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Overdoseteamet Trondheim Kommune HELSETEAMET/ OVERDOSETEAMET TRONDHEIM KOMMUNE Lavterskelsamling Oslo 2017 John-Petter S. Jamt 2017 Fentanyl ● Relativt billig ● Blandes med heroin og andre illegale rusmidler ● Kommer fra Kina og Mexico (til USA) ● Distribueres via det mørke nettet (spesielt fra Kina iflg DEA) ● 4 Overdoser i Trondheim på Fentanyl (kjent av Helse- og Overdoseteamet) ● 1 dødsfall (Ortofluorofentanyl) ● Rigid ChestWall Syndrome ● 45s Tidsvindu - respirasjonsstans ● 3-6ggr dose med Nalokson - 25% av OD mer enn 5min på oppvåkning John-Petter S. Jamt 2017 Fentanyl ● Syntetisert i 1959 ● Flere typer med årene; Orto-fluoro-, para-fluoro-, Acetyl-, Butyryl-, Furanyl-, Car-, Al-, Remi- og kanskje farligst og nyest(?) Akrylfentanyl som er naloksonresistent!!! (Tetrahydrofur(an)(eon)). ● Lipidbasert ● Hurtig(!)virkende ● Relativt raskt nedbrutt/metabolisert til Norfentanyl med halveringstid ca. 8 timer. ● I lovlig form som; ● Sugetabletter ● Sublingualtabletter ● Plaster - Durogesic og Fentanyl “Hexal” John-Petter S. Jamt 2017 ● China Girl ● China White (H+F) ● Apache ● Dance Fever ● Goodfella ● Murder 8 ● TNT (H+F) ● Jackpot ● Tango and Cash ● Great Bear ● He-Man ● Jackpot ● King Ivory ● Murder 8 ● Poison (H+F) ● Perc-a-Pop John-Petter S. Jamt 2017 NPS - Nye Psykoaktive Substanser Sammendrag/Fellestrekk De fleste NPS virker stimulerende på hjernen ● Økt våkenhet og utholdenhet ● Hevet stemningsleie ● Bedre selvfølelse ● Nedsatt kritisk sans Mange er hallusinogene med ● Sansebedrag ● Illusjoner ● Hallusinasjoner John-Petter S. Jamt 2017 NPS - Nye Psykoaktive Substanser Inndeling i flere typer; ❖ Syntetiske cannabinoider ➢ Lignende virkning som THC - I hovedsak på cannabinoidreseptorer. ➢ Betydelig mer potente ■ Større risiko for psykose, kramper, koma ■ kardiovaskulære bivirkninger ➢ Redusert kritisk sans ➢ Økt aggresjon ➢ Psykoser, angst ■ ulykker, selvmord og voldsepisoder ➢ Forgiftningsdødsfall (MDMB-CHMICA (på Steinkjer)) ➢ K2 (i USA) ❖ En hel “skog” av forskjellige typer cannabinoider…… HOLD FAST!! John-Petter S. Jamt 2017 Syntetiske cannabinoider….. 4-HTMPIPO, 5F-AB-FUPPYCA, 5F-AB-PINACA, 5F-ADB, 5F-ADBICA, 5F-ADB-PINACA, 5F-AMB, 5F-AMB-PICA, 5F-APINACA, 5F-CUMYL-PINACA, 5F-EMB-PINACA, 5F-NNE1, 5F-PB-22, 5F-PCN, 5F-SDB-006 A-836339, AB-001, AB-005, AB-CHFUPYCA, AB-CHMINACA, AB-FUBICA, AB-FUBINACA, AB-PICA, AB-PINACA ADB-CHMINACA, ADB-FUBICA, ADB-FUBINACA, ADB-PINACA, ADBICA ADAMANTYL-THPINACA, ADBICA, ADSB-FUB-187 AM251, AM-404, AM-630, AM-678 (= JWH-018), AM-679, AM-694, AM-1220, AM-1221, AM-1235, AM-1241, AM-1248, AM-2201(funnet i Trondheim), AM-2232, AM-2233, AM-2389, AMB-CHMINACA, AMB-FUBINACA, APICA, APINACA, APP-FUBINACA, BAY 38-7271, BAY 59-3074 BB-22, BIM-018, BML-190, BRL-4664, Cannabicyclohexanol, CB-13, CP-47497, CP-55940, CP-55244, CT-3, CUMYL-PICA, CUMYL-PINACA, CUMYL-THPINACA, DMA (5'-dimethylammonium delta-8-tetrahydrocannabinol), TMA (5'-trimethylammonium delta-8-tetrahydrocannabinol) (water-soluble) DMHP, EAM-2201, FAB-144, FDU-NNE1, FDU-PB-22, FUB-144, FUB-APINACA, FUB-JWH-018, FUB-PB-22, FUBIMINA, GW-405,833 HHC, HU-210, HU-211, HU-239, HU-243, HU-308 JWH-007, JWH-015, JWH-018, JWH-019, JWH-073, JWH-081, JWH-098, JWH-116, JWH-122, JWH-133, JWH-149, JWH-167, JWH-182, JWH-193, JWH-198, JWH-200, JWH-203, JWH-210, JWH-249, JWH-250, JWH-251, JWH-302, JWH-398, JWH-424 JTE-907, JTE 7-31, L-759,633, L-759,656, LY-2183240, LY-320135, MAM-2201, MDA-19, MDMB-CHMICA (forgifningsdødsfall Steinkjer), MDMB-CHMINACA, MDMB-FUBICA, MDMB-FUBINACA, MEPIRAPIM, MN-18, MN-25, Nantradol, Nabilone, Nabitan, NESS-0327, NESS-040C5, NM-2201 NNE1, O-774, O-1057, O-1812, O-2050, O-2694, O-6629, Org 28611, NB-22, PF-03550096, PTI-1, PTI-2, PX-1, PX-2, PX-3,RCS-4, RCS-8 SDB-005, SDB-006, SP-111, SR-141716A, SR-144528, SRS-135, Synhexyl, THJ-018, THJ-2201, UR-144, WIN-48098, WIN-54461, WIN-55212-2, WIN-55225, WIN-56098, XLR-11…..for å nevne noen…… ;-) John-Petter S. Jamt 2017 NPS - Nye Psykoaktive Substanser ❖ Katinoner ➢ Selges bl.a. som badesalt eller plantegjødsel og som “lovlige” alternativer til kokain og meth. ➢ Pulver vanligst, finnes som tabletter. ➢ Kjemisk beslektet med katinon som er det psykoaktive virkestoffet i khat - mildt stimulerende ➢ Kan inntas p.o., sniffes, i.v., rektalt. ➢ Eufori, bevegelsestrang (uro), agitasjon, økt seksuell lyst, klare tanker, økt pratsomhet ➢ Mefedron og MDPV vanligst forekommende ➢ Mer potent på hjerte- og karsystemet enn kokain. ➢ Flere dødsfall rapportert ■ psykoser, selvmord, nyresvikt, muskelspasmer ➢ Helse- og overdoseteamet i Trondheim har rykket ut til person inntatt Mefedron John-Petter S. Jamt 2017 NPS - Nye Psykoaktive Substanser ❖ Fenetylaminer ➢ Kjemisk beslektet med amfetamin. ➢ Hovedsaklig sentralstimulerende, kan være hallusinogene ➢ PMMA/PMA, MDMA, 4-MA, 2C-B, Bromo, Dragonfly etc. ■ PMMA er i Norge assosiert med over 30 dødsfall siden 2010 ■ Sterkt toksisk ➢ Noen kan være ekstremt potente og psykoaktive i mikrogramsdoser ➢ Pulver, tabletter, kapsler, i.v., inhaleres. ➢ Eufori, økt energi, oppstemthet, åpenhet, endrede sanseopplevelser John-Petter S. Jamt 2017 NPS - Nye Psykoaktive Substanser ❖ Tryptaminer ➢ Seretoninlignende stoffer med hallusinogene effekter i hovedsak ➢ LSD, DMT, naturlige kjente som kan spises eller drikkes ➢ Syntetiske, f.eks. foxy methoxy kan inntas p.o., i.v., røykes eller sniffes ■ Dødsfall ikke bare pga toksisitet, men også pga hallusinogene effekter med fatale ulykker. John-Petter S. Jamt 2017 NPS - Nye Psykoaktive Substanser ❖ Piperaziner ❖ Til behandling av innvollsorm i 1950-årene. Ikke psykoaktivt i seg selv ❖ Piperazinavledede stoffer kan være psykoaktive ❖ Stimulerende og hallusinogene ❖ Selges som tabletter og “lovlige” alternativer til amfetamin og MDMA ➢ Legal-E, Herbal ecstasy, BZP, mCPP, TFMPP, DBZP ➢ Hovedsaklig p.o., men noen kan sniffes. ❖ Uforutsigbare effekter, kan være alvorlig etter vanlige rusdoser. ❖ Ikke dødsfall rapportert på piperaziner alene John-Petter S. Jamt 2017 NPS - Nye Psykoaktive Substanser ❖ “Andre stoffer” ❖ Stoffer som ikke kan kategoriseres i de øvrige gruppene ❖ Kan ha dempende, hallusinogene- og/eller stimulerende effekter ❖ Fentanylderivater, nye benzodiazepiner (dempende) ❖ “gamle kjente” som er tatt i bruk påny; ➢ AH-7921(opioid 1970-årene), desomorfin(krokodil) John-Petter S. Jamt 2017 Det mørke nettet Hvor mørkt er det, egentlig??? John-Petter S. Jamt 2017 John-Petter S. Jamt 2017 John-Petter S. Jamt 2017 John-Petter S. Jamt 2017 John-Petter S. Jamt 2017 John-Petter S. Jamt 2017 John-Petter S. Jamt 2017 John-Petter S. Jamt 2017 John-Petter S. Jamt 2017 John-Petter S. Jamt 2017 Takk for meg!! John-Petter S. Jamt 2017 Fentanyler, NPS - Nye Psykoaktive Substanser og Det mørke nettet. Kilder: Folkehelseinstituttet, U.S. Dept. of Justice (DEA), Tidsskriftet for Den Norske Legeforening, Journal of Analytical Toxicology, Forbundet mot Rusgift (fmr.no), EMCDDA, Det mørke nettet, Helse- og Overdoseteamet i Trondheim kommune. John-Petter S. Jamt 2017.
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