Substance Abuse Course and New Drugs Voodoo and Strox Under vision of Professor Dr. Medhat Attia Assignment Prepared by Asmaa ELsheikh

The content

 Introduction  Definitions  Component  Routes of administration  Mechanism of action  Adverse Effects  The Magnitude of the problem  Impact  References

Introduction

Governments have established laws and protocols to deal with classical drugs like and amphetamines. Screening tests are provided to detect their usage. Furthermore, there are many preventive programs to control their impact. Recently, many new psychoactive drugs are discovered. They are man-made, mostly for recreational use and mainly to overcome drug control laws and routine blood tests .

They were defined as ‘analogs, or chemical cousins, of controlled substances. They are designed to produce effects similar to the controlled substances they mimic. Alongside more traditional retail outlets (head shops), the growth of the internet opened up new channels for their sale or for online ‘chat‐rooms’, where their properties could be openly discussed. It was at this time that the expression ‘research chemical’ appeared .

By around 2006, it became clear that manufacturers of new substances were now trawling the world's scientific and patent literature in search of failed pharmaceuticals. They took advantage of such researches, by using their recipes in producing new psychoactive drugs.

These compounds include amphetamine derivatives, illicit phenethylamines, piperazine derivatives, and synthetic cannabinoid agonists

The first synthetic cannabinoid agonists were identified in smoking mixtures, which are often known as ‘Spice’. As before, they had been developed as potential pharmaceutical agents, particularly as analgesics, and their synthesis was well described in the accessible scientific literature. Some were naphthoylindoles, others were cyclohexylphenols and some were closer to traditional in their chemical structure (i.e. dibenzopyrans), but the ability to react with cannabinoid CB1 receptors as cannabimimetic is a property shared by a diverse group of substances .

Nearly six years ago, the Egyptian Ministry of Health warned of new types of drugs that were spreading throughout Egypt; "Voodoo" and “strox”, both are obscure . On the 7th of October 2018, Al Ahram gate, the English version, published that the Ministry of Health added five new substances to the country’s drug list, bringing the total number of illicit substances added to the list in the same year to 11 .

The most popular brands of synthetic cannabis are traded under the names Voodoo and Strox. The effects of these drugs vary in severity and are up to 400 times more potent than organic cannabis.

Social tolerance and acceptability to natural cannabis in Egypt encourage abuse of its synthetic potent analogs. Moreover, Strox is easily to be a synthesis that led to its availability with low prices in comparison with cannabis. Furthermore, the standard toxicology screens could not identify Strox users whereas natural cannabis would be traced .

Definitions

The new psychoactive drugs were known as ‘designer drugs’ and informally as ‘legal highs’. The preferred term, as adopted by the European Community in 2005 is ‘new psychoactive substances’. They are defined as ‘Narcotic or psychotropic drugs that are not scheduled under the United Nations 1961 or 1971 Conventions, but which may pose a threat to public health comparable to scheduled substances’. The word ‘new’ means newly misused; in reality, nearly all of the substances encountered were first synthesized many years ago.

Synthetic cannabinoids (SCs) are new human-made mind-altering chemicals that are similar to chemicals found in the marijuana . SCs are dissolved in ethanol or acetone and sprayed on plant material, which is then sold in packets as incense, herbal blends. These products are sold under a variety of names including "Spice," "Black Mamba," and in Egypt are known as "Voodoo" and "Strox". The chemical constituents and concentrations of compounds vary between and within packages

Component

Usually, 0.5 to 3 g of finely cut green/brown plant material is presented in colorful and professionally designed packets. Various herbs such as Pedicularis densiflora and latifolia were declared as ingredients.

Hundreds of SC were categorized into many structural groups and can be detected by Gas chromatography such as cyclohexylphenols, quinolinyl ester indoles, and indazole carboxamide compounds. In Egypt, five common types of synthetic cannabinoids present in Strox have been added to the Egyptian’s list of highly addictive and dangerous narcotics, denoted under the newly minted ministerial act No. 440 of 2018 and they are ;

 AB-FUBINACA  AMB-FUBINACA,  5F-ADB  AB-CHMINACA  XLR-11

Unfortunately, Strox creators are always altering their chemical structures using non prohibited substances to stay away from the long arm of the law. Routes of Administration

 Smoking (common(  Oral  Pulmonary (via vaporization)  Rectal administration Mechanism of Action

Overall, the commercially available SCBs elicit effects similar to those of the prototypical cannabinoid Δ9-THC. Furthermore, these effects are believed to be CB1receptor-mediated since pretreatment with CB1- receptor antagonists can block these effects.

The activity of Phase I metabolites of some common SCBs raises the intriguing possibility that genetic polymorphisms in cytochrome P450 enzymes may play an important role in determining an individual's response to these drugs. For example, an individual with a liver enzyme profile leading to biased production of antagonist metabolites might experience greatly attenuated drug effects, while an individual with a liver enzyme profile favoring the formation of agonist metabolites might experience potentiated or longer-lasting drug effects .

This predicts greater cannabinoid-receptor mediated effects in both the central and peripheral nervous systems. Some SCs bind to non- cannabinoid receptors, which may, in part, contribute to the physiological and behavioral consequences reported in the literature .

Adverse Effects

-Acute Intoxication

Case reports and retrospective studies of acute SC intoxication indicate that they can produce a wide range of physiological and psychiatric adverse effects, which vary in duration and severity.Toxic effects of SC use including:

 psychosis  respiratory depression,  cardiac events including cardiac arrest  nephrotoxicity  gastrointestinal problems including hyperemesis  hyperthermia  acute cerebral ischemia

Chronic

There are a growing number of reports detailing adverse effects associated with withdrawal from daily SC use; patients report withdrawal symptoms as the primary reason for their continued use.

Abrupt discontinuation of daily SC use has been associated with severe symptoms including reoccurring seizures and cardiovascular and respiratory risks. Common adverse effects of moderate severity include cravings, headache, severe anxiety, insomnia, nausea and vomiting, loss of appetite, and diaphoresis The magnitude of the problem

Worldwide

 The prevalence of lifetime synthetic cannabinoid use is between 0.2% and 4%.  SC users tend to be male and prevalence peaks in the late teens and early twenties.  SC use tends to not be sustained and most only use SC a small number of times.  SC users generally report a history of extensive use of other substances.  Curiosity was the most commonly endorsed motive

Concerning Egypt

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

Yet some local newspapers use the statements announced by Amr Othman, head of the Fund for Drug Control and Treatment, a state agency authorized to combat and treat drug addiction. He said that according to Egypt these synthetic drugs are most popular among youths aged 15-17 and represent 3.4% of all drugs popular in Egypt. Also, he declared that 10% of aged 15 and 16 are on some form of an illegal drug. Impact

Cases of synthetic cannabis abuse were associated with the manifestation of violence in Egypt and worldwide. These cognitive alterations increase the risk of road accidents if cannabis or SC users drive while intoxication. Moreover, psychoactive substances are often regarded as possible contributing causal factors in cases of violent injuries, sexual abuse, and homicides.

References

1. https://clinicaltrials.gov/ct2/show/NCT03866941 2. https://onlinelibrary.wiley.com/doi/full/10.1002/dta.319 3. http://english.ahram.org.eg/NewsContentP/1/311917/Egypt/Voodo o--battle-against-Satans-drug.aspx 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582439/ 5. https://ichgcp.net/clinical-trials-registry/NCT03695419 6. https://link.springer.com/article/10.1007/s11920-016-0694-1 7. https://www.sciencedirect.com/science/article/abs/pii/S036192301 6300880 8. https://www.researchgate.net/publication/334974503_Strox_Novel _Synthetic_Cannabinoids_in_Egypt_Medical_and_Legal_Challeng es 9. https://www.al-monitor.com/pulse/originals/2019/02/egypt-amend- drug-law-users-traficking.html