Neue Drogen – Neue Therapie? Crystal Speed, ATS &

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Neue Drogen – Neue Therapie? Crystal Speed, ATS & Neue Drogen – neue Therapie? Crystal Speed, ATS & NPS Arbeitsgruppe / Workshop auf der Buss-Jahrestagung am 12.03.2014 Dipl.-Psych. Marcus Breuer psycholog. Psychotherapeut Begriffsklärung • Crystal = Crystal Speed; kristallines Metamphetamin • ATS = Amphetamin Type Stimulants • NPS = New Psychoactive Substances • Badesalze = Szenebezeichnung, denkbar ungeeignet, weil sie nichts erklärt und außerdem verharmlost • Research Chemicals = diese Stoffe sind „Abfallprodukte“ aus der Medikamentenentwicklung oder aber gezielte Veränderungen bekannter psychoaktiver Substanzen • Legal Highs = viele dieser neuen Stoffe sind bzw. waren zunächst legal (nicht dem BtmG unterstellt) • Kräutermischungen = Spice & Co., rauchbare synthetische Cannabinoide (viel toxischer als Cannabis) Definition ATS • engl.: Amphetamine-Type-Stimulants • Amphetaminartige Substanzen, die eine ähnliche Ringstruktur haben wie das „klassische“ Amphetamin • Aber: unterschiedliche Wirkung….. Wirkbogen der Partydrogen Entaktogene Ecstasy-MDMA MDEE Häufigkeit • ATS= Amphetamine Type Stimulants • Amphetamin (Speed) • XTC (MDMA; MDE; MDA) • Methamphetamin (Crystal) • Weltweit zusammen 26 million “regular users” vs: • Kokain 14 million reg. users • Heroin 16 million reg. users Nach WHO and UNODOC-Schätzungen (2010) ist Methamphetamin weltweit alleine die nach CANNABIS am häufigsten konsumierte illegale Substanz(18 Mio) (Nikotin und Alkohol sind Hauptproblem…..) Gesamtzahlen erstauffällige Konsumenten nach BKA: Trend 2000-2009 Drogentrends ATS – Geschichte I - 1800 Ephedrin erstmalig aus Pflanze isoliert - 1801 Kokain isoliert - Ephedra als Asthmamittel - 1893 d-Amphetamin erstmals in Japan synthetisiert - WW I Ephedra reduziert verfügbar - 1927 Einsatz eines Derivates als Asthmatherapeutikum - 1937 erstmals Missbrauch beschrieben - 1938 erste Amphetaminpsychose beschrieben - Meth: Angeblich Hitler im Führerbunker, Rommel in Wüste; angeblich deutsche Flieger „Hitler-Speed“- „Panzerschokolade“ -> Methamphetamin / Pervitin - Angriff auf Pearl Harbour unter Methamphetamin - gesichert: 1946 erste „Crystalwelle“ in Japan Quelle: Dr. Härtel-Petri, BKH Bayreuth, 2011/2012 ATS – Geschichte II (Medikamente) • 70er Jahre AN1, (auch Captagon) d-Amphetamin. Als Antidepressiva und gegen Schlafsucht und als Schlankheitsmittel… • „Braindoping der 68er“ • Ritalin kam in den 1950er Jahren auf den Markt und wurde schon in den 1960ern von vielen Menschen ohne medizinische Indikation eingenommen (z.B. Andy Warhol). • Kraftfahrer zur erhöhten Vigilanz (speed) D-amph: Jonny Cash, Elvis Presley, Fernfahrer…. Quelle: Dr. Härtel-Petri, BKH Bayreuth, 2011/2012 ATS – Geschichte III Insgesamt ist es eher verwunderlich, dass die 1. Welle nicht schon die Gesamt-BRD erreicht hatte! Woran lag das? Westdeutschlands Partydrogenszene wurde mit XTC und Speed (d-amphetamin) aus HOLLAND versorgt. Langsam zunehmend der Osten aus der Tschechischen Republik mit kleiner Verzögerung nach dem Zusammenbruch des Ostblocks…… mit Methamphetamin (Crystal-speed) Quelle: Dr. Härtel-Petri, BKH Bayreuth, 2011/2012 ATS – Geschichte IV Erste Zusammenfassung: Stimulantienthema eigentlich KEIN neuer Trend, …. aber die erneute Welle irgendwie schon …. ….. u.a. wegen Braindopingthematik Quelle: Dr. Härtel-Petri, BKH Bayreuth, 2011/2012 Crystal - Wirkung • WECKAMIN: wach machend, „Stimulierend“ • Schmerzempfindung reduzierend • Appetit zügelnd • Leistungsfähigkeit steigernd • Monotone Tätigkeiten • Selbstbewusstsein steigernd • SEX Antrieb und Genuss steigernd • Veränderung des Zeitempfindens • Stereotypien • Evtl. mit Kick (Euphorie), besonders bei i.v. und ice (geraucht) • HWZ= 8-24h (Urin-ph) Bis 48h wirksam! • Billiger als Kokain • Raschere Toleranzentwicklung • schneller abhängig (2), mehr Comorbidität (1), als bei Kokain! (2) Gonzalez Castro F, Barrington EH, Walton MA, Rawson RA.: Cocaine and methamphetamine: differential addictionrates Psychol Addict Behav 2000 Dec;14(4):390-396 (1) Kalechstein AD, Newton TF, Longshore D, Anglin MD, van Gorp WG, Gawin FH. Psychiatric comorbidity of methamphetamine dependence in a forensic sample. in J Neuropsychiatry Clin Neurosci 2000;12(4):480-484 ATS - Einnahme • Tabletten (bei Crystal selten, bei Speed/XTC häufig) • Nasal „lines“ • Intravenös: „ballern“, „spritzen“ und • „Ice rauchen“ - Schnellerer Wirkungseintritt • zunehmend schnellerer Wirkungseintritt -> mehr Comorbidität • Selten größere Menge schlucken „Bombe“ (z.B. bei Nasenbluten) Abhängigkeitsentwicklung: • Gelegenheitskonsum • Wochenendkonsum Freitag-Sa... mit /ohne Nachlegen? • Montag blau machen, Depressionen, Antriebsarmut. • Mittwoch „nachlegen“ zur Überbrückung bis Freitag..... • Täglicher oder Konsum jeden 2. Tag (Halbwertszeit bis 24h!) mit • rascher Toleranzentwicklung (Dosissteigerung) BINGES, SPEEDRUN: • Totaler Kontrollverlust bis keine Substanz mehr beschaffbar oder körperlicher Zusammenbruch Pharmakologie / Toxikologie (Uni Leipzig) Konsumformen und Wirkungseintritt: – oral (20-30 Min.) – nasal, überwiegend (5-10 Min.) – Rauchen (~ 1-3 Min.) – parenteral (i.v.) (< 1 Min.) Dosierung: therapeutische Dosis oral 3 mg pro/Tag: 10-30 mg, (3-10 Pervitin-Tabl.) Blutspiegel (therapeutisch): 10–50 ng/ml Wirkung 6-12 Stunden, Eliminations-Halbwertzeit: 9 -15 Std. Heutzutage: UNI LEIPZIG: Befunde aus 200 – 400 positiven Fällen pro Jahr (Verkehrskontrollen: Blutabnahmen): Blutspiegel bis > 2000 ng/ml Mittelwert ansteigend, derzeit ca. 300 ng/ml 10-50X höhere Konzentrationen im Blut…. „recreational user“ ? 1 line crystal-meth: 100-200mg 20-40x höhere Dosis abhängige Konsumenten mit Toleranz: 500-1000mg/Tag, oft bis 1500-2000mg (70-90% Wirkstoff) 10-100 X „therapeutische“ Dosis Toleranz tritt bereits auf nach 3 Dosierungen von 10 mg oral an 2-3 aufeinander folgenden Tagen! (10mg pro Tag!) (Hart et al. 2001) Also auch bei „Pervitin“ Abhängigkeit…. Konsumententypen • „Probierer / Gelegenheitskonsumenten“: Konsum wurde mangels Interesse oder wegen Nebenwirkungen / Risiko wieder eingestellt. • „Substituierer“: Illegale Drogen werden durch NPS ersetzt, etwa wegen eines bevorstehenden Drogenscreenings. • „Kiffer 2.0“: wechselnder Konsum von Cannabis und NPS, häufig werden Versorgungsengpässe mit Räuchermischungen überbrückt. • „Spezialisten“: experimentierfreudige „Psychonauten“, die das breitgefächerte Wirkspektrum von Research Chemicals nutzen. • „Allesnehmer“: regelmäßige Konsumenten unterschiedlicher Drogen, je nach Verfügbarkeit, Stimmung und Setting. Warum „explodiert“ das Thema derzeit so? • Tw. Sehr hohes Abhängigkeitspotential (je nach Substanz und Konsumart –> i.v./geraucht) • Leichte Verfügbarkeit • Leichte Herstellbarkeit • Internet als Informations- und Verbreitungsmedium • IIlegalisierungsproblem (viele verschiedene, neue Stoffe, Gruppenunterstellungsproblem im dt. BtmG) • Drogen werden zunehmend ortsnah produziert (d.h. in unserem Fall innerhalb Europas) -> minimiert die (Zoll)-Aufdeckungsgefahr • ATS „passen“ in unsere Zeit – schneller-höher-weiter ATS – Akute Schäden • Herzrhythmusstörungen • Bluthochdruckkrisen - cardiale Komplikationen • Schlaganfälle durch Bluthochdruckkrisen • Epileptische Anfälle • Akute Intoxikationspsychosen • Hyperthermie (akutes Medikamentenfieber mit Nierenversagen und Tod) Meth-Schäden: kurz- und langfristig • Schlaganfälle, Krampfanfälle, Kopfschmerzen • Gereiztheit, Unruhe • Depressionen, Ängstlichkeit, Reizbarkeit, Wut • Gedächtnisstörungen, Verwirrtheit (“Verpeiltheit”), Aufmerksamkeitsstörungen • Schlafstörungen/ Alpträume • Paranoia (Verfolgungsgedanken), akustische Halluzinationen (Stimmen hören), Panikreaktionen • Suizidgedanken (Selbstmordgedanken) • Nasennebenhöhleninfektionen • Verlust des Geruchssinnes, Nasenbluten, chronisches Naselaufen, • Heiserkeit • Trockener Mund, aufgesprungene Lippen • Abgenutzte Zähne und Karies (ständiges Knirschen- zu wenig Speichel-Mundreinigung vergessen) • Schluckbeschwerden • Brustschmerz, Husten und Atemstörungen (beim Entzug) • Herzrhythmusstörungen bis Herzinfarkt (Herzanfall) • Magendarmprobleme (Magenschmerzen und Übelkeit) • Libidoverlust (keine Lust auf Sex) • Mangelernährung, Unterernährung, Gewichtsverlust. • Schwäche, Müdigkeit • Tremor (Zittern) • Schwitzen • Fettige Haut, Pickel, aufgekratzte Stellen (Exkoriationen) • Muskelschmerzen und Rückenschmerzen Crystal - Entzug Problem: - Entzug nicht vegetativ, nicht körperlich sichtbar….. - wird (z.B. von Opiatpat. und vielen Kollegen) nicht ernst genommen…. - Suchtdruck (Craving), - Emot. Instabilität-Gereiztheit, - vermehrtes Schlafbedürfnis, dann unerholsamer Schlaf (DROGENTRÄUME) - Depressionen mit Suizidalität, - Antriebsmangel / Hyperkinet. Syndrom - Heißhungerattacken (Essstörungen) - Dauer: > 2-3 Wochen Crystal - Langzeitschäden Zusätzlich zu „suchttypischen“ Netzwerkveränderungen wie bei anderen Stoffen: NEUROTOXIZITÄT. • Nervenzellen sterben ab. Kognitive Störungen: • Gedächtnisstörungen, • Aufmerksamkeitsstörungen, • Konzentrationsstörungen. • (Unfähigkeit, sich an Termine zu erinnern) UND PSYCHOSEN! Speed - Psychose • Paranoid halluzinatorisch • „Filme schieben , Paranoia haben“ • (Verfolgungswahn) -> Gefahr des Konsums sedierender Substanzen als Selbstmedikationsversuch Exkurs: Research Chemicals I Neue Clubdrugs/Trenddrogen - fast alles RC-Drugs: • Substanzen, die zu Forschungszwecken genutzt werden und als solche „gekauft“ werden…. • RC-Substanzen (research chemicals) / Designerdrugs….. • Zeitweise nicht dem BTMG der jeweiligen Länder unterliegend….. • z.B. Mephedrone, Butylone etc….. 280 Substanzen! • Teilweise keine ATS, synthet. Kokainderivate… Exkurs: Research
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