before legislation 32 . ...
... Data currently available suggest that the abuse of mephedrone is still a public health issue even after its classification 32 . Case reports indicate that there is no safe mephedrone dose, since negative consequences may appear in association with any dosage taken. ...
OBJECTIVE: Synthetic cathi-nones are an emerging class of designer drugs abused of due to their psychostimulant and hallucinogenic effects, similar to those of cocaine, methylenedioxymethamphetamine (MDMA), amphetamines and methampheta-mines. Mephedrone is a cathinone analogue (4-methyl aromatic analogue of methcathinone) that was reported to be implicated in several fatalities in the media across Europe, but only a few have actually resulted in mephedrone cited as the cause of death. In this paper, we aim to systematically review analytically confirmed cases of mephedrone-related fatalities. RESULTS: In total, 10 citations met the criteria for inclusion, representing 18 fatal cases with analytically confirmed mephedrone in biological sample/s of the deceased. The death was attributed to mephedrone intoxication in 9 cases (range of post-mortem blood mephedrone concentration: 1.33-22 mg/L), whereas multiple drug toxicity, involving mephedrone was cited as cause of death in 6 cases (range of post-mortem blood mephedrone concentration: 0.04-1.3 mg/L). CONCLUSIONS: Data suggest that the abuse of mephedrone remains to be a public health issue. Mephedrone appears to have a rather narrow therapeutic window that makes its use dangerous. Dosages which supposedly fall within recreational use limits could also lead to death when combined with other drugs in certain circumstances. Forensic Toxicology laboratories must assess their testing procedures to ensure they can achieve both an appropriate screening regime and targeted quantitative analysis for the detection of mephedrone in various biological matrices.
... Una encuesta realizada en 2009 a usuarios de drogas de diseño en el Reino Unido, reveló que el 34% de los encuestados había consumido mefedrona en el mes anterior (8). Aunque su uso descendió de forma acusada desde su ilegalización, hay estudios que reflejan que un 63% de los antiguos usuarios de mefedrona del Reino Unido continúan consumiéndola, a pesar del aumento de su precio y la reducción de su pureza (9).En España la mefedrona fue prohibida en 2011. ...
... La precaución debe intensificarse en el caso en que se modifique la presentación, el proveedor o las vías de administración. 9. PAUTAS PARA REDUCIR LOS RIESGOS Y DAÑOS ASOCIADOS AL CONSUMO DE NUEVAS SUSTANCIAS 9) Cuando se consuman sustancias con efectos potenciadores del deseo sexual debe tenerse presente que estas pueden alterar nuestro juicio, existiendo un mayor riesgo de involucrarse en prácticas sexuales de alto riesgo. ...
... Although the legislation ultimately succeeded in terminating sale of NPS by head shops, it provoked considerable criticism from experts in the fields of sociology and drugs policy (Ryall & Butler, 2011;Winstock, Mitcheson, & Marsden, 2010). There were predictions that users would quickly and easily migrate to criminal dealers to source NPS, with possibly increased harms. ...
... In common with the Irish Act, the UK legislation has been greeted with criticisms from drug policy experts (Reuter & Pardo, 2017;Stevens et al., 2015). Included among the criticisms, there were predictions that a criminal black market would quickly evolve to meet demand (Winstock et al., 2010). ...
Aim
New psychoactive substance (NPS) use can negatively impact mental health and may result in drug‐related psychiatric admissions (DRPA). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. This occurred in the context of a rapid expansion in specialist high street shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions were futile. We sought to determine if changes in head shop activity coincided with changes in DRPA.
Method
The national database on psychiatric admissions was examined focusing on young adults admitted from 2008 to 2012. Joinpoint regression analysis was utilized to examine for the presence of trend changes in DRPA.
Results
The monthly rate of DRPA was higher in 2010 than 2008, 2009 and 2012 (P < 0.01). Joinpoint regression analysis identified a significant downward trend change which occurred in July 2010 (95% CI Feb 2010 to April 2011). Young males aged 18 to 24 years showed evidence of greatest change, DRPA falling by 1.4% per month (95% CI 0.7 to 3.7% decline) from May 2010 to December 2012.
Conclusions
Cessation of NPS sale by head shops coincided with a reversal in the upward trend of DRPA, this change being most evident in young men. While correlation does not imply causation, legislation which successfully targets the sale of NPS may result in reduced drug‐related mental disorders.
... One of the most predominant synthetic cathinones, 3,4 methylenedioxypyrovalerone (MDPV), is the fifth most commonly used hallucinogen within the US (DEA 2017), and an increase in reported use of another form, 4-methylmethcathinone (mephedrone), was observed in various countries (e.g., Australia, US) beginning in 2007 (Winstock et al. 2011;Winstock, Mitcheson, and Marsden 2010). Calls to poison control centers regarding bath salts exposure increased from 304 calls in 2010 to 6136 in 2012 (American Association of Poison Control Centers 2011) and accounted for 12% of all toxicologyrelated cases tracked by the Toxicology Investigators Consortium in 2011 (Wiegand et al. 2012). ...
... There is presently a gap in the literature with regard to understanding these factors, which limits the ability of policymakers, researchers, and treatment providers to effectively direct their efforts to decrease use. The only published research that examines large samples of users has predominantly been conducted on mephedrone in the United Kingdom (Winstock et al. 2011;Winstock, Mitcheson, and Marsden 2010) and only recently in the US (Ashrafioun et al. 2016;Johnson and Johnson 2014). Thus, the current study aimed to provide descriptive information about a geographically representative sample of bath salt users in the US. ...
Synthetic cathinones, commonly referred to as “bath salts,” are recreational designer drugs that recently emerged as a drug of abuse. However, little is known about bath salt users, particularly in the United States (US). This descriptive study aims to better characterize users and user behavior, including common motives for and consequences of use. Individuals with a lifetime history of bath salt use (BSU; n = 110) completed an Internet survey. Participants (50.9% male) were aged 18 to 58 (M = 31.21, SD = 10.25) years and were from 32 US states. Most participants reported past-year BSU, via intranasal use, obtained from a friend or acquaintance. Recreational motives (e.g., to get high, experimentation) were commonly reported, as was use due to drug availability. Participants reported experiencing an average of 5.50 consequences, with both physical (e.g., rapid heartbeat) and psychological (e.g., anxiety) negative outcomes commonly reported. This descriptive information on BSU from a small but diverse sample of users may inform efforts to reduce use and negative consequences, such as eliminating riskier routes of administration (e.g., injection) and targeting specific motives for use (e.g., providing alternative methods for mood expansion).
... In April 2010 mephedrone and substances structurally related were classified as Class B substances in the UK under the Misuse of Drugs Act. Legislation [4]. The drug has been also classified in some other countries as a measure for the control of its availability. ...
... Users report obtaining the drug from both local dealers and Internet sources [6]. However, after regulatory measures that restrict possession, sale, and manufacture of synthetic cathinones passed in the UK, the number of users who purchased the drug from dealers increased considerably, while its price increased, almost two times higher than its price before legislation [4]. ...
... While NPS are very heterogeneous, they can be broadly grouped by route of use. Firstly, there are the powdered stimulant drugs which typically are snorted, many of which are cathinones (Winstock, Mitcheson & Marsden, 2010). Secondly, there are the smoked synthetic cannabinoids (Dargan et al., 2011). ...
... Much international literature points to the potential futility of simply banning NPS. It is argued that prohibition will move NPS from their quasi-legal status into criminal supply networks and that new drugs will emerge to quickly replace any banned NPS (Winstock et al., 2010). Surveys indicate ongoing easy access to and substantial use of NPS in spite of legislative bans (McElrath & O'Neill, 2011; Measham, Wood, Dargan, & Moore, 2011). ...
... 1,2,7,8 Internet como elemento necesario de la vida cotidiana, con acceso inmediato y universal a cualquier producto mediante las tiendas online, así como las redes sociales y los foros de usuarios, hacen que la mezcla resultante sea, probablemente, un desconocimiento importante para los sanitarios en general, tanto en los aspectos relativos a su prevención como para el tratamiento de sus efectos en los trastornos producidos por intoxicación aguda, los trastornos por abstinencia, el cravingy los trastornos crónicos, lo que asociado al rápido avance de las tecnologías de la informática y de las comunicaciones y su rápida asimilación por la población, particularmente la joven, genera mayor preocupación todavía. 7,8,9,10 Estos productos sintéticos han sido introducidos en el mercado sin estudios clínicos conocidos sobre farmacología y toxicología, ni siquiera se han realizado modelos en animales, siendo la única fuente de información los foros de usuarios en internet. 11,13 Otra arista del mismo fenómeno la constituye también la regulación y persecución de su venta y consumo, que está sujeta a varios impedimentos, tales como la rapidez con que se fabrican los nuevos productos y se distribuyen, el escaso conocimiento químico y farmacológico de sus componentes, lo cual impide adoptar medidas legislativas de forma rápida, al necesitarse suficiente información científica contrastada para ello, la deslocalización de su fabricación y su fácil compra a través de la red, con una accesibilidad universal. ...
Se exponen por primera vez en nuestro medio los conocimientos más relevantes de las nuevas sustancias psicoactivas que entraron a Cuba oficialmente en el año 2011.
... In a 2013 review of forty-three synthetic cathinone toxicity cases, these were among the top synthetic cathinones confirmed (1). Moreover, in one such study in the UK, 95 of 150 responders (63%) reported continued use and 57% had resorted to obtaining their drugs from street dealers, an increase from 41% prior to prohibition (3). Despite the continually changing synthetic drug market, the 2015 National Forensic Laboratory Information System report indicates that methylone and MDPV still rank among the top 15 most commonly abused phenethylamines in the US; and the European Monitoring Centre for Drugs and Drug Addiction includes mephedrone and MDPV among the top abused phenethylamines (4,5). ...
The abuse of synthetic cathinones, formerly marketed as "bath salts", has emerged over the last decade. Three common drugs in this class include 3,4-methylenedioxypyrovalerone (MDPV), 4-methylmethcathinone (mephedrone), and 3,4-methylenedioxymethcathinone (methylone). An LC-MS/MS method has been developed and validated for the simultaneous quantification of MDPV, mephedrone, and methylone in brain tissue. Briefly, MDPV, mephedrone, methylone, and their deuterium-labeled analogs were subjected to solid phase extraction (SPE) and separated using an HILIC Silica Column. The HPLC was coupled to a Shimadzu IT-TOF (ion trap-time of flight) system with the electrospray source running in positive mode (+ESI). The method was validated for precision, accuracy, and extraction efficiency. All inter-day and intra-day % RSD (percent relative standard deviation) and % error values were less than 15% and extraction efficiency exceeded 80%. These conditions allowed for limits of detection of 1ng/mL for MDPV, and 5 ng/mL for both mephedrone and methylone. The limits of quantification were determined to be 5ng/mL for MDPV and 10 ng/mL for mephedrone and methylone. The method was utilized to evaluate the pharmacokinetics of these drugs in adult male rats following administration of a drug cocktail including MDPV, mephedrone, and methylone. All three compounds reached peak concentrations in the brain within 15 min. Although methylone and mephedrone were administered at the same dose, the peak concentration (Cmax) of mephedrone in the brain was significantly higher than that for methylone, as was the area under the curve (AUC). In summary, this quick and sensitive method for measuring synthetic cathinones may be used for future pharmacokinetic investigations of these drugs in target tissue.
... The synthetic cathinone class includes substances such as mephedrone, methylone, and MDPV. Originally mephedrone (4-methylmethcathinone; 'MCAT'; 'meow-meow'; 'plant food') was marketed as a 'legal high' and was largely sold online or in specialty shops (Brunt, Poortman, Niesink, & Van den Brink, 2010;Davey, Corazza, Schifano, & Deluca, 2010;Measham, Moore, Newcombe, & Welch, 2010), and despite the introduction of legislative controls, it has remained available via traditional face-to-face dealing in addition to online purchases (Winstock, Mitcheson, & Marsden, 2010a). In contrast, other NPS such as MDPV and methylone have not necessarily had such a pervasive or lasting presence. ...
Background:
Over the past decade, monitoring systems have identified the rapid emergence of new psychoactive substances (NPS). While the use of many NPS is minimal and transitory, little is known about which products have potential for capturing the attention of significant proportions of the drug consuming market. The aim of this study was to explore self-reported experiences of three commonly used NPS classes within the Australian context (synthetic cathinones, hallucinogenic phenethylamines and hallucinogenic tryptamines) relative to traditional illicit drug counterparts.
Methods:
Frequent psychostimulant consumers interviewed for the Australian Ecstasy and related Drugs Reporting System (EDRS) (n=1208) provided subjective ratings of the pleasurable and negative (acute and longer-term) effects of substances used in the last six months on the last occasion of use, and the likelihood of future use.
Results:
Stimulant-type NPS (e.g., mephedrone, methylone) were rated less favourably than ecstasy and cocaine in terms of pleasurable effects and likelihood of future use. DMT (a hallucinogenic tryptamine) showed a similar profile to LSD in terms of pleasurable effects and the likelihood of future use, but negative effects (acute and comedown) were rated lower. Hallucinogenic phenethylamines (e.g., 2C-B) showed a similar negative profile to LSD, but were rated as less pleasurable and less likely to be used again.
Conclusion:
The potential for expanded use of stimulant-type NPS may be lower compared to commonly used stimulants such as ecstasy and cocaine. In contrast, the potential of DMT may be higher relative to LSD given the comparative absence of negative effects.
... Tra i principali effetti psicoattivi si annoverano: euforia, effetti psicostimolanti, aumento dell'ener- gia, empatia, maggiore apertura e socializzazione, miglioramento del tono dell'umore, maggiore lucidità mentale, riduzione dell'appetito, logor- rea e aumento della libido. A dosaggi maggiori si assiste alla comparsa di dispercezioni sensoriali, esperienze allucinogene e proprietà empatoge- ne ( Measham et al., 2010;Winstock et al., 2010; ). Nel trattamento in acuto risulta utile l'impiego di benzodiazepine per con- tenere l'agitazione psicomotoria e ridurre il rischio di crisi epilettiche ( Wood et al., 2009;2010a;2010b;Wilson et al., 2013;Fass et al., 2012). ...
... Furthermore, these researchers found that the packaging of this emerging drug emulated street drugs after it fell into the hands of street dealers, perhaps calling into question the consistency of an already questionable product. Winstock et al. (2010) also reported that UK users now mainly buy the stimulant from street dealers. As such, they are paying approximately twice as much and have even fewer guarantees of safety, purity, or quality. ...
One of the more difficult issues facing decision makers in regard to recent emerging drug threats is the novel nature of their manufacturing process, marketing tactics, distribution schemes, and even the large range and diverse nature of the players in each of these arenas. That is, at every stage of traditional drug control and interdiction modifications must be made to be able to monitor these emerging products. The following section describes this new marketplace with the most current intelligence and research and gives some insight into the scope and logic of novel high production, distribution, and use.
... In this scenario, mephedrone was sold openly on the grey market (online vendors from surface and deep websites) and in head shops as a number of authentic commercial products. It was typically marketed and sold as 'bath salts', 'incense', and 'plant food/fertilizer', and advertised as 'not for human consumption' to circumvent potential legislative control [8,[11][12][13]. ...
4-Methyl-N-methylcathinone (mephedrone) is a popular new psychoactive substance (NPS) that is structurally related to the parent compound cathinone, the β-keto analogue of amphetamine. Mephedrone appeared on the street drug market as a substitute for 3,4-methylenedioxy-N-methylamphetamine (MDMA, ecstasy) and was subsequently banned due to the potential health risks associated with its use. Nevertheless, mephedrone continues to be widely consumed among specific populations, with unique patterns of misuse. To date, most information about the biological effects of mephedrone comes from user experiences, epidemiological data, clinical cases, toxicological findings, and animal studies, whilst there are very few data regarding its human pharmacodynamics and pharmacokinetics. This chapter reviews the available published data on patterns of mephedrone use, its acute and chronic effects, and its pharmacokinetic properties. More human research is needed to elucidate the safety, toxicity, and addiction potential of mephedrone and related NPS.
... Furthermore, new synthetic cannabinoid receptor agonists not covered by the legislation appeared after legislative controls. 818 found a decrease in the number who continued to use mephedrone after classification. There were also changes in access to, and sources of, mephedrone, with a 40% increase in purchases from dealers and a significant increase in the mean price per gram of mephedrone from £10 to £16. ...
Background
Although illegal drug use has largely been declining in the UK over the past decade, this period has witnessed the emergence of a range of novel psychoactive substances (NPS) (‘legal highs’). These are new, mostly synthetic, substances that mimic the effects of existing drugs). Despite there being many causes for concern in relation to NPS, there has been little prior study of the burden associated with their use in public health terms. Clarity is lacking on research priorities in this rapidly developing literature.
Objectives
To inform the development of public health intervention research on NPS by reviewing existing data on their use, associated problems and potential responses to such problems.
Design
A scoping review and narrative synthesis of selected bodies of evidence was undertaken to summarise and evaluate what is known about NPS use and the related harms of, and responses to, such use. Relevant literature was identified from electronic databases (covering January 2006 to June 2016 inclusive), Google (Google Inc., Mountain View, CA, USA), relevant websites and online drug forums and by contacting experts. Articles were included if they were primary studies, secondary studies involving the analysis and interpretation of primary research or discussion papers. A conceptual framework postulating an evidence-informed public health approach to NPS use in the UK was developed through a pragmatic literature review, the iterative development of concepts and finalisation in light of the results from the empirical review work. The process also involved feedback from various stakeholders. Research recommendations were developed from both strands of work.
Results
A total of 995 articles were included in the scoping review, the majority of which related to individual-level health-related adverse effects attributable to NPS use. The prevalence of lifetime NPS use varied widely between (e.g. with higher prevalence in young males) and within population subgroups. The most commonly reported adverse effects were psychiatric/other neurological, cardiovascular, renal and gastrointestinal manifestations, and there is limited evidence available on responses. In these and other respects, available evidence is at an early stage of development. Initial evidence challenges the view that NPS should be treated differently from other illicit drugs. The conceptual framework indicated that much of the evidence that would be useful to inform public health responses does not yet exist. We propose a systems-based prevention approach that develops existing responses, is multilevel and life course informed in character, and emphasises commonalities between NPS and other legal and illegal drug use. We make 20 recommendations for research, including nine key recommendations.
Limitations
Scoping reviews do not interrogate evidence in depth, and the disjunction between the scoping review and the conceptual framework findings is worthy of careful attention.
Conclusions
Key research recommendations build on those that have previously been made and offer more evidence-based justification and detail, as previous recommendations have not yet been acted on. The case for decision-making on commissioning new research based on these recommendations is both strong and urgent.
Future work
The validity of recommendations generated through this project could be enhanced via further work with research commissioners, policy-makers, researchers and the public.
Study registration
The systematic review element of this study is registered as PROSPERO CRD42016026415.
Funding
The National Institute for Health Research Public Health Research programme.
... This was perhaps unexpected as increases in price have previously been demonstrated following control of other NPS under the Misuse of Drugs Act 1971 such as mephedrone. 12 This kind of study clearly carries inherent limitations-Internet supply is only one route of supply and this study does not assess availability of MDMB-CHMICA through other routes such as street dealers or high street head shops. Furthermore we only accessed publically available websites and did not conduct any searches of the 'dark web' nor did we attempt to purchase any substances from any of the websites and therefore cannot verify that these websites sold the substance as advertised. ...
Background: In May 2016, the UK Government enacted the Psychoactive Substances Act which made it an offense to produce or supply many drugs including new psychoactive substances (NPS).
Aim: We aimed to assess the impact of the Act on the availability of the synthetic cannabinoid receptor agonist methyl 2-[[1-(cyclohexylmethyl)indole-3-carbonyl]amino]-3,3-dimethylbutanoate (MDMB-CHMICA) from internet-based suppliers.
Design: Internet snapshot availability study.
Methods: We conducted two snapshot availability surveys looking at the number of websites offering to sell MDMB-CHMICA: the first in March prior to implementation of the Act and the second in June, 1 month post-implementation.
Results: In March and June 2016, we identified 47 and 38 websites, respectively, which offered to sell MDMB-CHMICA. There were no significant differences in the price of the drug nor the forms available for purchase. In the June survey there was a significant decrease in the number of websites which openly stated they were based in the UK (from 14 down to 2), three websites stated that they did not supply customers based in the UK and two websites stated they had ceased sales of MDMB-CHMICA due to the Act.
Conclusions: This study showed a small but limited reduction in the availability of MDMB-CHMICA from internet-based suppliers following implementation of the Act.
... This eventuality prompted the additional legislation in August. It is also possible that a ban just moves drugs from their quasi-legal status to enter criminal drug supply networks, with increased attendant risks or possibly diverts would-be NPS users towards other drugs [20]. There have been increasing calls to explore regulation of this marketplace [21]. ...
Introduction and aims:
New psychoactive substances (NPS) have hedonic effects that may lead to dependence. Headshops selling NPS increased in number in Ireland from late 2009. Legislation was enacted in May and August of 2010 that caused their closure. It is unknown whether such events impact the rate of NPS use disorders.
Designs and methods:
We conducted a population-based study using the Irish national database of episodes of addiction treatment between 2009 and 2012. We examined trends in the rate of NPS-related treatment episodes among young adults. Joinpoint trend analysis software was used to identify significant changes in trend.
Results:
Of the 31 284 episodes of addiction treatment commenced by adults aged 18 to 34 years, 756 (2.4%) were NPS related. In 2012, the 12-month moving average rate had fallen 48% from its peak in 2010, from 9.0/100 000 to 4.7/100 000. Joinpoint analysis indicated that the rate of NPS related episodes increased by 218% (95% confidence interval 86 to 445, P = 0.001) every 4 months until the first third of 2010. From that point, the rate declined by 9.8% (95% confidence interval -14.1 to -5.4, P = 0.001) per 4-month period. There was no significant trend change in the rate of non-NPS related treatment episodes.
Discussion and conclusions:
Over the 2 years after the enactment of prohibition-styled legislation targeting NPS and headshops, the rate of NPS related addiction treatment episodes among young adults declined progressively and substantially. We found no coinciding trend change in the rate of episodes linked to other drug groups. [Smyth BP, Lyons S, Cullen W. Decline in new psychoactive substance use disorders following legislation targeting headshops: Evidence fromnational addiction treatment data. Drug Alcohol Rev 2017;00:000-000].
... These discrepancies could reflect the legality of NPS; for instance, before the introduction of legislation, users generally obtained mephedrone via the Internet, whereas after the ban went into effect, they started buying from dealers (McElrath & O'Neill, 2011;Winstock et al., 2010). This article is protected by copyright. ...
Today there is continued, and in some cases growing, availability of psychoactive substances, including treatments for mental health disorders such as cognitive enhancers, which can enhance or restore brain function, but also 'recreational' drugs such as novel psychoactive substances (NPS). The use of psychoactive drugs has both benefits and risks: whilst new drugs to treat cognitive symptoms in neuropsychiatric or neurodegenerative disorders could have great benefits for many patient groups, the increasing ease of accessibility to recreational NPS and the increasing lifestyle use of cognitive enhancers by healthy people means that the effective management of psychoactive substances will be an issue of increasing importance. Clearly, the potential benefits of cognitive enhancers are large and increasingly relevant, particularly as the population ages, and for this reason we should continue to devote resources to the development of cognitive enhancers as treatments for neurodegenerative diseases and psychiatric disorders, including Alzheimer's disease, attention deficit hyperactivity disorder (ADHD) and schizophrenia. However, the increasing use of cognitive enhancers by healthy individuals raises safety, ethical and regulatory concerns, which should not be ignored. Similarly, understanding the short- and long-term consequences of NPS use as well as better understanding the motivations and profiles of users could promote more effective prevention and harm reduction measures.
... Mephedrone appeared in Europe as a common component of "legal highs" (15). Users of racemic mephedrone report both cocaine-like stimulant effects and MDMA-like empathogenic effects (38,39). Mephedrone is thought to act like a substrate for transporters of serotonin (5HT) and dopamine (DA), and stimulates neuronal release of 5HT and DA (40). ...
Chiral discrimination has become one of the most important fields in analytical and medicinal chemistry, and forensic toxicology. The enantiomers may have different binding to proteins that may lead to many pharmacological and toxicological differences between them, including kinetic (at the absorption, distribution, metabolism and excretion level) or dynamic (level of potency and efficacy or even differences in mechanism of action) variations. Cathinone derivatives are chiral compounds, sold via the internet for recreational use, and little is known about their enantiomeric selectivity. Consequently, it is of crucial importance for the development of resolution methods to obtain pure enantiomers to study their biological effects. In the last few years, techniques for chiral drug analysis, as chromatography, have been developed and some works related to the analytical enantiomeric resolution of synthetic cathinones were described. However, information about synthetic cathinones in the literature is scarce specially concerning single enantiomers. In this mini-review, analytical chiral resolution and biological differences between enantiomers of cathinone derivatives will be addressed.
... Legislation passed in the UK, US and worldwide has criminalized MEPH. Although some data suggest a reduction in MEPH use after criminalization, MEPH is still abused worldwide, often being sold under new 'legal high' brand titles (Brandt et al., 2010;Winstock et al., 2010;McElrath and O'Neill, 2011). ...
... However, there was still some NPS use which confirms that there was some migration of use into the black market. (165) In the few cases where use persisted in the black market era, this was associated with significantly less problems than occurred among users during the head shop era. ...
Substance use, and substance use disorders (SUD), are major contributors to global burden of disease among youth. They constitute an important risk factor for other disorders, including mental disorders. This thesis seeks to examine methods to reduce the harm associated with youth substance use, looking at the impact of treatment on the individual adolescent with a SUD and at legislative measures operating at the population level. While treatment models for SUD have become more liberal and harm reduction orientated in recent decades, legislation remains conservative and prohibitionist. The archetypal harm reduction treatment is opiate substitution treatment (OST) used with heroin dependence. The evidence base for OST in adolescents is sparse. Outcome of OST was examined. It emerged that OST delivers early reductions in heroin use, which continue to improve significantly from month three to month twelve of treatment. Evidence of improved psychological wellbeing is also demonstrated by adolescents on OST. In order to explore the impact of conservative legislative measures on harm related to substance use, a quasi-experimental approach was undertaken to explore changes which occurred in Ireland before, during and after the arrival of a vast network of head shops selling new psychoactive substances (NPS). Evidence is presented indicating that the expansion of head shops coincided with increased NPS addiction episodes among both adolescents and young adults. There was also evidence of increased drug related psychiatric admissions. All of these harms began to diminish within months of the closure of the head shops. Overall, these findings lend support to the position of providing tolerant and responsive treatment which does not demand abstinence for the small subset of youth who develop a SUD, while simultaneously maintaining an intolerant and conservative approach to prevention of substance use at the wider population level.
... Those substances which are initially available at local outlets and stores seem to experience a surge in use that often continues even after the removal of those products from store shelves. While much has been made of the Internet serving as a direct source of NPS (47), it appears that most end-users purchase them from legitimate shops prior to bans and street dealers after regulation (48). Novel drugs that are sold legitimately, even for a short period of time, or are readily available from a street dealer are far more likely to reach widespread use than those trafficked only via online sales. ...
Countless novel psychoactive substances have been sensationally described in the last 15 years by the media and academia. Though some become significant issues, most fail to become a substantial threat. The diversity and breadth of these potential problem substances has led policymakers, law enforcement officers, and healthcare providers alike to feel overwhelmed and underprepared for dealing with novel drugs.
Inadequacies in training and preparation may be remedied by a response that is more selective and more proactive. The current manuscript seeks to clarify how to most efficiently forecast the "success" of each newly introduced novel psychoactive substance in order to allow for more efficient decision making and proactive resource allocation.
A review of literature, published case reports, and legal studies was used to determine which factors were most closely linked to use of a novel drug spreading. Following the development of a forecasting framework, examples of its use are provided.
The resulting five-step forecast method relies on assessments of the availability of a potential user base, the costs - legal and otherwise - of the drug relative to existent analogues, the subjective experience, the substance's dependence potential and that of any existent analogue, and ease of acquisition. These five factors should serve to forecast the prevalence of novel drug use, but reaction should be conditioned by the potential for harm.
The five-step forecast method predicts that use of acetyl fentanyl, kratom, Leonotis leonurus, and e-cigarettes will grow, but that use of dragonfly and similar substances will not. While this forecasting approach should not be used as a replacement for monitoring, the use of the five-step method will allow policymakers, law enforcement and practitioners to quickly begin targeted evaluative, intervention, and treatment initiatives only for those drugs with predicted harm.
... 1,2,7,8 Internet como elemento necesario de la vida cotidiana, con acceso inmediato y universal a cualquier producto mediante las tiendas online, así como las redes sociales y los foros de usuarios, hacen que la mezcla resultante sea, probablemente, un desconocimiento importante para los sanitarios en general, tanto en los aspectos relativos a su prevención como para el tratamiento de sus efectos en los trastornos producidos por intoxicación aguda, los trastornos por abstinencia, el cravingy los trastornos crónicos, lo que asociado al rápido avance de las tecnologías de la informática y de las comunicaciones y su rápida asimilación por la población, particularmente la joven, genera mayor preocupación todavía. 7,8,9,10 Estos productos sintéticos han sido introducidos en el mercado sin estudios clínicos conocidos sobre farmacología y toxicología, ni siquiera se han realizado modelos en animales, siendo la única fuente de información los foros de usuarios en internet. 11,13 Otra arista del mismo fenómeno la constituye también la regulación y persecución de su venta y consumo, que está sujeta a varios impedimentos, tales como la rapidez con que se fabrican los nuevos productos y se distribuyen, el escaso conocimiento químico y farmacológico de sus componentes, lo cual impide adoptar medidas legislativas de forma rápida, al necesitarse suficiente información científica contrastada para ello, la deslocalización de su fabricación y su fácil compra a través de la red, con una accesibilidad universal. ...
Introduction: Emerging drugs are added to the global tragedy of drugs with a growing trend of supply and demand, of which Cuba is not exempt. Objective: To increase the relevant knowledge of emerging drugs, for which an analysis of certain characteristics that has taken this phenomenon in recent years, and the conditions that favor its production, consumption, distribution, proliferation and engagement was performed in populations each younger time. Methods: For this we searched the Cochrane Library, MEDLINE, EMBASE, PsyclNFO, EBSCO, HINARI, Dissertation Abstracts and articles identified in their bibliographies, in addition to individual searches of MEDLINE of authors who have reported information regarding the emerging drug consumption in the last five years. Conclusions: The line between legal and illegal drugs becomes increasingly tenuous. The continuous updating of emerging drugs, knowledge of the limitations in the analytical determinations and clinical suspicion, are the only weapons to monitor the changing world of these substances, which become a serious social and health problem. For its development, commercialization and availability, there is no doubt that we are facing the emergence of an innovative market and extremely dynamic, highly accessible, globalized, sophisticated and very attractive to young people, favoring large international drug mafias for the great benefits economic derived from illegal trade in a globalized and neoliberal world.
Designer or synthetic drugs which include legal highs and other “club drugs” are substances which have a propensity to cause euphoria, central nervous system stimulation, and hallucinations. Based on chemical formulae for opioids, mescaline, and cannabis, they are created in laboratories under lax conditions for no defined medical purposes. Because they vary in composition from batch to batch they are potentially dangerous for users. Furthermore, the chemical structure is continually changing in order to avoid legislation and therefore users can never be sure what they are taking. For the purpose of this article readers should use the terms legal highs, designer drugs, bath salts, herbal highs, ‘research’ chemicals, and novel psychoactive substances, interchangeably. Their main purpose is to induce psychoactive effects that mimic amphetamines, cannabinoids or psychedelic drugs. The term ‘research’ only infers that very little is known about these substances and information on adverse effects is often sparse. The reader should also bear in mind that it is beyond the scope of this article to include many other agents.
The new recreational designer drugs known as “bath salts” are synthetic cathinones (e.g., mephedrone, 3,4-methylenedioxypyrovalerone, methylone) that are being abused as stimulants. Bath salts have similar effects as amphetamine, cocaine, and MDMA (3,4-methylenedioxymethamphetamine, also known as ecstasy). Cathinone is a naturally occurring phenylalkylamine alkaloid present in the khat plant that has been used for centuries, but in Western countries, they are primary used by “young clubbers.” In this review, the pharmacology and neurotoxicity of bath salts will be discussed and the prevalence and pattern of bath salt use will be presented. The U.S. Poison Control Center received an increasing number of calls regarding bath salt intoxication in 2011, which led to an emergency temporary ban in September 2011. Despite the ban, the use of bath salts has continued. Multiple reports have described the clinical features of bath salt intoxication and withdrawal symptoms, as well as the potential for abuse and the development of dependence. There are reports of bath salts causing hallucinations, delirium, and psychosis. For patients presenting with bath salt intoxication, management includes using medications for behavioral control and other symptomatic support. In this review, we will report the use of bath salts in a patient with a history of schizophrenia and comorbid methamphetamine dependence. His clinical course will be discussed. In order to prevent the further abuse of bath salts, we need to encourage the continuing ban on the sale of bath salts and also educate both clinicians and patients about the risks of using such drugs.
Knowledge about the neuropharmacology of mephedrone (MEPH) applies primarily to the racemate, or street form of the drug, but not to its individual enantiomers. Here, through chemical isolation of MEPH enantiomers and subsequent behavioral characterization in established invertebrate (planarian) assays, we began separating adverse effects of MEPH from potential therapeutic actions. We first compared stereotypical and environmental place conditioning (EPC) effects of racemic MEPH, S-MEPH, and R-MEPH. Stereotypy was enhanced by acute treatment (100-1000 μM) with each compound; however, S-MEPH was less potent and efficacious than racemate and R-MEPH. Both R-MEPH (10, 100, 250 μM) and racemate (100 μM) produced EPC, but S-MEPH was ineffective at all concentrations (10-100 μM). After showing that S-MEPH lacked rewarding efficacy, we investigated its ability to alter three of cocaine's behavioral effects (EPC, withdrawal, and stereotypy). Cocaine (1 μM) produced EPC that was abolished when S-MEPH (100 μM) was administered after cocaine conditioning. Spontaneous withdrawal from chronic cocaine exposure caused a reduction in motility that was not evident during acute or continuous cocaine treatment but was attenuated by S-MEPH (100 μM) treatment during the cocaine abstinence interval. Acute stereotypy produced by 1 mM cocaine, nicotine or racemic MEPH was not affected by S-MEPH (10-250 μM). The present results obtained using planarian assays suggest that the R-enantiomer of MEPH is predominantly responsible for its stimulant and rewarding effects and the S-enantiomer is capable of antagonizing cocaine's addictive-like behaviors without producing rewarding effects of its own.
Copyright © 2014 Elsevier Ltd. All rights reserved.
Animal models of drug self-administration are currently the gold standard for making predictions regarding the relative likelihood that a recreational drug substance will lead to continued use and addiction. Such models have been found to have high predictive accuracy and discriminative validity for a number of drug classes including ethanol, nicotine, opioids, and psychostimulants such as cocaine and methamphetamine. Members of the entactogen class of psychostimulants (drugs that produce an “open mind state” including feelings of interpersonal closeness, intimacy and empathy) have been less frequently studied in self-administration models. The prototypical entactogen 3,4-methylenedioxymethamphetamine (MDMA; “Ecstasy”) supports self-administration but not with the same consistency nor with the same efficacy as structurally related drugs amphetamine or methamphetamine. Consistent with these observations, MDMA use is more episodic in the majority of those who use it frequently. Nevertheless, substantial numbers of MDMA users will meet the criteria for substance dependence at some point in their use history. This review examines the currently available evidence from rodent self-administration studies of MDMA and two of the new and emerging psychoactive substances (NPS) that produce entactogen type neuropharmacological responses – mephedrone (4-methylmethcathinone; 4MMC; “meow meow”) and methylone (3,4-methylenedioxymethcathinone). Overall, the current evidence predicts that these NPS entactogens have enhanced abuse liability compared with MDMA.
Since the 1800s, increasing numbers of new substances have hit the drug scene. Over time, the official responses to these substances have become increasingly more sophisticated. Yet, there still is much to learn from how societies have dealt and continue to deal with the next “scary drug of the year” as there appears to be more similarities than differences in these responses across time and place. While there is a demand for recreational intoxicants in most modern societies, various forces limit the list of legal substances available to those who wish to indulge. The following traces a selection of emerging substances through history to draw attention to the patterns that bridge these cases over time. This exercise will grant us a better focus on our current challenges with the benefit of over a century of hindsight.
According to the Chief Sanitary Inspectorate, 75% of the compounds identified as new psychoactive substances in Poland are represented by synthetic cathinones. The aim of the presented paper is to describe the pharmacological profile of synthetic cathinones, including the structure-activity relationship and its impact on their biological effects. This article also includes a review of the literature on fatal and non-fatal intoxication cases associated with the administration of well-described synthetic cathinones, as well as their new derivatives. This review also characterises the influence of the amendment to the Act of August 2018 concerning the prevention of drug abuse on the process of banning new drugs and the current legal situation related to the abuse of new psychoactive substances.
More than 130 synthetic cathinones have emerged as novel psychoactive substances (NPS) over the past 15 years. Both the US Drug Enforcement Agency and Council of the European Union have implemented control measures to prohibit the use of synthetic cathinones in recent years and there has subsequently been a decline in their use. This chapter provides a general overview of the clinical implications of cathinone use, followed by focused sections reviewing data relating to pharmacology, prevalence of use, acute and chronic toxicity, and potential dependence for the more widely used cathinones.
Availability and supply analysis of novel psychoactive substances (NPS) is complicated by sheer substance variety, the introduction of ever-newer compounds, linguistic diversity, evolving usage patterns in various nationalities and communities, and a shifting regulatory and legal landscape. Classical data sources are often inadequate, due to either NPS omission, inherent delays in the conduct or publication of research, lack of established government initiatives, or inflexible data systems. With these difficulties in mind, this chapter explores NPS availability and supply through an overview of the market and its structure, including NPS origins, market entry, manufacturing and distribution, and supply chain concerns. Online, retail, and non-retail vending practices are highlighted, with an emphasis on technological advances that have lowered, if not eliminated, barriers to diffusion of NPS knowledge, properties, and price discovery. Branding and misbranding underscore the competitive and potentially hazardous NPS market dynamics, and ongoing market pressures anticipate its continuing evolution.
Background
Many nations place drugs into various “schedules” according to their risk of abuse and/or recognized medical value that vary in terms of their restrictions. To mitigate diversion or abuse, drugs sometimes get rescheduled or are scheduled for the first time. Until now, there have not been efforts to integrate lessons from across the range of such past events.
Methods and data
We searched for peer-reviewed evaluations of instances of (re-)scheduling drugs in the United States after 1969 and a comparably large set of instances from other countries. Those 109 articles were supplemented by 30 others found in other ways but not meeting those search criteria (e.g., because the information on rescheduling was a minor part of a more general article).
Findings
Findings are reported for many outcomes and with diverse measures over different timelines, making standardization of outcomes difficult. For more than half of the events for which quantitative outcomes were reported, there were declines in use-related measures by at least 40 percent. It is common for there to be reports of increases in indicators pertaining to other substances, sometimes more dangerous but sometimes less dangerous; overall, substitution appears to occur, but be partial.
Conclusion
Scheduling and up-scheduling can – though does not always – have substantial effects on a range of outcomes. Substitution to other substances is a possibility and so should be anticipated.
Molecularly imprinted polymers (MIPs) having the potential to mimic the selectivity and sensitivity of
biological molecular recognition are blended here with piezoelectric transducer (EQCM) able to provide
‘real time’ monitoring of molecular level events with extreme sensitivity. In this work, molecularly
imprinted polymer nanoparticles selective for a psychoactive drug, cathinone were synthesized, characterized
and applied for specific and selective uptake in water. Nanoparticles were separated by centrifugation
and characterized for their size and zeta potential. p-Phenylene diamine was chosen as functional
monomer to imprint S-cathinone via in silico studies. Molecularly imprinted nanoparticles were eletrodeposited
on gold coated quartz crystal electrode of electrochemical quartz crystal microbalance (EQCM).
Molecular imprinting experiments were optimized for selective and specific uptake of S-cathinone.
Thus fabricated EQCM sensor was able to discriminate between stereoisomers and other close structural
analogues also. Imprinting data were successfully fitted to Freundlich adsorption isotherm and curves for
non-imprinted and imprinted data were compared. Under optimized conditions, response of nanoMIPEQCM
sensor is linearly proportional to S-cathinone concentration with detection limit as
0.12 ng mL�1 and quantification limit as 0.409 ng mL�1 and imprinting factor as 8. Hence, a highly specific
and selective nanoMIP-EQCM sensor is fabricated in a facile manner.
Background:
New psychoactive substance (NPS) use can negatively impact health and may result in drug-related hospital admissions (DRHAs). Irish youth reported very high rates of NPS use by international standards, the most common being synthetic cannabinoids and cathinones. There was a rapid expansion in specialist shops, called head shops, selling NPS in 2010. Government responded to public protests about head shops by enacting legislation in May and August 2010 to end this trade. Many academics argued that such actions would prove futile. We sought to determine if changes in head shop activity coincided with changes in DRHA.
Methods:
The national database on admissions to general hospitals hospital in-patient enquiry was examined focusing on young adults admitted from 2008 to 2012, and all emergency admissions with an International Classification of Diseases-10 diagnosis of mental disorder related to any drug (F11-F19) were identified. Joinpoint regression analysis was utilized to explore for the presence of trend changes in DRHA.
Results:
Joinpoint regression analysis identified a significant downward trend change which occurred in June 2010 (95% CI February 2010 to January 2011). DRHA increased by 0.5% (95% CI 0.1-0.9) per month prior to this and then fell by 2.6% (95% CI -1.4 to -3.8) per month over the next 16 months.
Conclusions:
Cessation of NPS sale by head shops coincided with a reversal in the upward trend of emergency hospital admissions related to drugs. Although correlation does not confirm causation, legislation which successfully curtails the commercial sale of NPS may result in reduced hospitalizations.
This paper reports the application of wastewater-based epidemiology (WBE) for the monitoring of one city in the UK in years 2014–2018 as a means of 1) exploring relative temporal changes of illicit drug usage trends across 5 sampling weeks in 5 years, (2) assessing policy impact in reducing drug consumption, focussing particularly on mephedrone, which was classified as a class B drug in the UK in 2010, and the effects of subsequent regulation such as the novel psychoactive substances (NPS) bill of 2016, (3) investigating temporal changes in consumption of prescription pharmaceuticals vs illicit drug usage, and (4) comparing consumption of prescription drugs with WBE to enable more accurate verification of prescription drugs with abuse potential. Mephedrone was quantified only for the first two years of the study, 2014–2015, and remained undetected for the next three years of the study. This shows that given enough time changes in drug policy can have an effect on drug consumption. However, after the introduction of the 2016 NPS bill, between the third and fourth study years, there was an observable increase in the consumption of “classic” drugs of abuse such as cocaine, MDMA and ketamine suggesting a shift away from novel psychoactives. The unique prescription dataset allowed for a more accurate calculation of heroin consumption using morphine by examining other sources morphine. Additionally, for compounds with controlled prescription like methadone, trends in consumption estimated by wastewater and trends in prescription correlated. Wastewater-based epidemiology is a powerful tool for examining whole populations and determining the efficacy and direction of government actions on health, as it can, alongside prescription and wider monitoring data, provide a clear insight into what is being consumed by a population and what action is needed to meet required goals.
Alpha-PVP can be defined as a novel psychoactive substance (NPS)—more specifically, a novel synthetic cathinone with unpredictable stimulant effects in humans. “Marvin” arrived at a Dual Diagnosis Unit at Parco dei Tigli, Italy. He underwent a 30-day rehabilitation program to overcome his problematic Alpha-PVP use as a psychonaut. We conducted an online search to understand the properties of Alpha-PVP and its presence in scientific literature, reviewing official reports and the online drug market (e.g., fora, webpages). In the Dual Diagnosis Unit, Marvin completed the 30-day rehabilitation program that included assessments and group and individual cognitive behavioral therapy. Alpha-PVP is a synthetic cathinone with stimulant properties, available in the online market but with unpredictable effects in humans. The present case reports an important risk of psychosis in a psychonaut patient who arrived and declared its intense use before admission to our Unit. This article describes the psychopathological effects of the novel compound Alpha-PVP in a psychonaut patient. Patients attending clinics that have used Alpha-PVP pose a new challenge for traditional services of mental health and addiction.
The recreational use of substituted cathinones continues to grow as a public health concern in the United States. Studies have shown that extended access to intravenous (i.v.) self-administration of stimulants, such as cocaine and methamphetamine, results in escalation of drug intake relative to shorter access; however, little is known about the impact of extended access on self-administration of entactogen class stimulants such as methylone and 4-methylmethcathinone (mephedrone). Male Wistar rats were randomly assigned to short-access (ShA, 2- h) and long-access (LgA, 6- h) groups and trained to self-administer methylone or mephedrone (0.5 mg/kg/infusion) using a fixed-ratio 1 response contingency. The methylone-trained groups were evaluated on a progressive-ratio (PR) procedure incorporating dose-substitution of methylone (0.125-2.5 mg/kg/infusion), mephedrone (0.125-2.5 mg/kg/infusion) or methamphetamine (MA; 0.01-0.5 mg/kg/infusion). Mephedrone-trained rats were similarly evaluated on a PR with mephedrone and MA. Rats trained with LgA to methylone and mephedrone earned more infusions during acquisition compared with ShA groups. Mephedrone-trained LgA rats reached significantly higher breakpoints than all other groups in mephedrone and MA PR tests. Methylone-trained LgA rats exhibited a rightward shift of the peak effective dose but no overall efficacy change compared with methylone-trained ShA rats. These findings show that the self-administration of mephedrone escalates under LgA conditions in a manner similar to traditional stimulants whereas escalation of 6 h intakes of methylone is not accompanied by differences in PR performance. Thus mephedrone represents the greater risk for dysregulated drug consumption.
Background:
This review aimed to address what was known about the public health burden associated with novel psychoactive substances (NPS) use, and the effectiveness of responses targeting NPS use and/or associated problems.
Methods:
Relevant literature was identified through a range of searches covering the period from January 2006 to June 2016. Data synthesis was undertaken in three stages. Firstly we mapped the evidence available in order to characterize the literature according to a set of analytic categories developed a priori. Secondly, we identified evidence gaps from a set of a priori research questions. Finally, we then undertook a narrative synthesis of selected bodies of evidence, interpreting data using a conceptual framework specifically designed for use in this review.
Results:
A total of 995 articles were included in the scoping review with the majority being case reports/series on individual level adverse effects due to NPS use. We synthesized UK data from 29 surveys and 7 qualitative studies, and international data in 10 systematic reviews on harms associated with NPS use, and 17 evaluations of policy responses. We found little data on risk factors, harms associated with long-term NPS use, and interventions.
Conclusion:
In all cases we found the available evidence to be at an early stage of development.
Background:
Mephedrone is a β-ketoamphetamine belonging to the family of synthetic cathinones, an emerging class of designer drugs known for their hallucinogenic and psychostimulant properties as well as for their abuse potential.
Objective:
The aim of this review was to examine the emerging scientific literature on the possible mephedrone-induced neurotoxicity, yet not well defined due to the limited number of experimental studies, mainly carried on animal models.
Materials and methods:
Relevant scientific articles were identified from international literature databases (Medline, Scopus, etc.) using the keywords: "Mephedrone", "4-MMC," "neurotoxicity," "neuropharmacology", "patents", "monoamine transporters" and "neurochemical effects".
Results:
Of the 498 sources initially found, only 36 papers were suitable for the review. Neurotoxic effect of mephedrone on 5-hydroxytryptamine (5-HT) and dopamine (DA) systems remains controversial. Although some studies in animal models reported no damage to DA nerve endings in the striatum and no significant changes in brain monoamine levels, some others suggested a rapid reduction in 5-HT and DA transporter function. Persistent serotonergic deficits were observed after binge like treatment in a warm environment and in both serotonergic and dopaminergic nerve endings at high ambient temperature. Oxidative stress cytotoxicity and an increase in frontal cortex lipid peroxidation were also reported. In vitro cytotoxic properties were also observed, suggesting that mephedrone may act as a reductant agent and can also determine changes in mitochondrial respiration. However, due to the differences in the design of the experiments, including temperature and animal model used, the results are difficult to compare.
Conclusions:
Further studies on toxicology and pharmacology of mephedrone are therefore necessary to establish an appropriate treatment for substance abuse and eventual consequences for public health.
This chapter explores some of the social issues in the New Psychoactive Substances (NPS) debate including availability, prevalence and contexts of use, motivations for use, social harms, policy options and the impact of legislative control. In its consideration of the prevalence of use of key NPS in contrasting UK survey samples, this chapter presents previously unpublished data from the author’s annual surveys at English music festivals in the summers of 2010, 2011 and 2018, suggesting a picture of differentiated demand, pockets of waning popularity and a merging of drug markets. The key characteristics of the evolving NPS market moved from combining legitimate internet trading with features of the international trade in counterfeit prescription medications, to the misselling of NPS as established controlled drugs as those markets increasingly merged. A key theme of this chapter is speed: the speed of emergence of NPS echoes their predominantly stimulant effects and the rapidity of policy change around the world, contrasted with the recency of the phenomenon combined with the time lag between emergent trends in drug use and the development of a rounded scientific evidence base. I return to this point in the final section of this chapter where I cast a critical eye on the development of the NPS debate itself.
There have been increasing reports in the popular and scientific media of the use of drugs called “Bath Salts”. These drugs have nothing to do with ordinary bath salts but are synthetic ring substituted cathinones. The main drugs encountered are mephedrone, methylone and 3,4-methylenedioxypyrovalerone (MDPV). Most reports involve the drug mephedrone, which has been popular in Europe but “Bath Salt” cases are also seen in North America. These drugs have sympathomimetic effects and the reported deaths have had similar histories to other stimulant drugs. This review examines the use of “Bath Salts”, particularly mephedrone and its clinical effects and toxicology, along with reported autopsy findings.
The abuse of “bath salts” is a fairly new trend amongst teenagers and young adults. These substances, which are sold under various brand names, contain any one, or mixtures of, several synthetic cathinones such as 3,4-methylenedioxypyrovalerone (MDPV). The users of these substances may present with delusions, hallucinations, severe psychomotor agitation, and various other physiological effects. Special screens are required to detect these substances in users. Management is mostly supportive and has involved the use of benzodiazepines, antipsychotics, and general anesthesia in extreme cases. The use of beta blockers in users with elevated blood pressure is contraindicated as it may cause dangerous paradoxical increase in blood pressure.
We should focus on crafting the most effective public health response
With the aging of the population, an increasing number of older adults are diagnosed with Alzheimer's disease or a related disorder. Most people with a dementing illness will be cared for at home by a family member, who may experience a variety of physical, emotional, financial, and social burdens associated with the caregiving role. The purpose of this article is to (a) examine the physical and psychological effects of providing care to a family member with a dementing illness, (b) describe the factors that help determine the nature and magnitude of these effects, and (c) discuss several approaches to caregiver intervention designed to reduce the negative impact of this challenging role. Sociodemographic characteristics (e.g., gender, relationship to the patient, culture, race, ethnicity), caregiver resources (e.g., coping, social support, availability of a companion animal), and personal characteristics (e.g., personality, health behaviors) shape the dementia caregiving experience and have implications for interventions designed to prevent or lessen the stress and burden that often accompany the role.
Alzheimer's disease is the most frequent form of dementia, where behavioral and cognitive disruption symptoms coexist. Depression, apathy, anxiety, and other conduct disorders are the complaints most often reported by caregivers.
Fifty subjects were referred to our Institute with a diagnosis of probable Alzheimer's disease. Cognitive impairment was equally distributed among the subjects. Patients, aged 68 to 76 years old, were randomized to receive inhibitors of cholinesterase (Donepezil, 5 mg/ day) alone, or inhibitors of cholinesterase plus selective seratonin reuptake inhibitors (SSRIs) (citalopram HBr, 20 mg/day).
We followed up all the patients for one year, with particular concern for neuropsychological aspects associated with eventual behavioral changes. Results indicate that SSRI intake seems to be effective for depression, decreasing it and improving quality of life for both patients and caregivers. Side effects in both groups were few, and there were no study withdrawals.
This paper discusses the relationship between dementia-and depression, and presents our finding that depressive symptoms, if specifically treated, tend to reduce caregiver stress and improve well-being in patients with Alzheimer's disease.
Mephedrone: assessment of health risks and harms, 2010.
- Winstock AR
- Marsden J
Mephedrone, new kid for the chop?.
- Winstock AR
- Mitcheson LR
- Deluca P
- Davey Z
- Corazza O
- Schifano F