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Official websites use. Share sensitive information only on official, secure websites. Corresponding author: Feyza Bora. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. Ecstasy MDMA; 3,4-methylenedioxymethylamphetamine is an illicit drug that has been increasingly abused by young people. Its effects include euphoria, enhanced sociability and heightened mental awareness. These come about via the increase of serotonin in both the central nervous system and the sympathetic nervous system. Due to personal pharmacokinetics, effects from the same dosage vary according to the individual. However, it is seldom the case that hyponatremia and hyperthermia co-exist. Hyponatremia is caused by the inappropriate secretion of arginine vasopressin AVP and the excessive intake of hypotonic liquid accompanied by increased hyperthermia. Symptomatic, even deadly hyponatremia is seen more frequently in females, with the effects of oestrogen on arginine vasopressin believed to be the cause. Reasons for acute kidney injury may include rhabdomyolysis, malign hypertension, and necrotizing vasculitis. Synthetic tablet abuse has seen a dramatic worldwide increase. We also suggest treatment methods for these kidney injuries. Ecstasy MDMA; 3,4-methylenedioxymethyl-amphetamine is an illicit drug that has been increa-singly abused by young people. The most well-known of the illicit synthetic tablets, it was introduced to Turkey in the early s — a country which, due to its geographical location and youthful population, has been subject to the negative effects of the international drug trafficking. However, it is still third on the list of most-seized drugs 1. The amounts of ecstasy captured in Turkey between are shown in the Table 1. Although the active component of ecstasy is 3,4-methylenedioxy-methylamphetamine MDMA , users of the drug give the same name to all similar synthetic tables. These tablets, which are illegally manufactured and sold on the streets, contain amphetamine-type stimulants. They may also contain sugar, inorganic chemicals and inorganic salts that do not have any stimulant, sedative or sleeping effects on the human body. Amphetamine-type stimulant substances are illegally produced. As a result, they contain additional chemicals that are created during the production process and which present an added danger to drug users. Ecstasy tablets are made and sold in various colours, with different geometric shapes and logos intended to make them more attractive to young people. The increased attractiveness of synthetic tablets leads to greater curiosity, which in turn leads to higher levels of addiction. Examples of recently captured ecstasy tablets are shown in Figure 1. In , the number of the deaths directly related to illicit drugs in Turkey was , rising to in — a MDMA causes feelings of vibrancy and well-being, loss of anxiety, emotional fluctuations and indecisi-veness 1 , 5 , 8 , 9. Initially, the body experiences hyperthermia and hyperactivity 1 , 5 , There may also be adverse effects such as exhaustion, sleeping disorders, nausea, vomiting, shudders, sweats, chin-lock, gnashing of teeth, blurry sight, dilating pupils, discomfort caused by light, and arrhythmia 1 , 5 , MDMA has a stimulant, hallucinogenic effect, and is also known to enhance mental factors such as energy, empathy and euphoria Generally considered a recreational drug, MDMA produces these effects by preventing the re-uptake of neuroactive hormones such as serotonin, dopamine and noradrenalin in both the central nervous system and the sympathetic nervous system Tablets that include amphetamine-type stimu-lants have a mass of between mg and mg 1. On average, they contain mg of MDMA. The drug begins to take effect after min, peaking at 90 min 14 , In general, its effect may last between hr, occasionally longer. The effects of illicit tablets on humans may depend on the contents and amounts of the tablet consumed. Effects may also differ from case to case depending on the varieties and amounts of the active ingredients in different synthetic tablets 5. MDMA metabolizes in two pathways. In the first, it conjugates with N-dealkylation, deamination, oxidation and glycine, becoming HMA 4-hydroxymethoxyamphetamine. Medicines that are inhibitors of cytochrome P 2D6 isoenzyme ritonavir and antifungal can prevent ecstasy from being metabolized 16 - It has been established that the effect of cytochrome P 2D6 isoenzyme, in addition to inhibiting other medicines, varies from person to person. As the drug stays longer in the body of people who metabolize it slowly, there is a higher risk of acute toxicity Due to the lower enzyme activity in people of Korean, Chinese and Japanese origin, there is an inclination towards hyperthermia, rhabdomyolysis, serotonin syndrome and multi-organ failure 19 , Also, it has been shown that MDMA metabolites might create an inhibitor complex with the cytochrome P 2D6 enzyme, leading to toxicity in repetitive doses. MDMA and metabolites 21 are removed by the kidneys, and variations in the removal process might explain why people taking the same dose of MDMA do not experience the same adverse effects. Although ecstasy usage is relatively common, instances of fatal adverse effects are rare. MDMA has a negative effect on the immune system. IL is an anti-inflammatory or immunosuppressive cytokine that inhibits the production of pro-inflammatory cytokine TNF-alpha, IL, and IFN-gamma, as well as decreasing many macrophage functions. MDMA also has a suppressive effect on catechol aminergic beta-adrenoceptor and nicotinic acetyl-choline receptor-mediated immune function 23 , The drug increases levels of glucocorticoid cortisol, plasma corticosterone, and also the inactive steroid dehydrocorticosterone. MDMA use may negatively affect cancer progression by inhibiting immune regulatory systems and reducing the resistance of host cells to viral infections The effects of ecstasy on the kidneys can be placed into the following sub-groups: effects on fluid and electrolyte metabolism; hyperthermia; and acute kidney injury. These categories are discussed in further detail below. Acute symptomatic hyponatremia heads the list of serious ecstasy-related complications. In terms of physiopathology, inappropriate secretion of AVP is believed to be the cause of hyponatremia. Psychogenic polydipsia resulting from the belief that large amounts of generally hypotonic liquid should be taken to avoid hyperthermia during parties could be of benefit to the physiopathology. In one study, there was a statistically significant increase from 1. Case studies in which AVP levels were not measured have also shown that urine osmolality increases incompatibility in the case of serum hypoosmolality, which is compatible with the inappropriate secretion of AVP MDMA and metabolites have been shown to increase serotonin levels in the central nervous system, and this high level of serotonin causes AVP release due to neurohypophysis It is believed that AVP release could increase with stress, physical activity and the use of nicotine—additional factors that are generally present in situations where ecstasy is used As seen in the case of fluoxetin—a serotonin-specific reuptake inhibitor SSRI —another factor might be increased water absorption in the internal medullar collector channel linked to an increase in the expression of aquaporin 2 channels Hyperthermia, which could be caused by a reduction in MDMA levels and an increase in HMMA, is not frequently seen in cases that are accompanied by hyponatremia Hyponatremia symptoms generally commence between two to twelve hours after ecstasy intake. In patients with Ayus—Arieff syndrome, there may be neurogenic pulmonary oedema. Hyponatremia in patients with this syndrome will cause the development of pulmonary oedema after cytotoxic cerebral oedema. Pulmonary oedema would result in hypoxia, which inhibits the volume regulation of the brain cells, which in turn causes further deterioration to the cerebral and pulmonary oedema The same Na values are more symptomatic in women than in men Some studies affirm that there is a higher risk of symptomatic hyponatremia in women and that the condition may even be fatal 38 , It is more likely for women to experience hyponatremia for the following reasons:. A study involving eight men and eight women found that the levels of copeptin, which is easier to quantify than MDMA, is higher in men. Hyperthermia is a fatal complication of MDMA. However, the condition might lead to non-traumatic rhabdomyolysis, hypotension, disseminated intravas-cular coagulation DIC , acute kidney failure, hepatic failure, cardiovascular collapse, intracranial bleeding and death 48 , Some studies state that hyperthermia originates from sustained heat resulting from the activation of 5-OH tryptamine and dopamine receptor systems 54 - It has been observed that hyperthermia does not originate from a change in heat adjustment in the hypothalamus, and antipyretics are hence not included in the treatment options. It has also been observed that increased muscular activity could contribute to hyperthermia Long-lasting hyperthermia may result in DIC and multi-organ failure 11 , The most significant reason for acute kidney injury is acute tubular necrosis caused by pigment due to non-traumatic rhabdomyolysis necrosis of myocytes caused by a rapid rise in cellular calcium. Acute kidney injury might be caused by hyperthermia, extreme activity, seizures, or by the direct toxic effects of MDMA on muscle cells Volume depletion increases the nephrotoxic effect of rhabdomyolysis. There may also be myoglobinuria, hyperuricemia, hyperkala-emia and hyperphosphatemia. Obvious and long-lasting hyperuricemia in particular may cause renal vasoconstriction, endothelial dysfunction, infla-mmatory response, oxidative stress and failures in autoregulation Reasons for acute kidney injury may include urinary bladder neck obstruction 60 and malign hypertension In a patient who has isole proximal tubule dysfunction, temporary glycosuria, phosphaturia and solute diuresis have all been observed In the literature, there are histopathologic diagnoses of necrotising vasculitis 63 and vascular thrombosis The presence of vascular thrombosis and fibrinoid necrosis 65 have also been seen in the results of renal biopsy performed due to the loss of graft function in two renal kidney transplant patients. A greater number of biopsy results would leave us better placed to establish the relationship between acute kidney injury and MDMA. The underlying cause of tissue damage due to MDMA may be increased oxidative stress or mitochondrial dysfunction The over-expression of antioxidant enzymes such as N-acetylcysteine, ascorbic acid or superoxide dismutase may neutralize the potential toxic effects of MDMA 70 , As there is increased urine osmolality due to the inappropriate secretion of AVP, hypotonic fluids and 0. In cases of acute medium symptomatic hyponat-remia, the transition from hyponatremia to normo-natremia may be achieved by restricting the intake of liquids. The patient should be clinically monitored for urine output, serum Na, urine osmolality and urine Na. AVP antagonists have recently been introduced for clinical use in cases where AVP secretion is inappropriate e. Paralysis and intubation could be performed to reduce muscular thermogenesis, while benzodiazepines can be used for reducing agitation and seizures. Although there are conflicting data on the use of Dantrolene a muscle relaxant in the treatment of hyperthermia caused by MDMA, there are cases in which Dantrolene has been employed successfully 74 , In a study by Hysek et al involving 16 healthy volunteers, Carvedilol helped reduce the low-level hyperthermia and cardiostimulant effects that occurred after a single dose of MDMA. Hyperthermia resulting from MDMA is caused by alpha 1 and beta adrenoceptor, and Carvedilol inhibits alpha 1 and beta 1. The authors therefore support the use of Carvedilol in treating hyperthermia Non-traumatic rhabdomyolysis is caused by long periods of dancing, seizures or hyperthermia. Hyperkalaemia originating from rhabdomyolysis can cause arrhythmias. Treatment requires hydration-force diuresis, monitoring of the fluid and electrolyte situation, including intake and removal, and kidney function tests. For hyperkalaemia, hemodialysis can be used. For hyperuricemia, rasburicase might be used A study by Karami et al has shown that an extract made from the leaves of plant called Feijoa sellowiana acca sellowiana histopathologically showed a protective effect in mice from MDMA-related injury by increasing kidney glutathione CKD presence, kidney function and albuminuria were not found to be related to the use of cocaine, methamphetamine and heroin 80 , despite a study by Vupputturi et al claiming this to be the case However, these studies are not sufficiently large to state with confidence that the use of illicit drugs is not linked to the development of CKD. An increase in the number of young people, coupled with the ease of cross-border transportation, mean that the use and accompanying health effects of MDMA will become more frequent in the future. The adverse effects of ecstasy use include mortality, particularly in young patients with hyperthermia or serious hyponatremia. Fatal hyperthermia is caused by increases in serotonin affecting muscular activity, the treatment for which requires peripheral cooling. Severe hyponatremia is caused by the inappropriate secretion of the antidiuretic hormone psychogenic polydipsia. In order to prevent hyperthermia, a high fluid intake is required. Besides fatal hyperthermia and hyponatre-mia, rhabdomyolysis generally non-traumatic causes acute renal failure. Rhabdomyolysis treatment in this instance is unconventional. Urine alkalization is not recommended, as it would reduce the ability of the kidneys to remove the MDMA We clinicians have an obligation to recognize these deadly side effects of MDMA. Most importantly, young people should be kept away from drugs in order to avoid complications that may result in their deaths. As a library, NLM provides access to scientific literature. Iran J Basic Med Sci. Find articles by Feyza Bora. Find articles by Taner Bora. Received Sep 10; Accepted Apr Open in a new tab. 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Ecstasy (MDMA) and its effects on kidneys and their treatment: a review

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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. Key findings and threat assessment. Global context. Production in Europe. Trafficking and supply. Criminal networks. Prices and purities. Retail markets. Effects, risks and harms of use. Actions to address current threats and increase preparedness. At the global level, Europe is a key producer of amphetamine, with most of it manufactured in the Netherlands and neighbouring countries in illicit laboratories where other synthetic drugs may also be produced. Synthetic drug producers in the Netherlands are believed to control much of the production taking place in Belgium, with laboratories often found close to the border with the Netherlands, and more recently near the Belgian-French border. Production facilities for synthetic drugs — including amphetamine — are often set up in remote regions on farms or in warehouses, where the risks of detection are relatively low. In addition, there are indications that Dutch criminal networks have expanded production activities to Germany and potentially to other EU countries. Information collected during the dismantling of illicit laboratories by law enforcement and precursor seizure data show that the Leuckart method, which requires BMK and formamide, is the most commonly used means to produce amphetamine in Europe. BMK may itself be imported, but the BMK used is typically produced in Europe from alternative chemicals that are trafficked from abroad, typically China. These substances appear on the market, only to be replaced by alternatives when authorities put controls in place to restrict their use. The Leuckart method is relatively straightforward, yet somewhat low yielding and reliant on a number of controlled chemicals. The amphetamine consumed in the EU is believed to be exclusively produced in the EU, with production concentrated in the Netherlands and Belgium. In some cases, the manufacturing of the consumer product is not completed in these countries and the amphetamine base oil is exported to another country, where it is converted into amphetamine sulfate salt. A much smaller proportion of the amphetamine produced in the EU is used to make captagon tablets, which are then exported to the main consumer markets in the Arabian Peninsula see Box Amphetamine as captagon tablets. Like most synthetic drugs, amphetamine can be produced by multiple methods, depending on the available chemicals and equipment, reaction conditions and, to some extent, the skills of the producer. Importantly, many of these methods are versatile enough to yield a variety of drugs, with only small changes needed to the chemicals and equipment used. This is the case for the Leuckart method, a standard organic chemistry method that can be used in the synthesis of amphetamine, methamphetamine and MDMA, as well as a number of other chemical products. To avoid the legal controls placed on BMK, the production of amphetamine often starts with the conversion of commercially available chemicals into BMK. A number of illicit laboratories specialise in this process. The process comprises five main steps, with an additional, optional, first step being the production of BMK from alternative chemicals see Figure Simplified general schema of amphetamine production :. Although there is no systematic collection of data in this area, the available information suggests that BMK and alternative chemicals for amphetamine production are mostly sourced in China, whereas solvents and other essential chemicals acids, bases, solvents may be obtained directly in EU countries. The sourced chemicals are often transported to the main production countries of the Netherlands and Belgium by road via transit countries. Between and , sites related to illicit amphetamine production were dismantled in the EU. Among these were production sites, chemical or equipment storage facilities and waste dump sites. Of these sites, were dismantled in in Belgium 6 , Bulgaria 4 , Germany 35 , Estonia 1 , the Netherlands 38 , Poland 25 , Spain 4 and Sweden 1. The totals for Germany and Poland include a number of laboratories where amphetamine oil was processed into amphetamine sulfate 28 and 15 sites respectively. Out of the sites dismantled in , 44 were operational compared to 72 in , and were detected in Germany 4 , the Netherlands 32 , Poland 3 , Spain 4 and Sweden 1 see Figures Number of amphetamine production sites dismantled in the EU, and Location of sites related to amphetamine production in the EU, The source data for this graphic is available in the source table on this page. According to the available data, the Netherlands is a notable hub for synthetic drug production in the EU, with Dutch law enforcement data revealing that a total of synthetic drug production sites were detected between and Combination laboratories, where at least two different types of synthetic drugs are manufactured, were less frequently found, but 25 such sites were discovered that involved amphetamine. Combined production of amphetamine or MDMA with methamphetamine was found to have increased over this period, while combined production of amphetamine and MDMA decreased National Police of the Netherlands, Amphetamine laboratories are often situated in rural or residential areas, on farms, in private houses, in industrial parks or in remote industrial premises. Criminal networks engaging in this business are adaptable and take measures to reduce the risks of, and any losses resulting from, detection. Such measures include setting up laboratories that can be quickly dismantled when they are no longer needed or become unsafe, as well as using separate locations for different stages of the production process. Equipment that can be reused may be removed when a laboratory is dismantled by the criminal networks, and waste is often left behind. Europe has historically been the source of amphetamine and other synthetic drugs for the United Kingdom UK drug market, however, evidence of large-scale amphetamine production in the UK has emerged since This may be partly explained by the withdrawal of the UK from the EU. For example, in December , four members of a criminal network were convicted of running an industrial-scale amphetamine lab in Scotland. Information from law enforcement in Europe suggests that most of the amphetamine produced in Europe is synthesised using the Leuckart method. Other techniques have been encountered, albeit infrequently, including what is commonly called the nitrostyrene method and the pressure reaction method. There have been some recent signals, however, that the nitrostyrene method may become more prominent in the future. This reflects the adaptability and resilience of synthetic drug producers, who can shift and adjust production methods in response to or in anticipation of changes in the availability of chemicals. The Leuckart method is the most commonly used means of manufacturing amphetamine in illicit laboratories in the Netherlands and Belgium. Between and , this method of synthesis was reported in cases in the Netherlands and 23 in Belgium. By contrast, the nitrostyrene method was only identified in one case in the Netherlands in The Leuckart method is a relatively simple, versatile and well-established organic chemistry process that converts carbonyl compounds aldehydes or ketones into amines, under heating. This method may also be used in the synthesis of methamphetamine, MDMA, MDA and a number of other compounds, depending on what carbonyl and amine combination is used see Figure Main precursors and essential chemicals needed for the synthesis of amphetamine, methamphetamine, MDMA and MDA via the Leuckart method. Typically, the Leuckart synthesis of amphetamine starts with heating BMK with formamide, often in the presence of formic acid, to form an intermediate N -formylamphetamine or N-FA. This intermediate is converted to amphetamine base oil and the base oil is subsequently processed into the desired amphetamine salt typically amphetamine sulfate. Although uncomplicated, the method suffers from product losses, mostly due to impurities generated from side reactions, but also because of the extensive and often incomplete purification steps. Risks associated with the Leuckart method are mostly related to fire, if open flames are used, and possible overheating during the initial synthesis steps, which can result in hot chemicals being spilled or projected. BMK is a crucial starting material for the synthesis of amphetamine and methamphetamine. Despite legal controls on its trade, significant amounts of BMK oil are still trafficked predominantly from China and Hong Kong into Europe every year, with the Netherlands reporting the most seizures. To avoid these controls, synthetic drug producers can use a number of non-scheduled alternative chemicals that can be converted into BMK. The last few years have seen a number of alternative chemicals being successively and rapidly introduced into Europe in response to or even in anticipation of the introduction of legal controls; this is indicative of a resilient and adaptable market, run by well-informed synthetic drug producers. When BMK is used to produce amphetamine, formamide is the chemical used to synthesise the drug. This can occur in the presence or absence of formic acid, which can reduce the temperatures reached in the Leuckart reaction. Reflecting its role as a global amphetamine producer, Europe remains the region where the largest seizures of formamide and formic acid are reported INCB, In , almost 39 litres of formamide were seized by four EU countries Belgium, Germany, Poland and the Netherlands , alongside almost 28 litres of formic acid reported by Belgium, Germany and the Netherlands see Figure Quantities of seized chemicals associated with the Leuckart method in the EU, In , the scale of seizures was slightly more modest 10 litres of formamide, close to 10 litres of formic acid , yet still significant at the global level. Where contextual information was available, the seizures were carried out in illicit laboratories and warehouses associated with amphetamine production, either exclusively or in conjunction with other drugs or precursors INCB, , a. Dutch law enforcement intelligence indicates that formamide, BMK and its alternative chemicals are mostly obtained from China. Formamide is often found in large litre barrels National Police of the Netherlands, These shipments are frequently imported into various European countries and eventually transported to the Netherlands by road, rather than being shipped there directly. Formamide is also diverted from legitimate chemical suppliers in the EU, a practice that has been noted in Germany. These chemicals, regardless of their origin, are typically mislabelled, for example as cleaning products. Other chemicals, including solvents, gas cylinders, acids and bases may be sourced from several European countries, including Poland and Germany, where a number of legitimate chemical companies are based see Box Illegal dumping of chemical waste leads to precursor supplier. Russia is also thought to be an important source of sodium hydroxide for Dutch synthetic drug laboratories, including those producing amphetamine National Police of the Netherlands, , but presumably this supply has been interrupted by the war in Ukraine. In one case, reported by Germany in , the seizure of precursors associated with amphetamine production occurred in a large illicit laboratory operated with the support of Dutch criminals. The use of BMK and its alternative chemicals in the synthesis of amphetamine can be circumvented by use of the nitrostyrene method also known as the nitropropene method. Production of amphetamine using the nitrostyrene method has rarely been reported in Europe, with the exception of Poland. In Europe, seizures of precursors and essential chemicals associated with the nitrostyrene method are typically small in scale compared to those associated with the Leuckart method. A possible reason for this may be that the chemicals needed for the nitrostyrene method are widely used in various industries. Where data are available, the seizures typically occur in small to mid-size illicit laboratories. Between and , the method of amphetamine synthesis used in illicit laboratories in Poland was reported in 22 cases, with 10 using the nitrostyrene method and 12 using the Leuckart method. The nitrostyrene method proceeds through the formation of a bright yellow intermediate 1-phenylnitropropene or P2NP from benzaldehyde and nitroethane in the presence of catalytic amounts of an amine via a standard Knoevenagel reaction. This intermediate can be converted into amphetamine oil by a number of reduction techniques and is finally purified and converted into amphetamine sulfate. These processes are relatively simple, high yielding and avoid the use of controlled chemicals. The second step is particularly hazardous as it generates heat and needs to be carefully controlled to avoid explosions and fires breaking out at the production sites — particularly if the synthesis is being conducted on a large scale. In , seizures amounted to only 19 kilograms all in Austria see Figure Quantities of seized chemicals that may be associated with the nitrostyrene method in the EU, While this suggests that the method is mainly restricted to small production sites and has not been gaining ground in recent years, it should be noted that in at least one seizure of just over litres of benzaldehyde was reported by the Netherlands. Together with recent seizures of these chemicals elsewhere, this may indicate that this production method may become more prominent in Europe. These developments need to be carefully monitored in the future. Information from law enforcement agencies suggests that this synthetic route is mostly associated with the production of MDMA, but that on a limited number of occasions it has been used in amphetamine production, simply by changing the precursor from PMK to BMK. In these cases, the method is initiated by reacting BMK and ammonia in a solvent in the presence of a catalyst e. Raney nickel. The air generated by the reaction is removed by vacuum and hydrogen gas is added at a defined pressure. As the reaction proceeds, the temperature rises while the pressure lowers until both are stable. The resulting amphetamine oil can then be separated from the catalyst and purified by distillation. This method is more demanding and requires more sophisticated equipment than the other two methods described here. The piece of equipment that is central to amphetamine production is the reaction vessel, however other equipment is also needed, for example separators, drying apparatus, presses, vacuum heat sealers and tablet presses, some of which are commercially available. Large-scale amphetamine producers use increasingly customised — or fully custom-made — high-quality reaction vessels in order to eliminate possible tracing and to increase the amount of amphetamine produced, and hence their profits. In addition to custom-made equipment, which is on occasion outsourced to specialists, equipment may also be purchased from online and offline vendors. Reaction vessel capacities vary depending on the need, from small-scale, litre capacity, to industrial-scale vessels that can hold 4 litres or more of reactants. Criminal networks are adaptable and can readily find equipment suppliers, either via brokers or by engaging directly with the producers. Companies and individuals in the metal industry may be approached by criminal networks for the purpose of sourcing, building or customising equipment. As production equipment becomes more sophisticated, the task of identifying and dismantling the equipment becomes more challenging, and, in some cases, more dangerous for law enforcement. Synthetic drug production poses a number of other possible hazards. In the last few years, several fatalities have been recorded in synthetic drug production laboratories in the Netherlands and Belgium as a result of fires or explosions van den Berg, or due to suffocation from carbon monoxide or other toxic fumes caused by the production process Steenberghe, A scientific review of cases of exposure to chemicals in illicit drug laboratories linked this contact not only to mild or moderate respiratory, ocular and dermal effects, but also to severe symptoms and fatalities Koppen et al. The manufacture of amphetamine not only poses hazards to those involved in its production; it also entails the generation of chemical waste products, which are typically dumped away from the production site, sometimes even in neighbouring countries. Such waste has been found dumped in Belgium, Germany, the Netherlands and Poland. Such practices can frustrate efforts to identify production sites and present collateral risks for the environment and the people involved, as well as the local community. The waste generated by the production of synthetic drugs can be estimated on the basis of instructions found in dismantled illicit laboratories. For the conversion of BMK to amphetamine and the synthesis of BMK from alternative chemicals, it has been estimated that the manufacture of one kilogram of amphetamine generates between 19 and 39 kilograms of chemical waste Ter Laak and Mehlbaum, This results in health risks, environmental damage and high clean-up costs. A variety of methods are used to dispose of these large quantities of chemical waste. For example, the waste may be simply poured down the sink or toilet, although this is unlikely to be a common practice, as the waste can be corrosive or so viscous that it would damage the pipes or block the drains. However, if chemical waste is disposed of in this way, it may affect the quality of drinking water or adversely affect municipal wastewater treatment plants Emke et al. A more common occurrence is that members of the public report containers of waste dumped in the countryside. There have also been instances where waste has been found buried underground or discharged directly into the soil. Waste can also be left in abandoned properties or loaded into stolen vans or lorry trailers, which may then be set on fire to conceal forensic evidence. More elaborate methods have been found, including the use of modified vans that pump waste onto road surfaces. The dumping of synthetic drug production waste directly into surface waters, or indirectly via the sewers and wastewater treatment plants, can affect surface water quality Emke et al. Scenario studies making use of hydrological modelling illustrate that a large emission of drug production waste from an illicit laboratory into a sewer or directly into surface water can temporarily affect surface water quality over wide distances Pronk, Waste discharged into surface water can be cleaned up when the water is stagnant, such as in lakes or ditches, and the response time is short. However, this is not possible in large rivers and fast-flowing streams Ter Laak and Mehlbaum, Four dumping sites specifically related to amphetamine production were reported in the EU in two in Belgium and another two in the Netherlands. This represents only a fraction of the total dumping sites reported in the EU that year. It is therefore likely that many more of these sites were related to amphetamine production but this cannot be confirmed, as samples are not always taken for analysis to ascertain the particular synthetic drug or chemical processes to which the waste related. Knowledge of the mechanisms and extent of environmental damage related to synthetic drug production is fragmented and the topic is under-researched. A study on the impact of synthetic drug production on the environment through the analysis of contaminants in groundwater samples was commissioned to shed some light on this issue see Box Groundwater contamination related to synthetic drug production waste disposal. While stand-alone studies on specific impacts have been conducted, a more comprehensive and complete assessment of the environmental impact of synthetic drug production has not yet been carried out. Show source table hidden by default due to large size. Consult the list of references used in this resource. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. This make take up to a minute. Once the PDF is ready it will appear in this tab. Sorry, the download of the PDF failed. Table of contents Search within the book. Introduction Introduction Key findings and threat assessment Key findings and threat assessment Global context Global context Production in Europe Production in Europe Trafficking and supply Trafficking and supply Criminal networks Criminal networks Prices and purities Prices and purities Retail markets Retail markets Effects, risks and harms of use Effects, risks and harms of use Actions to address current threats and increase preparedness Actions to address current threats and increase preparedness. Search within the book Operator Any match. Exact term match only. Source data. Quantities of seized chemicals associated with the Leuckart method in the EU, Quantity litres Formamide Formic acid Quantities of seized chemicals that may be associated with the nitrostyrene method in the EU, Quantity kg Benzaldehyde Phenylnitropropene Nitroethane 1 0 1 0 12 15 3 35 22 44 78 1 1 14 2 2 11 4 4. Main subject. Target audience. Publication type. EU Drug Market: Amphetamine — main page. 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