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Illicit substances identified in the urine of 11.170 suspected drug users in north Tunisia
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Official websites use. Share sensitive information only on official, secure websites. Drug addiction and trafficking became an urgent public health problem that affects human health and social life. A cross-sectional study was conducted from January to December , to identify the socio-demographic profile of drug users captured by the anti-narcotics squad in North of Tunisia North African country and to type, through toxicological analysis, the nature of the substances consumed. Fresh urine samples were collected from suspected drugs users and submitted in the toxicology laboratory of the center for Urgent Medical Assistance Tunis for forensic urinalysis. Drugs screening was carried out by immunochemical methods. Positive samples were analyzed with gas chromatography coupled to mass selective detector GC-MS for confirmation. On a total of urine samples screened, 5 The prevalence of positive samples was Polydrug abuse was observed in 79 specimens 1. Drug use became an urgent public health problem that affects human health, social life and economy worldwide. According to the latest World Drug Report , million people worldwide 5. In Tunisia North African country , traffic and consumption of psychoactive substances have risen substantially since the uprising of Drugs of abuse became increasingly available particularly to school students \[ 2 \]. Indeed, teens access illicit drugs in schools, from street dealers and through internet purchase « Darknet » \[ 3 \]. Previous epidemiological studies confirmed the increase of drug abuse in North Africa. An epidemiologic study conducted on a total of 28 cases in Tunisia from to , stated that cannabis was the most widely consumed illicit drug among young adults followed by benzodiazepines, buprenorphine, cocaine and MDMA Ecstasy \[ 4 \]. The frequency of consumption was These frequencies have increased substantially compared to the first MedSPAD survey conducted in \[ 2 \], whereas these frequencies still less than those noted in other Mediterranean countries Cyprus, France, Greece, Italy, Portugal, Malta, Lebanon and Morocco \[ 5 \]. An epidemiologic investigation was conducted to evaluate the prevalence of drug abuse in suspected drug users by analyzing urine samples collected from January to December It was a cross-sectional study. The investigation was conducted in the toxicology laboratory of the center for Urgent Medical Assistance which is the public reference center for forensic detection of drug abuse. We have extracted the variables of interest sex, age, occupation, place of residence and marital status of each individual tested from expertise files using a data collection sheet. These data were registered by police enforcement in expertise files which exist in paper format and were stored in the laboratory archives. In Tunisia, drug testing in biological samples is carried out at the request of the judicial authority. Individuals suspected of drug use or deal were arrested by the anti-narcotics squad and transferred to the national forensic laboratory for drug urinalysis. Urine samples were collected from each individual by a police officer with the suspect's consent. Only one sample was taken from each individual. A serial number was given to each sample and the urine analysis was carried out anonymously. Diluted specimens were excluded from this study. During the period lasting from January to December ; samples were tested as follows: samples in ; in and in Urine specimens exhibiting visible precipitates were centrifuged to obtain a clear supernatant for testing. It was about a rapid immunochromatographic assay. The strip was immersed in the sample for 5 seconds; urine was drawn along the rapid test by capillary action during 5 minutes, if two red lines appear next to both the control region and test region, the test was negative. If a line appears only next to the control zone, the test was positive. Roche, Switzerland. Subsequent positive samples were confirmed by gas chromatography coupled to mass selective detector GC-MS. The analytical technique of GC-MS combines the efficient separating power of gas chromatography with the high sensitivity and specificity of mass spectrometric detection. This method was the most conclusive method of confirming the presence of drugs in urine \[ 6 \]. The identification of the eight compounds was carried out using their retention times and their mass spectra Agilent commercial libraries. The variables of interest were listed on a SPSS table; variables such as sex, occupation, and marital status were coded. The data analysis plan was based on descriptive statistics positive samples frequency, the median age of drug users, the sex ratio and the percentage of each class of illicit substances were processed by SPSS Statistics A compilation of three years to of epidemiologic investigation was conducted. Summary, arrested people suspected to be drug consumers was reported. Out of specimens tested samples We reported positive cases in ; in and in Figure 1 summarizes the number of positive and negative samples listed during three years. Figure 2 illustrates the distribution of total arrests by month and positive rates of drug users average of three years The current investigation showed that drug users were mainly males Socio-demographic characteristics of drug users screened positive in the current study are summarized in Table 1. Positive urine samples revealed the presence of several classes of illicit drugs. Barbiturates were not detected. Polydrug use was observed in 79 specimens 1. Figure 3 illustrates in detail the positivity rates of illicit drugs detected all over the 3 years of investigation , and Nevertheless, a decrease in drug positive cases has been observed as follows; We suggest that this contrast may be due to the emergence of NPS new-generation synthetic psychoactive substances which are growing worldwide; beginning with Europe, followed by Asia, Africa, the Americas, and Oceania \[ 7 \]. The consumption of designer drugs is underestimated because this new class of narcotics synthetic cannabinoids, cathinones derivatives, Alpha-PVP and mephedrone is undetectable in biological samples by standard toxicology screens witch lead to false negative results. In many countries, this issue is still relevant because of the lack of analytical methods and the unavailability of standards \[ 8 \]. However, future testing will need to be performing to confirm this statement. More male drug users were observed compared to female The existing research points to unequal opportunities also relating to social and cultural norms in access to illicit drugs as one of the reasons for differences in the prevalence of drug use between men and women \[ 9 \]. Curiosity and induction by a partner are the most common reasons of initiation drug use for women \[ 11 \]. According to the Canadian Addiction Survey, almost In Europe, According to consumers, drugs use is an expression of persons in search for experience, identification and pleasure \[ 14 , 15 \]. According to several studies, the use of drugs is mainly linked to factors such as poverty, unemployment, lower social status, instability and violence in families and communities \[ 16 \]. Besides, the legislation is much less severe when it comes to cannabis than with hard drugs. Moreover, important cannabis trafficking from neighboring countries existed in the region. Cannabis trafficking follows a circuit that goes from North Africa to Europe across Spain \[ 19 \]. In the world, Cannabis continues to be the most widely used drug; in , million 3. Over 24 million people in USA aged 18 or over were estimated to be users of cannabis \[ 20 \]. The current results showed that 79 specimens 1. This misuse increased significantly since 0. On the other hand, Benzodiazepines BZD were detected in 67 urine samples 1. These psychotropic pills have a powerful addictive potential but remains much less dangerous than other drugs if not associated with alcoholic beverages \[ 23 \]. Some addicts use BUP intravenously because it provides the same euphoric effects as opiates but at a lower cost \[ 25 \]. It should be noted that BUP is the most commonly injected drug in Tunisia. Numerous studies have documented this issue: In France, buprenorphine replaces heroin as the mainly injected product. In Europe, Georgia and Finland face high prevalence of injection of this molecule \[ 27 \]. This upward trend is in part due to the expansion of the global market of amphetamine and cocaine, according to the United Nations Office on Drugs and Crime UNODC , the seizures of amphetamines across the world quadrupled between and while the global quantity of cocaine seized in was tons, the largest quantity ever reported. Otherwise, access to opiates such as morphine, Heroin was minor 0. In North Western Nigeria, the most used drug among youths in a rural agrarian community was Tramadol A population-based survey in South Africa revealed that cannabis use was 4. The main limitations of this study were firstly, the short detection window of drugs in urine samples; it would be suitable to use an alternative biological matrix such as hair samples to avoid false negative results. The current study revealed that the typical profile of drug user has changed; it was no longer a single young man delinquent, unemployed, with low educational level and resident in an urban area; presently, drugs of abuse are accessible to all social classes from all age groups, residing in urban or rural localities. Cannabis was the most common used drug; cocaine and MDMA are expanding as everywhere in the world. This study provides an overview of the illicit drug consumption in the north of Tunisia knowing that nowadays epidemiological data are almost same since in order to set up an effective policy to fight against drugs and addictive behaviors and to provide health professionals with the epidemiological elements necessary for better medical care of drug users. This study has shown that drugs of abuse are accessible to all social classes from all age groups, residing in urban or rural localities;. Cite this article: Nadia Chaouali et al. Illicit substances identified in the urine of Pan African Medical Journal. Chaouali N. All authors have contributed immensely towards the contents of the manuscript and have all read and approved the final draft. As a library, NLM provides access to scientific literature. Pan Afr Med J. Find articles by Nadia Chaouali. Find articles by Bilel Moslah. Find articles by Kamel Ben Salem. Find articles by Dorra Amira. Find articles by Abderazzek Hedhili. Find articles by Nabil Ben Salah. Received Nov 1; Accepted Dec 7; Collection date Copyright: Nadia Chaouali et al. Open in a new tab. 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.
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Illicit substances identified in the urine of 11.170 suspected drug users in North Tunisia
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