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Illicit drug use is a global problem imposing social, economic, and health burdens on society. Wastewater-based epidemiology is an approach based on calculating the consumption of substances in the target population by analyzing the concentrations of human metabolic excretion products of licit and illicit substances in wastewater. This study estimated the changes in illicit drugs cocaine, amphetamine, methamphetamine, ecstasy 3,4-Methylenedioxymethamphetamine , heroin, and marijuana THC , alcohol, and nicotine consumption in Adana Province during Ramadan compared to normal periods using wastewater-based epidemiology. For cocaine, the variation was the slightest 8. The differences were statistically significant for ecstasy, heroin, nicotine, and alcohol but not for cocaine, amphetamine, methamphetamine, and marijuana. This study is the first to show changes in the use of illicit drugs, alcohol, and nicotine under the influence of religious beliefs. This study provides information on the literature on this subject. Illicit drug use is a global problem and a social, economic, and health burden on society Castiglioni et al. Wastewater-based epidemiology WBE is an increasingly popular approach to providing information on drug use and abuse due to its objectivity, cost-effectiveness, potential to increase data accuracy, and ability to reveal near real-time data Thomas et al. WBE is based on identifying human metabolic excretion products biomarkers of licit and illicit drugs in wastewater Zuccato et al. It also allows tracking of temporal variations in drug consumption to identify trends and compare drug use across cities, regions, and countries Daglioglu et al. However, data obtained by these methods may be affected by subjective factors sampling, chemical analysis, stability of biomarkers in wastewater, limitations in back-calculation e. Since its first implementation by Zuccato e al. There are various studies on the assessment of illicit drugs, alcohol, and nicotine consumption in countries such as China Gao et al. In Turkey, such studies have gained momentum in the last 5 years Daglioglu et al. Likewise, WBE has been used to investigate changes in using illicit drugs, alcohol, and nicotine on various occasions festivals, special events, COVID pandemic period, etc. Benaglia et al. Meanwhile, another study conducted on wastewater collected in 6 festivals in Europe reported that the most frequently detected drugs were cocaine, ecstasy, cannabis, and ketamine Bijlsma et al. Likewise, Ramadan was selected in the current study as the sampling period since it covers a one-month-long period, which is important for Muslims in terms of religion. During Ramadan, the ninth month of each year on the Islamic calendar, adult Muslims must refrain from consuming any food, drinks, or oral medication from sunrise to sunset Aveyard et al. Since Ramadan can occur in any of the four seasons, the fasting time varies between 11 and 18 h per day, depending on sunrise and sunset Aslam and Assad Despite the common practice of fasting, Ramadan-specific customs, lifestyles, and social habits may vary among Islamic countries Aadil et al. Turkey is also among those countries with Islamic culture since most of the population is Muslim, as referred to in the European Commission report European Commission EC To the best of our knowledge, the present study aiming at estimating the consumption of these 6 illicit drugs, alcohol, and nicotine is the first to show changes in their consumption during Ramadan by WBE. Adana Province is the sixth-largest province of Turkey with a population of 2. Samples were collected from Seyhan wastewater treatment plant WWTP , the biggest in Adana serving approximately 1,, people, for 1 week during Ramadan 21—27 May and 1 week after Ramadan as a normal week 11—17 June The real daily flow rates were used for back-calculation. The flow rates were Composite h influent samples were collected for 7 days starting on Tuesday of each week at The samples were filtered with 0. The extraction methods for the illicit drug analysis, and alcohol EtS and nicotine cotinine analysis were used according to Daglioglu et al. The same method was used for the analysis of illicit drugs and cotinine. Detector and interface voltages are 1. Specific MS parameters such as fragmentor voltage and collision energies CE were optimized. The selected fragment ions and CE used for the instrumental analysis are shown in Table 1 including retention times, calibration ranges, and limits of quantitations LOQs for all target analytes. MeOH was injected before each sequence. In addition, after every 20 samples, internal quality control samples were analyzed. This procedure was applied to analyze illicit drugs, nicotine, and alcohol biomarkers. Analyses at each concentration level were repeated six times. Obtained results of non-spiked water samples were subtracted before recovery calculations. The standard deviation SD , relative standard deviation, and recovery values of the above-mentioned repeatability studies were calculated. The accuracy was No marked carry-over was observed for all of the analytes. LODs for illicit drugs were estimated between 0. Method validation parameters were given for all spiking levels in Table S1. The consumption of target substances was back-calculated considering concentrations of biomarkers, wastewater flow, the size of the population served by the WWTP, and applying a correction factor regarding human metabolism. The amount of therapeutic morphine was obtained and subtracted for heroin back-calculations van Nuijs et al. The amount of therapeutic morphine used in Adana Province during the sampling period, obtained from the Provincial Health Directorate, was 0. The back-calculation equations of Daglioglu et al. With the data obtained from the Turkish Statistical Institute TUIK , the estimated consumption per capita has been adjusted for the age range of 15— The average number of cigarettes smoked by people per day was calculated using the average amount of nicotine absorbed by the body during smoking 1 mg Hukkanen et al. One-Sample Kolmogorov-Smirnov test was used to determine the normality of the data. Wilcoxon signed-rank test or T test were applied depending on the normal distribution to investigate the changes between normal and Ramadan periods. Figure 1 shows the per capita illicit drug consumption during the normal week and Ramadan. All illicit drugs were detected in all samples. Table 2 shows the mean, standard deviation, and minimum and maximum values of illicit drugs consumption measured during the normal week and Ramadan. The trend is similar to all illicit drugs, with a decrease in consumption observed during Ramadan. The weekly pattern of consumption estimates for illicit drugs during Ramadan and a normal week note that the y -axis is different for each compound. When the daily MDMA consumption estimate in this study was examined, it was determined that the usage on Friday was lower than on the other days in both sampling periods normal week and Ramadan. The least change in Ramadan was detected for COC 8. In a study conducted in 11 provinces in Turkey in , the mean estimated COC consumption was reported as Although estimated COC consumption was higher than observed in China 2. Nevertheless, this decrease was determined to be statistically not significant AMPH p value: 0. In the study by Daglioglu et al. The AMPH values obtained in the present study, which were 8. Daglioglu et al. Likewise, Daglioglu et al. When mean values of these studies for Adana were compared to values observed in the current one, there was an increasing trend in HER use. There was no statistically significant difference in the consumption of marijuana p value: 0. Regarding another study in Turkey considering THC consumption, the highest figures were observed predominantly in summer in Gaziantep another city near Adana. At the same time, it was the fall in Adana during which marijuana consumption was relatively high Daglioglu et al. The nicotine metabolite cotinine and the alcohol metabolite EtS were measured in all samples. Table 3 shows the mean, standard deviation, minimum and maximum alcohol ALC and nicotine NIC consumption values during the normal week and Ramadan. Assuming that a single cigarette contains 1 mg of nicotine, it was found that 2. While the average of tobacco use obtained in this study was similar to TAPDK data, it was lower than the value of 4. In , the per capita annual alcohol consumption in Turkey was 1. In Fig. While there was no significant change for illicit drug use on Friday during Ramadan, a significant change was observed in alcohol and nicotine use Fig. Similarly, when the literature was reviewed, it was found that there was an inverse relationship between church attendance and excessive drinking behavior Michalak et al. Friday is considered a holy day for Muslims, and praying as a community is particularly common. During Ramadan, a time when Muslims give extra importance to worship, nicotine and alcohol use decreases even more on Fridays. Weekly pattern of consumption estimates for nicotine NIC and alcohol ALC during Ramadan and a normal week note that the y -axis is different for each compound. In a study on alcohol consumption conducted in Turkey, the average estimated consumption varied from In the study of Ghouri et al. Studies reported that the onset of Ramadan was used as an incentive to encourage stopping smoking since obligatory non-smoking during Ramadan could cause many regular smokers to quit Ghouri et al. This study determined that nicotine use decreased in Ramadan, which confirms the results of the previous studies. There is no study reporting the number of fasting people in Adana province. Studies show that, during Ramadan, Muslim patients arbitrarily change their prescription drug regimen without any medical consultation Aslam and Assad ; Aadil et al. This study, which compared the use of illicit drugs, alcohol, and nicotine, showed that the use of all these substances decreased during Ramadan. Studies using the WBE approach have some uncertainties and limitations, such as sampling, chemical analysis, stability of biomarkers in wastewater, and limitations in back-calculation e. The standard uncertainties and limitations for biomarkers were instrumental measurement i. Therefore, it should not be overlooked that the population of Adana does not consist of only Muslims. The aim of this study, the variations in Ramadan was based on the fact that Turkey is among the countries with a predominantly Muslim population. Each of these limits is likely to affect per capita substance consumption calculations. Nonetheless, WBE is of paramount importance in profiling drug consumption in real-time and monitoring changing trends, where other methods are unavailable. Also, the study showed the effectiveness of wastewater epidemiology as a method for evaluating the consumption of illicit drugs, alcohol, and nicotine, particularly its usefulness in monitoring swiftly changing trends during periods such as Ramadan or different interests. Finally, this study is the first to show changes in the use of illicit drugs, alcohol, and nicotine under the influence of religious beliefs. Finally, this study provides information on the literature on this subject. Br Med J — Water Res Public Health — Accessed 5 Apr Addiction — Article Google Scholar. Environ Int Forensic Sci Int —8. Bijlsma L, Celma A, Castiglioni S et al Monitoring psychoactive substance use at six European festivals through wastewater and pooled urine analysis. Sci Total Environ Bowery NG Codeine. Buzrul S Alcohol Consumption in Turkey. J Food Heal Sci — Castiglioni S, Zuccato E, Crisci E et al Identification and measurement of illicit drugs and their metabolites in urban wastewater by liquid chromatography—tandem mass spectrometry. Anal Chem — Castiglioni S, Bijlsma L, Covaci A et al Evaluation of uncertainties associated with the determination of community drug use through the measurement of sewage drug biomarkers. Environ Sci Technol — Castiglioni S, Senta I, Borsotti A et al A novel approach for monitoring tobacco use in local communities by wastewater analysis. Tob Control — Causanilles A, Kinyua J, Ruttkies C et al Qualitative screening for new psychoactive substances in wastewater collected during a city festival using liquid chromatography coupled to high-resolution mass spectrometry. Chemosphere — J Relig Health — Forensic Sci Int — Environ Sci Pollut Res — Sci Total Environ — Sci Total Environ —— BMJ Drug Test Anal. Hershkop E, Bisharat B Ramadan and smoking cessation. Isr Med Assoc J Google Scholar. Pharmacol Rev — In: Neurobiology of Addiction. Elsevier, pp — Kuloglu M, Mercan S, Yayla M et al Monitoring geographical differences in illicit drugs , alcohol , and tobacco consumption via wastewater-based epidemiology: six major cities in Turkey. Curr Opin Environ Sci Heal — Environ Toxicol Pharmacol — Mercan S, Kuloglu M, Tekin T et al Wastewater-based monitoring of illicit drug consumption in Istanbul: preliminary results from two districts. Environ Pollut — National Alcohol Survey: how important is religion for abstention and drinking? Drug Alcohol Depend — Int J Drug Policy — Trends Environ Anal Chem Vuori E, Happonen M, Gergov M et al Wastewater analysis reveals regional variability in exposure to abuseddrugs and opioids in Finland. Sci Total Environ 1 — Zarei S, Salimi Y, Repo E et al A global systematic review and meta-analysis on illicit drug consumption rate through wastewater-based epidemiology. Zuccato E, Castiglioni S, Fanelli R Identification of the pharmaceuticals for human use contaminating the Italian aquatic environment. J Hazard Mater — Download references. The author would like to thank Asli Atasoy and Ismail Ethem Goren for their valuable technical support in field and laboratory studies. You can also search for this author in PubMed Google Scholar. All of the research, methodology, validation, data curation, original drafting, writing, visualization, and editing were done by the author Evsen Yavuz Guzel. Correspondence to Evsen Yavuz Guzel. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and permissions. Guzel, E. Monitoring of changes in illicit drugs, alcohol, and nicotine consumption during Ramadan via wastewater analysis. Environ Sci Pollut Res 29 , — Download citation. Received : 05 January Accepted : 11 July Published : 18 July Issue Date : December Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Download PDF. Abstract Illicit drug use is a global problem imposing social, economic, and health burdens on society. Graphical abstract. Comparison of pharmaceutical, illicit drug, alcohol, nicotine and caffeine levels in wastewater with sale, seizure and consumption data for 8 European cities Article Open access 01 October Tracing consumption patterns of stimulants, opioids, and ketamine in China by wastewater-based epidemiology Article 04 January Analysis of crude wastewater from two treatment plants in South Wales for 35 new psychoactive substances and cocaine, and cannabis Article Open access 29 August Use our pre-submission checklist Avoid common mistakes on your manuscript. Introduction Illicit drug use is a global problem and a social, economic, and health burden on society Castiglioni et al. Sampling period and location Adana Province is the sixth-largest province of Turkey with a population of 2. Wastewater sampling Composite h influent samples were collected for 7 days starting on Tuesday of each week at Analytical procedure and data treatment Sample preparation and extraction The samples were filtered with 0. Table 1. Results and discussion Illicit drugs use during normal week and Ramadan Figure 1 shows the per capita illicit drug consumption during the normal week and Ramadan. Fig 1. Full size image. Table 2 Per capita consumption estimates of illicit drugs Full size table. Table 3 Per capita consumption estimates of nicotine and alcohol Full size table. Data availability All data generated in this study is found in this manuscript. Elsevier, pp — Kuloglu M, Mercan S, Yayla M et al Monitoring geographical differences in illicit drugs , alcohol , and tobacco consumption via wastewater-based epidemiology: six major cities in Turkey. Acknowledgements The author would like to thank Asli Atasoy and Ismail Ethem Goren for their valuable technical support in field and laboratory studies. Funding The author did not receive support from any organization for the submitted work. Ethics declarations Ethics approval Not applicable. Consent to participate Not applicable. Consent for publication Not applicable. Conflict of interest The author declares no conflict of interest. Supplementary information. Rights and permissions Reprints and permissions. About this article. Cite this article Guzel, E. Copy to clipboard. Search Search by keyword or author Search. Navigation Find a journal Publish with us Track your research.

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