Buying coke online in Seefeld

__________________________

📍 Verified store!

📍 Guarantees! Quality! Reviews!

__________________________

▼▼ ▼▼ ▼▼ ▼▼ ▼▼ ▼▼ ▼▼

▲▲ ▲▲ ▲▲ ▲▲ ▲▲ ▲▲ ▲▲

Buying coke online in Seefeld

Official websites use. Share sensitive information only on official, secure websites. Ontario St. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Patients may misunderstand the substance they have been exposed to, there are rarely any readily available laboratory confirmatory tests for these substances, and the exact substances being abused may change on a near-daily basis. This review will attempt to group legal agents into expected toxidromes and discuss associated common clinical manifestations and management. A focus on aggressive symptom-based supportive care as well as management of end-organ dysfunction is the mainstay of treatment for these patients in the emergency department. Keywords: legal highs, novel psychoactive substances, toxicology, opioid toxidrome, anticho-linergic toxidrome, sympathomimetic toxidrome, hallucinogens, inhalants. After the Geneva Opium Convention attempted to establish international control over morphine, drug manufacturers started flooding the market with uncontrolled morphine chemical derivatives. Patients may misunderstand what the substance is they have been exposed to, there are rarely any readily available laboratory confirmatory tests for these substances, and the exact substances being abused may change on a near-daily basis. Recognizing these challenges we will attempt to group legal agents into expected toxidromes and discuss associated common clinical manifestations and management. Producing the toxidrome of tachycardia, mydriasis, urinary retention, dry mucosal membranes, skin flushing, and hypo-active bowel sounds, anticholinergic agents have long been abused for their hallucinogenic, euphoric, and stimulant effects. The belladonna alkaloids are atropine, hyoscyamine, and scopolamine, which are found in large concentrations in plants such as deadly nightshade Atropa belladonna , Jimson weed Datura stramonium , and moonflower Datura inoxia. Belladonna alkaloid overdoses manifest as anticholinergic toxicity. An analysis of cases reported to American poison centers revealed no attributable fatalities. In addition to supportive care, management of belladonna alkaloid plant toxicity centers around treating agitation as well as reversing severe anticholinergic effects if needed. Decontamination with activated charcoal is controversial, as most patients will present for medical care when clinically intoxicated and agitated. The classic signs of diphenhydramine overdose are an anticholinergic toxidrome combined with profound sedation and at times marked agitation. Management of diphenhydramine toxicity centers around control of agitation and hyperthermia, as well as treating rhabdomyolysis, potential tachyarrhythmias, and seizures. Widely available, nutmeg is known to provoke hallucinogenic effects in high dosages. According to available case reports, nutmeg reached a peak of abuse in the s and s. Nutmeg produces a biological effect similar to an anticholinergic toxidrome, with altered mental status, skin flushing, dry mucus membranes, tachycardia, and hypertension. The clinical toxidrome of fly agaric has been said to mimic that of an anticholinergic toxidrome, with flushing, fever, and pupillary dilation. Treatment is supportive, with consideration of GI decontamination with charcoal. As the USA grapples with unprecedented levels of opioid abuse, there has been an increased push among prescribers and regulatory bodies to curb long-term prescribing of these medications. Management of loperamide toxicity includes extended consideration of decontamination, treatment of respiratory depression, and monitoring and treatment of potential cardiotoxicity. Although opium and the poppy plant itself are controlled in the USA, poppy seeds are completely unregulated and can be bought in bulk. Although they do not contain any psychoactive opiates, poppy seeds have been shown to have trace amounts of opium latex containing morphine and codeine on their surface. Although official case reports of fatalities are sparse, scattered fatalities in the popular media have been reported among young people using PST. Kratom is the common name for the plant Mitragyna speciosa , a large leafy tree which is indigenous to Southeast Asia, containing psychoactive alkaloids with dose-dependent stimulatory and opioid-like effects. The safety profile of kratom has not been fully evaluated. Well-controlled data on the toxic effects of kratom on human subjects are lacking, and case reports of toxicity are relatively rare. There have been scattered case reports of intractable seizures that are refractory to benzodiazepines in patients with acute kratom ingestions, although many cases are associated with co-ingestion of other prescription and illicit drugs. However, it would be reasonable to give naloxone in the setting of a kratom ingestion with respiratory depression. Kratom has been frequently adulterated with other opioid receptor agonists such as O -desmethyltramadol, resulting in 9 deaths in 1 case series. In an effort to stem the flood of these agents, the DEA has continuously added synthetic opioids to Schedule I, including U, AH, and many fentanyl analogs. Still unscheduled, an opioid known as MT, a piperazine derivative, has found abuse as a legally available opioid. A more substantial public health threat than MT is the re-emergence of fentanyl and a wide range of fentanyl analogs to the illicit drug market. Many of them are abused by those seeking similar effects as the classic illicit psychostimulants such as cocaine, methamphetamine, and 3,4-methylenedioxy-N-methylamphetamine MDMA. Others are abused for their serotonin-mediated hallucinogenic effects, but are notable for producing sympathomimetic toxicity. Many of these agents will share similarities in their treatment approach, which entails benzodiazepines, active cooling for hyperthermia, and specific management of end-organ complications related to hypertension and vasoconstrictive effects. A Schedule I substance, cathinone is a monoamine amphetamine analog with stimulatory properties found in the shrub Catha edulis , commonly known as khat. Synthetic cathinones reached a peak of reports in , declining to in , 58 likely due to federal and state efforts at scheduling and regulating these psychoactive substances. Chemical similarity of amphetamine, cathinone, and mephedrone; note the addition of the ketone functional group to the latter two compounds. The toxicologic effects of synthetic cathinones mimic those of the amphetamines as well as MDMA, and treatment is primarily supportive around managing the agitation, fever, hyponatremia, and end-organ complications that can sometimes occur with these agents. The subjective effects of benzofurans have been described as much like MDMA, but with more adverse effects in the form of nausea, dry mouth, dry eyes, insomnia, diarrhea, palpitations, headache, and various adverse psychological symptoms, including visual and auditory hallucinations. Like many of the NPS, detailed toxicological information on the benzofurans are lacking, and acute ingestions are often concurrent with other intoxicants. The benzodifurans, commonly known as the Bromo-dragonFLY compounds, refer to a relatively novel group of hallucinogenic drugs that saw escalating amounts of abuse as legally available research chemicals over the past decade. Case reports indicate that Bromo-dragonFLY compounds have potent sympathomimetic and vasoconstrictive toxicity. Bromo-dragonFLY overdose treatment is supportive. The single chemical difference between propylhexedrine top and methamphetamine bottom is the aromatic ring. Toxicity of propylhexedrine mimics that of the amphetamines, but with seemingly more profound end-organ complications from its relatively higher hypertensive and vasoconstrictive effects, especially with intravenous injection. Clinical toxicity presents with a sympathomimetic-like toxidrome but with profound tachycardia and hypertension. Mescaline is a serotonergic phenethylamine hallucinogen most famously found in peyote, a small spineless cactus found in the deserts between the USA and Mexico that has been traditionally consumed by Native American tribes. Mescaline is chemically related to amphetamines, and cases of toxicity produce a sympathomimetic-like toxidrome. N-methyl-D-aspartate NMDA receptor antagonists such as phencyclidine PCP and ketamine are abused in recreational settings for their dissociative effects. Ketamine was officially scheduled in , 78 and in the decade to follow the recreational drug market saw the synthesis and emergence of legal ketamine analogs such as methoxetamine and others. Furthermore, the over-the-counter cough remedy DXM has long been abused for its dissociative effects. Methoxetamine, an analog of ketamine that has NMDA antagonist activity, has been marketed via the internet as a legal high, and oftentimes as a safer alternative to ketamine abuse. Much of the morbidity of methoxetamine and other novel dissociative psychoactive substances seem to be centered around their neurocognitive effects as well as sympathomimetic qualities and propensity to be taken with other stimulatory psychoactive substances. The subjective effects of DXM abuse have been noted to entail 3 dose-dependent plateaus, with low doses producing mild stimulant and euphoric effects, middle doses producing an effect like concurrent alcohol and marijuana intoxication, and large doses producing a dissociative effect like ketamine or PCP intoxication. The major toxic effects of DXM are managed with supportive care, and are centered around benzodiazepines for acute agitation, management of toxicity from coformulatory agents, as well as possible serotonin syndrome. A major concern with DXM ingestion, even at therapeutic dosages in concert with certain other serotonin-affective drugs, is the risk of serotonin syndrome. There have been cases of serotonin syndrome when DXM was taken at antitussive therapeutic dosages in patients on therapeutic MAOIs such as phenelzine, as well as selective serotonin reuptake inhibitors such as fluoxetine. As DXM is commonly found in bromide salt, there have been theoretical concerns that massive ingestions will result in bromide toxicity as well as false elevations of chloride and even negative anion gaps due to misidentification of bromide for chloride by laboratory autoanalyzers. However, the only available evidence of bromism in the form of elevated chloride and a low or negative anion gap in the context of DXM use comes from a single case report. There are many legal hallucinogenic compounds that lack a discrete toxidrome. Many do increase serotonergic transmission resulting in stimulatory effects, including tachycardia and hypertension. Agitation and neuropsychiatric symptoms predominate with these agents. Native to Oaxaca, Mexico, Salvia divinorum is a leafy plant of the mint family that has been long recognized for its psychoactive properties when inhaled or sublingually absorbed. There is a lack of reports of salvia intoxication resulting in any serious physiologic toxicity. Although seeds are often treated with an emetic by seed producers in order to discourage abuse, morning glory and woodrose seeds have been long abused as a legally available LSD substitute. Major side effects include nausea, vomiting, and abdominal discomfort, which are thought to limit the abuse potential of LSA-containing seeds. SCs are chemically heterogeneous but what they have in common is their affinity for cannabinoid receptors. Unlike marijuana, which contains over 50 known psychoactive chemicals, many of which have attenuating effects on THC, which is itself a partial agonist of cannabinoid receptors, many of the SCs are full agonists that demonstrate a much stronger affinity for these target receptors. Physical examination findings of those using SCs have been found to be similar to those with cannabis intoxication, with delayed pupillary light reactions, slurred speech, and retarded sequence of movements. Cases of rhabdomyolysis, acute kidney injury, and even myocardial infarction have been reported. Ayahuasca, also known as hoasca, yage, and natema, is a hallucinogenic tea brewed traditionally among Amazonian tribes for religious purposes from the jungle vine Banisteriopsis caapi together with the leaves of the Psychotria viridis plant. The most common clinical manifestations of ayahuasca intoxication as reported to poison centers were hallucinations, tachycardia, agitation, hypertension, mydriasis, and vomiting. Kava refers to a traditional beverage prepared from the tropical shrub plant Piper methysticum , native to the South Pacific. Used for centuries for its euphoric and anxiolytic effects, kava has seen increased use in the USA, where it is considered a health supplement. Reports of acute kava toxicity resulting in adverse events requiring medical care are rare, accounting for 20 cases reported nationally in Patients abusing inhalants may present with a wide variety of subjective complaints, including dyspnea, palpitations, lightheadedness, sneezing and coughing, as well as GI complaints, including nausea and vomiting. The inhalational hydrocarbons of abuse have numerous toxic effects on the body, with cardiotoxic, neurotoxic, hepatotoxic, and nephrotoxic effects having been reported. Nitrous oxide inactivates vitamin B12, decreasing conversion of homocysteine to methionine, ultimately resulting in demyelination within the central and peripheral nervous systems. However, a focus on aggressive symptom-based supportive care is the mainstay of treatment for these patients in the ED. As a library, NLM provides access to scientific literature. Open Access Emerg Med. Find articles by Charles R Caffrey. Find articles by Patrick M Lank. Collection date This work is published and licensed by Dove Medical Press Limited. Open in a new tab. Disclosure The authors report no conflicts of interest in this work. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

When good times go bad: managing ‘legal high’ complications in the emergency department

Buying coke online in Seefeld

Drug trafficking via apps like Telegram is booming. In Zurich, it has never been easier to get hold of illegal substances than it is today. Raphael Nassar is what one would call a small fish in the drug milieu. But as he drove his red Opel Astra through Zurich's university district at the end of April , he had a whole potpourri of substances in his backpack. In it were: 47 grams of cocaine, grams of amphetamines, ecstasy pills, 93 LSD tabs, 15 grams of ketamine, 75 grams of cannabis and half a dozen other illegal substances. Nassar, whose name has been changed, is a university graduate and normally works as a small business owner. But on that spring evening, he was on his way to his clients as a courier for a major drug network. They were residents of Zurich who waited at home on the sofa or at the kitchen table for the doorbell to ring. Maybe they were still holding their cell phone. Because that's how they ordered the drugs that Nassar was bringing to their door. But Nassar and the drugs did not arrive. The police arrested the courier on his way to his next deal. Maybe he stood out because of the way he was driving, maybe because of the backpack on the passenger seat. Maybe because there were fewer people on the streets because of the first pandemic lockdown. It is possible that the police had been on the trail of the young man for some time. Nassar ended up in custody for two days. Police searched his room in Seefeld and confiscated more drugs, several cell phones and thousands of francs in cash. Nassar was charged. The information about him and his arrest comes from the indictment. The clients went empty-handed that evening. But they have little to fear. The same is true for the dealers upstream of Nassar. Even if the drug courier wanted to blow the whistle on them in court today, nearly three years later, he couldn't. Because the young man never saw them. In Zurich, drugs are increasingly being sold over the internet. More and more consumers who have their substances tested in the DIZ laboratory say they bought them online. And the number of unreported cases is probably much higher. The selection in the online drug market is wide - much wider than traditional street dealers. Some vendors tout lists of two dozen different banned substances. Buying the drugs requires no advanced computer skills. A messenger service like Telegram and an app for crypto payments or an SBB ticket machine for bitcoin transfers are all that is needed. Meanwhile, some dealers even use Instagram and Tiktok to hawk their wares. The providers present themselves as hip and trendy. With promotions and volume discounts, a customer service and FAQ pages, they vie for the favor of clientele. Consumers no longer have to walk down a dark alley to get their fix. Drugs can be discreetly delivered to your home by mail or courier. This has consequences. It has probably never been easier to get drugs than it is today. The rush is always just a click away. Almost three years after his arrest, Raphael Nassar stood before the Zurich District Court last week. He has a criminal record for falsifying a scholarship application a few years ago. Otherwise, the year-old Swiss seems more like a financial advisor than a drug dealer. He wears horn-rimmed glasses, a black turtleneck, has several years of professional experience in serious and lucrative jobs, and claims to now run a company with more than 20 employees. Since the day of his arrest, he has confessed. The judge asked the question that was on everyone's mind in the courtroom, «How do you, as an academic with highly specialized training, come to do something like this? Nassar answered quietly, struggling for words, apologetic. There is no real explanation, he said, but then tried to explain: In , he was plagued by money worries. He said his company suffered from the coronavirus pandemic, and government support failed to materialize for a long time. In a Zurich nightclub, he was approached by a man who identified himself as a drug courier. The next day, he said, he went into business. Nassar then delivered a large quantity of drugs to at least 50 different individuals. Within five weeks, he earned almost 23, francs. It is a network that in was still called «vitamin pigeon. In order to avoid advertising for an illegal business, we refrain from mentioning the new name here. On the trader's Telegram channel, every imaginable substance from amphetamine to Xanax is for sale. The only exception is heroin. One portion, called a unit, costs francs. The more you buy, the cheaper the price becomes. At regular intervals, the provider entices customers with special offers. It is unclear who is behind the ad. When asked, the operators of the Telegram channel reply in a remarkably friendly manner: «Good day, the pigeon thanks you very much for the request. Dealers are also recruited on the Telegram channel. The drug list includes large quantities, such as 50 grams of cocaine or half a kilo of marijuana, for sale. They cost thousands of francs, but should fetch many times that amount when sold to consumers. People like Nassar are tempted by such an offer. They have much more to fear than those responsible in the background, who can hide in the anonymity of the internet. In addition to Nassar, another courier has also been tried in Zurich, and a third case is pending, according to the Zurich-Limmat prosecutor's office. Strikingly, after the arrests of two couriers for the «vitamin pigeon» in the summer of , the Telegram channel went offline. A year later, the ad reappeared — without a courier service. Nevertheless, it is difficult for the police to take action against the illegal supply. This is obviously more difficult on the internet than in the case of physically established crimes,» writes the media office of the Zurich cantonal police upon request. The public prosecutor's office of the canton of St. Despite «extensive investigations,» the perpetrators could not be located. For tactical reasons, the Zurich cantonal police are not disclosing exactly how the investigators are proceeding. Just this much: The investigations are also taking place online. However, the perpetrators are often not in Switzerland, the report continues. Cross-border proceedings pose special challenges for the investigations. There are also repeated calls for legal regulation of the platforms on which the deals are made. Telegram, meanwhile, is denying any responsibility. Upon request, the company wrote that it has been actively combating harmful content — including the sale of banned substances — since its establishment in In addition, moderators monitor the platform's public chats and channels and accept deletion requests from users. Anyone who sees the advertisments for illegal products on the platform may doubt that the messaging service puts a lot of effort into fighting them. Dominique Schori, head of DIZ, has been observing the drug market on Telegram and other channels for years. He warns of possible consequences of the broad online offering. Online stores offer almost everything. That can lead users to try other substances. However, it is also possible the people behind the adverts are simply responding to an existing demand and offering additional substances, Schori points out. After all, «It's a market — economic laws apply here, too. This is also reflected in the purity of the substances. Cocaine laced with rat poison is a myth, Schori says. According to Schori, however, the quality of substances traded online is no better or worse than from other sources. Here, too, you will find many substances that are stretched, overdosed or mislabeled. To be sure, most drugs tested at the DIZ are still acquired in private settings. According to Schori, however, online retail is becoming increasingly important, especially for a young and tech-savvy clientele. However, he does not believe that the ads will attract new consumers. Anyone who wanted to get drugs could have done so in the past — without a cell phone. Raphael Nassar's career as a drug mule was short, steep and only seemingly lucrative. Nasser will receive a conditional prison sentence of 24 months and a fine of 80 Swiss francs per day for days for violating the Narcotics Act. He must also pay the costs of the proceedings of more than 11, francs. The district court thus followed the prosecution's proposed sentence. The well-educated drug courier shows remorse in his closing statement. In order to alleviate the suffering he caused, he had voluntarily donated the 23, Swiss francs he had earned from his illegal business, in addition to all other costs, to a center for addiction medicine. With its curated selection of English-language articles on Swiss and international news, politics, business, technology and society, NZZ in English provides readers with a fresh and independent perspective. Learn more about the project here. There is hardly a city where more cocaine is used than in Zurich. Buying is easier than ever before. International View. Ulrich Speck October 21, 6 min. Markus Ackeret, Moscow October 21, 7 min. Inside Europe. Eric Gujer October 21, 7 min.

Buying coke online in Seefeld