Hemmat Ali Mohammed 9th April 2020, Done on 2nd April at 8:30 AM (Voodoo & Strox Assignment) New addictive drugs Synthetic cannabinoids (SC) are a new class of psychoactive substances, it is potent agonists of cannabinoid receptors, which mimic the psychoactive effects of the principal psychoactive component of cannabis. It is a drug with properties and effects similar to a known hallucinogen or narcotic but having a slightly altered chemical structure. SC are the widest and most diffused class of Novel Psychoactive Substances. History: 2005: Synthetic cannabinoids first emerged in Europe. 2009: Appeared in the United States, where it was marketed initially as “K2” and “Spice” and inhaled via a pipe or rolled into a cigarette. 2014: Two new drugs known as Strox and Voodoo have hit the Egyptian market. Street and commercial names for SC products: K2, Spice, Barely Legal, Black Mamba, Galaxy, Mojo, and Yucatan Fire. Voodoo: Voodoo is a mixture of herbs and spices that are sprayed with a synthetic compound that mimics the effects of (Tetrahydrocannabinol) THC. Voodoo spice is marketed as an herbal incense. It is a synthetic cannabinoid 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”. 1 Strox: Strox is popular synthetic cannabis in Egypt that consists of smokable herbal products laced with synthetic cannabinoids (THC) analogues. Strox is the Egyptian version of the Spice in which Atropa Belladonna, Datura or Hyposymus is used as plant matrix to be enhanced with unidentified synthetic cannabinoids. These substances can have psychotropic effects when taken in large doses. Social tolerance and acceptability to natural cannabis in Egypt encourage abuse of its synthetic potent analogues. Moreover, Strox is easily to be synthesis that led to its availability with low prices in comparison with cannabis. The standard toxicology screens could not identify Strox users whereas natural cannabis would be traced, and synthetic cannabinoids are extensively metabolized, which makes it difficult to identify them in biological samples. Magnitude of the both in Egypt: No statistics in Egypt documenting the number of victims killed by Voodoo and Strox, however strox seems to be the more deadly of the two. There are regular reports in the Egyptian media of people who have died of a Strox overdose. Male more than females. The median age of reported exposure was 20 years. Gccg 2017 2020 2 Mechanism of action: Synthetic cannabinoid act as a potent Cannabinoid 1 and Cannabinoid 2 (CB1/CB2) receptors, the active principle of cannabis that bind to the same cannabinoid receptors in the brain to exert their psychoactive effects. CB1 receptors are found throughout the body but are densely concentrated in the brain, spinal cord and peripheral nervous system affecting pain. This receptor is responsible for most of the psychoactive effects of cannabinoids such as elevating a person’s mood, analgesia, memory impairment and altering one’s sense of time. CB2 receptors are found primarily in tissues of the immune system and have a role in pain as well, so it can decrease pain caused by inflammation without the psychoactive effects of CB1 receptors. Synthetic cannabinoids are used in a variety of ways: Sprayed onto plant material and smoked. Mixed into a liquid and vapid in electronic nicotine delivery devices Added to herbal tea or to food and swallowed. Usually, these two drugs are mixed with tobacco and then smoked. Effect on brain function: Psychosis, delusions, visual and auditory hallucinations and paranoia, which can lead to aggressive behavior. Irritability, confusion and concentration problems, suicidal thoughts, and violent behavior, seizures, sleepiness, dizziness and speech impairments. Etiology & Risk Factors: Genetic, physiological, environmental, conduct disorder in childhood or adolescence and antisocial personality disorder, externalizing or internalizing disorders. 3 Intoxication: Usually presented by visual and auditory hallucinations accompanied with fear and intense aggression, seizure and acute psychosis. Such manifestations due to the presence of THC analogues, anticolinergic substances,. Moreover, pupillary dilatation, tachycardia, dry flushed skin and other elements of anticholinergic toxidrome could occur following Strox smoking. In severe cases, acute myocardial infarction, fatal cardiovascular collapse and/or deep coma was reported. Also breathing problem, chest pain, gastrointestinal problems, heart attack, high blood pressure, stroke, kidney failure, hypokalemia and muscle damage. These health problems depend on the specific synthetic cannabinoid, the dose and the duration of use. Withdrawal: Headache, nausea and vomiting, severe anxiety, sweating, trouble sleeping, irritability, anger, or aggression, nervousness or anxiety, sleep difficulty (e.g., insomnia, disturbing dreams), decreased appetite or weight loss, restlessness, depressed mood, significant discomfort (abdominal pain, shakiness/tremors, sweating, fever, chills, or headache). Impact of the problem: Individual: Dependence, cognitive impairment, mental disorders (Psychosis, depression) and physical effects. Family: Marital, relationship problems and financial burden. Social: Affect work performance, significant burden on health service facilities. 4 Prevention: Primary prevention: Universal: Awareness through media about side effect & of vodo & strox, community wide programs like public awareness campaigns. Selective: School based programs, improving physical well-being: (encouraging a healthy lifestyle, physical, social, and other activities, such as sleep hygiene, regular exercise, promote self-care and fulfilling hobbies), improving mental and emotional well-being (thinking processes and expressing thoughts and feelings), improving social well-being: (make a strength on family, partner and friends relations). Indicative: Targeting those who not full filling the whole criteria. Psycho education Secondary prevention: (Pharmacological & non pharmacological) Pharmacological: Symptomatic treatment for specific symptoms (restlessness, tachycardia, panic attacks Non pharmacological: Supportive treatment, Counseling for: (behavioral modification, developing healthier coping skills &CBT). Tertiary prevention: Treatment of complications, treatment of withdrawal symptoms, treatment of toxicity symptoms and social rehabilitation. 5 References EGYPT / DRUGS - 07/23/2018, https://observers.france24.com/en/20180723-voodoo-strox-drugs-cairo- egypt. Voodoo and Strox: the synthetic drugs wreaking havoc in Cairo. Egypt Under the influence, Egypt Today. Available from: http://www.egypttoday.com/Article/15/21048/Under-the-influence. Abo Regela Addiction Recovery Center, Cairo, Egypt. Available from: https://www.aboregela.com/strox-drug/. Kong, T.Y., Kim, J., Kim, D.K. et al. Synthetic cannabinoids are substrates and inhibitors of multiple drug-metabolizing enzymes. Arch. Pharm. Res. 41, 691–710 (2018). Hasnaa Khalifa Sobh and Zahraa Khalifa Sobh. Strox (Novel Synthetic Cannabinoids) in Egypt: Medical and Legal Challenges. Forensic Medicine and Clinical Toxicology, Faculty of Medicine, University of Alexandria, Egypt. Nicholasa P, Barbarac L, Maddalenab M. Synthetic cannabinoids: the hidden side of Spice drugs. Behav Pharmacol 2017; 28(6): 409-19. Giovanni Martinotti, Rita Santacroce, Duccio Papanti, Yasmine Elgharably, Mariya Prilutskaya* and Ornella Corazza, “Synthetic Cannabinoids: Psychopharmacology, Clinical Aspects, Psychotic Onset”, CNS & Neurological Disorders - Drug Targets (2017) 16: 567. Content source: National Center for Environmental Health, Page last reviewed: August 21, 2017. Nermin M. Shaker, Eman Gaber, Mahmoud El-Habiby, Daliaو Menan Rabie Ismail, Maha El-Gaafary,Amina Lotfy, Noha Sabry, Wael Khafagyand Richard Muscat. Prevalence updates of substance use among Egyptian adolescents. Middle East Current Psychiatry (2020) 27:4. Ramy etal, Results of the first Mediterranean School Survey Project on Alcohol and Other Drugs (MedSPAD) in Egypt. 2017. 6 .