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Many new psychoactive substances NPS under different names throughout the world, Macedonia and Slovenia included, have emerged in the past few years. The most common names are: designer drugs, legal highs, herbal highs, research chemicals, bath salts, plant food etc. The substances are usually marked as not for human consumption. They are synthetic or plant based mostly sold on the internet or shops known as smart shops or head shops. These substances are not protected with the international legislation. In , for the third time in a row, the largest number of new substances — 49 — was reported in Europe, which is more than the 41 in and the 24 substances in In , 73 new psychoactive substances were officially notified. The dominant substances in the last few years are mostly synthetic cannabinoid agonists CRA , phenethylamine and cathinones, which imitate the effects of the most desired illicit drugs. In addition, the number of internet stores in EU that provide clients with psychoactive substances or products has also increased. In January , internet stores were discovered, which is more than the in January and in January Apart from the aforementioned sources, NPS can also be purchased with the mediation of street sellers. The growing trend in new drugs can easily be tracked in the daily clinical practice of those working with people dependent on illicit drugs. NPS are substances of abuse either in pure form or a preparation not controlled by the existing conventions the Single Convention on Narcotic Drugs from or the Convention on Psychotropic Substances from , but may pose a public health treat. These substances are legal alternative to controlled substances, i. One of the first NPS is ketamine, followed by phenethylamine, piperazines, synthetic cannabinoids, synthetic cathinones and others. Madras divides the so-called designer drugs into four major groups: synthetic cathinones and amphetamines mephedrone, MDPV, methylone etc. Mostly, these substances are not with natural origin as are usually marketed , but are synthesized in laboratories in Europe and Asia mostly China and India. For the time being, the standard urine tests used daily in the clinical practice cannot detect them. The market has already offered tests which detect some of the substances from the synthetic cannabinoids group. The fact that a certain substance is still legal can offer false sense of safety, i. The offer quickly adjusts to the market. Once the substance in question is listed as prohibited the laboratories immediately synthesize a new one. It can be quite similar to the first one, however the slightest change in its chemical structure lists it back among the legal substances. There are the so-called anonymous networks, i. The technology required to visit these networks is now included in the standard program equipment, which makes it available for a broader circle of people. All of this, in addition to the convenient price, is the reason why young users reach to the new drugs. There is no data on the pharmacodynamics and pharmacokinetics or the possible long-term consequences on the mental or physical health. The short-term negative toxic effects are known only from clinical cases. The use if NPS has also led to a number of death cases. Research in the field of NPS is exceptionally rare. There are certain descriptions of clinical cases available mostly intoxication. The long-term effects regarding the use of these substances are almost unknown. The listed adverse effects are from mild to life threatening effects on the cardiovascular, nervous, gastrointestinal and respiratory system. There is a wide spectre of possible psychiatric complications with the use of these drugs and complications in users who suffer from mental diseases. Theory mostly lists: agitation, insomnia, difficulty concentrating, transitory paranoia, distorted perception, anxiety, transitory changes in the mood, delirium or even serious psychotic conditions, as well as suicidal impulses. The effects are similar to those of marihuana — relaxation, sedation, euphoria and altered perception. Contrary to tetrahydrocannabinol THC , found in marihuana and categorized as partial agonist of cannabinoid CB1 receptors, their effects are often related not only to CB1 but cannabinoid CB2 receptors also, as full agonists. Synthetic cannabinoids do not contain cannabidiol CBD which, among others, has antipsychotic affects. CBD is found in marihuana, hence is assigned with a protective role. The listed side effects are: agitation, distortion in time perception, anxiety, dysphoria, hallucinations and paranoia. There have been cases of induced psychotic symptoms in people who used cannabinoids and deterioration in these psychotic symptoms in people with psychosis. The listed peripheral side effects are: gastrointestinal distress sickness, vomiting , cardiovascular complications increased blood pressure, rapid heart rate, cardiac ischemia , metabolic effects hypocalemia, hyperglycemia, acidosis , effects on the nervous system dilated pupils, increased body temperature, nystagmus, convulsions, coma , acute renal failure. The second important group of new psychoactive substances is the synthetic cathinones. They are synthetic analogues of naturally occurring compounds found in the plant Catha edulis. They are a class of stimulants of the central nervous system CNS , also psycho-stimulants and can be hallucinogenic in higher dosage. They exert their effects by inhibiting the reuptake of monoamines — serotonin, dopamine and noroadrenaline and have strong sympathomimetic effects. They can cause euphoria, alertness, increased energy, a need to be active, decrease the appetite, improve the sense of music, influence the sexual activity, i. The described side effects are cardiovascular, neurological, respiratory, gastrointestinal and psychiatric. For instance, agitation, psychosis, hallucinations, paranoia, delusions , suicidal urges, aggression, anxiety, insomnia; sometimes the symptoms resemble to those of delirium disorganization, disorientation, attention deficit disorder and memory loss. Macedonia also has the first clients who use NPS from the group of synthetic cannabis. They also report on lack of marihuana illicit drugs on the black market lately, as well as an increase in its price, which, other factors aside, can also lead to the use of synthetic cannabis instead. There is still no research on the use of NPS in the country. The existing screening tests for toxicological analysis used in health institutions and laboratories available in the country cannot detect presence of these substances in the urine, while experts are not sufficiently prepared to face the challenges triggered by the use of the new legal psychoactive substances. Judging by the results from the research on NPS use in Slovenia by Sande and his collaborators, cathinones are the most common and favourite NPS group used in Slovenia. The average age of the respondents in the research was Almost one fourth were high school students, leading to the conclusion that NPS users are quite young. The most used among the cathinones in Slovenia is 3-MMC, or ice cream. The reason NPS users list is the pleasant effects, price and availability, rather than it being legitimate. It is an isomer of the favourite mephedrone, i. It is found in the form of crystals, white powder, used orally or nasally. It causes changes in consciousness, pleasure, euphoria, warmth, love, confusion, relaxation. It can cause severe side effects confusion, shaking, palpitations, arrhythmia, chest pains, stomach pains, convulsions, epileptic seizures, hyperthermia, blue or cold fingers, changes in the mood, i. It is spread among the young population apart from high school students, students from elementary schools are also suspected of using it. It can be found in the form of a liquid with no colour or odour, powder and capsules. Users mostly mix it in drinks. Small doses cause relaxation, possibly euphoria, it increases the sexual urge, making the user more communicative and sociable. Larger dosages cause vertigo, confusion, loss of memory and convulsions. It can also lead to addiction. Frequent and long-term use leads to physical dependence. Early abstinence syndromes are similar to those of alcohol dependence possible symptoms of delirium, psychosis, or catatonia. Abstinence syndromes occur 1 to 6 hours later, as anxiety, tremor, insomnia, sickness, vomiting, paranoia, intense hallucinations, changes in memory and aggression, leading to death if not treated. The abstinence crisis lasts from 3 to 21 days, and it is treated with benzodiazepines, while other countries also use baclofen GABA-B agonist , barbiturates and propofol. The manner in which it is dosed drops, spoonfuls , can lead to overdose or even possible death. Finally, we would like to mention that NPS use mostly synthetic cathinone has spread to other European countries even among intravenous drug users heroin or amphetamine users , who also use NPS intravenously. The new NPS with its specific market characteristics and the less known, for the time being, side effects on the physical and mental health require in-depth research and study not only to recognize the acute conditions after their use, but rather to adjust the existing treatment and programs for reduction of drug related harms with the current needs on the field. The programs should keep the pace with time, i. Cyril and Methodius University in Skopje. Andrej Kastelic is a doctor in medical sciences. She specializes in working with people who use drugs with complex needs and comorbid mental diseases. Biljana Stojceska is a specialist in neurology, at present specializing in psychiatry in Ljubljana, Slovenia. Save my name, email, and website in this browser for the next time I comment. This site uses Akismet to reduce spam. Learn how your comment data is processed. Type above and press Enter to search. Press Esc to cancel. Facebook Twitter Instagram. Healthy options project Skopje. What are the new psychoactive substances? Further below we list the most common psychological side effects of the mostly used NPS. The current situation in Macedonia and Slovenia Macedonia also has the first clients who use NPS from the group of synthetic cannabis. Conclusion The new NPS with its specific market characteristics and the less known, for the time being, side effects on the physical and mental health require in-depth research and study not only to recognize the acute conditions after their use, but rather to adjust the existing treatment and programs for reduction of drug related harms with the current needs on the field. Andrej Kastelic Andrej Kastelic is a doctor in medical sciences. Biljana Stojceska Biljana Stojceska is a specialist in neurology, at present specializing in psychiatry in Ljubljana, Slovenia. Previous Article Formal and non-formal education on working with marginalized communities. Next Article The third shift. Related Posts. Addiction and Family. 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New psychoactive substances (NPS) and side effects, the situation in Macedonia and Slovenia
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New psychoactive substances (NPS) and side effects, the situation in Macedonia and Slovenia
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