New addictive drugs (e.g voddo,strox)

Ahmed elsayed elrfaey دبلوم الصحه النفسيه 0909-2-048 Date :8-4-2020 Time :4 pm

Introduction and definition:

In the past two years, two new drugs known as Strox and Voodoo– have hit the Egyptian market.

Voodoo and stroks are types of synthetic drugs. they're not synthesized of plant but are manufactured to give the same effect of cannabis. The manufacturer sprays large amounts of synthetic materials on it to give the same effect of cannabis but these materials cause severe damage to the human body .

Voodoo is a combination of an aromatic plant, like marjoram or incense, which is infused with a synthetic that is up to 100 times as powerful as natural marijuana.

The most common brand is "Mister Nice Guy", which is sold in a small bag decorated with a smiley emoticon. The bag has a warning that reads “relaxing incense, not edible”. This drug is legal in several countries, including Israel, where it is notably popular among soldiers.

Strox is also made with an aromatic plant like marjoram and incense, which is then sprayed with active medical substances used as pain relievers in case of cramps or stomach aches, like atropine, hyoscine and hyoscyamine. These substances can have psychotropic effects when taken in large doses. The name "strox" is the Egyptian name for this type of drug,In America it is known as "Key 2" or "Spicy". Usually, these two drugs are mixed with tobacco and then smoked. Using these drugs can result in a wide range of symptoms, including speech impairments, visual and auditory hallucinations and paranoia, which can lead to aggressive behavior. Strox and voodoo Legal Challenges: six common types of synthetic cannabinoid – also known as Voodoo and Strox – have been added to the country’s list of highly addictive and dangerous narcotics.

Synthetic medical effects:

According to the US National Institute on Drug Abuse, are man-made, mind-altering chemicals sprayed on dried, shredded plant material so that it can be smoked or sold as liquids and inhaled in e-cigarettes and other devices.

Synthetic marijuana products are often marketed as "safe" alternatives to marijuana, but are known to cause serious health problems such as suicidal thoughts, seizures, breathing problems and kidney failure, according to the US Centers for Disease Control and Prevention.

Synthetic cannabinoids interact with CB1 and CB2 cannabinoid receptors and elicit cannabimimetic effects similar to Δ9- (THC), the primary psychoactive constituent in cannabis. Although Synthetic cannabinoids drugs mimic the psychotropic , their undesired effects are unpredictable and more severe than those associated with cannabis. Synthetic cannabinoids can result in acute, chronic and withdrawal manifestation Similar to cannabis, the acute intoxication of SCs may induce manifestations such as relaxation, euphoria, perceptual alteration, altered sense of time, and mild cognitive impairments. Other adverse effects include confusion, dizziness, drowsiness, agitation, irritability, nausea, vomiting, hallucinations, delusions, increased heart rate, hypertension, vertigo and mydriasis. Less common cardiac effects include chest pain, myocardial infarction, cardiac arrest and acute kidney damage. Studies are currently available that suggest an association between synthetic cannabinoids and psychosis.

The use of synthetic cannabinoids can be associated with psychosis and physicians are beginning to investigate if some patients with inexplicable psychotic symptoms may have at one point used synthetic cannabinoids.

In contrast to most other recreational drugs, the dramatic psychotic state induced by use of synthetic cannabinoids has been reported, in multiple cases, to persist for several weeks, and in one case for seven months, after complete cessation of drug use.

Strox and voodoo medical Challenges:

The medical challenge is raised from availability of sparse knowledge considering the current chemical composition of Strox and voodoo especially its synthetic cannabinoid ingredients, therefore, the descriptions of acute toxic effects of Strox and voodoo are based solely on clinical observations and the treatment is usually symptomatic.

From clinical point of view, acute Strox and voodoo intoxication usually presented by visual and auditory hallucinations accompanied with fear and intense aggression. Such manifestations could be attributed to the presence of THC analogues, anticolinergic substances, ketamine or other unknown additives. Moreover, pupillary dilatation, tachycardia, dry flushed skin and other elements of anticholinergic toxidrome could occur following Strox smoking. In sever cases, fatal cardiovascular collapse and/or deep coma was reported.

It is worth mentioning that, to the moment, almost nothing is known regarding the long-term sequels of Strox and voodoo on various body systems and questions considering its carcinogenic and teratogenic potential are still lacking the answers.

The most important symptoms of strox and voodoo withdrawal are those physical symptoms as a tremor in the patient's limbs ,pain in the joints and bones, excessive sweating,nausea,vomiting, headaches irregular heartbeat and increased blood pressure. Symptoms of psychological strox and voodoo withdrawal included the feeling of anxiety,the tension that engulfs the patient increased nervousness and sharpness on his part in words and deeds, increased movement in the patient,clearly insomnia and inability to sleep. magnitude of the problem in :

Though, no official statistical data is available to determine the magnitude of the problem, all indicators pointed to flourishing of Strox and voodoo use among different social classes in Egypt.

Social tolerance and acceptability to natural cannabis in Egypt encourage abuse of its synthetic potent analogues. Moreover, Strox and voodoo are easily to be synthesis that led to its availability with low prices in comparison with cannabis. Recommendations: Therefore, there is a critical demand to increase awareness of serious hazards of synthetic cannabinoids among general population of countries that are suffering from their presence.

Also, physician should be trained to deal efficiently with the cases of acute intoxication with synthetic cannabis. . Furthermore, Comprehensive studies are needed not only to elucidate the effects of THC analogues but also to identify their most abundant constituents with subsequent successful detection.

Moreover, amendment of the law is essential to include all substances that have cannabis-like actions in the schedules of prohibited substance.

References

1-Egypt Under the influence, Egypt Today. Available from: http://www.egypttoday.com/Article/15/21048/Under-the- influence.

2-Nicholasa P, Barbarac L, Maddalenab M. Synthetic cannabinoids: the hidden side of Spice drugs. Behav Pharmacol 2017; 28(6): 409-19.

3-Clayton HB, Lowry R, Ashley C, Wolkin A, Grant AM. Health risk behaviors with synthetic cannabinoids versus marijuana. Pediatrics 2017; 139(4): 14-23.

4-Palamar JJ, Barratt MJ, Coney L, Martins SS. Synthetic cannabinoid use among high school seniors. Pediatrics 2017; 140(4): 1-5.

5-Tellioglu T. Synthetic marijuana: what do we know about this recent hazard on the streets? J Drug Abuse 2018; 4: 1-2.

6-TF, Farquhar CE, Lefever TW, Marusich JA, Kevin RC, McGregor IS, Wiley JL, Thomas BF. Molecular and Behavioral Pharmacological Characterization of Abused Synthetic Gamage Cannabinoids MMB- and MDMB-FUBINACA, MN-18, NNEI, CUMYL-PICA, and 5-Fluoro-CUMYL-PICA. J Pharmacol Exp Ther 2018; 365(2): 437-46.

7-Abo Regela Addiction Recovery Center, Cairo, Egypt. Available from: https://www.aboregela.com/strox-drug/.

8-6 types of 'strox and voodoo' added to Egyptian ministry of health's dangerous narcotics list, Cairo Scene. Available from: http://cairoscene.com/Buzz/ministry-bans-synthetic- cannabinoids.