EMERGING DRUGS CLINICAL COMMITTEE REPORTS GOBIERNO MINISTERIO DE ESPAÑA DE SANIDAD, POLÍTICA SOCIAL E IGUALDAD GENERAL SECRESECRETARIATTTAARIAATT FOR SOCIAL POLICY AND CONSUMER GOVERNMENTGOVERRNMENT MINISTRYMINISTRRYY PPROTECTIONROOTTECTION OF SPAINSPPAAIN OF HEALTH,HEALLTTH, SOCIAL POLICYY AND EQUALITYEQUALITY GGOVERNMENTOVERNMENT DELEGDELEGATIONAATTION FOR THE NATIONALNAATIONALTIONAL PLAN ON DRUGSDRUGS EDITORIAL PANEL Clinical Committee of the Government Delegation for the National Plan on Drugs: Manuel Sanchís Fortea Julia González Alonso Elena Álvarez Martín Carlos Álvarez Vara Julio Bobes García Begoña Brime Beteta Exuperio Díez Tejedor Magí Farré Albaladejo Juan Flores Cid Aurelio Luna Maldonado Amparo Sánchez Máñez Rosario Sendino Gómez Marta Torrens Melich ACKNOWLEDGEMENTS The Clinical Committee of the Government Delegation for the National Plan on Drugs would like to acknowledge the contribution and documentary and technical support of the following people: Noelia Llorens Aleixandre Mercedes Rubio Ferreiro Francisco Ràbago Lucerga MINISTRY OF HEALTH, SOCIAL POLICY AND EQUALITY Published and distributed by: © MINISTRY OF HEALTH, SOCIAL POLICY AND PUBLISHING UNIT Paseo del Prado, 18. 28014 Madrid © GENERAL SECRETARIAT FOR SOCIAL POLICY AND CONSUMER PROTECTION GOVERNMENT DELEGATION FOR THE NATIONAL PLAN ON DRUGS ONLINE NIPO: 860-11-054-9 PAPER NIPO: 860-11-054-9 ISBN: 978-84-920522-8-8 Legal deposit: M-38788-2011 Layout: ADVANTIA COMUNICACIÓN GRÁFICA, S.A. Printed by: ADVANTIA COMUNICACIÓN GRÁFICA, S.A. Website: http://www.pnsd.mspsi.es Clinical Committee of the Government Delegation for the National Plan on Drugs Chair Mrs. Nuria Espí de Navas Government Delegate for the National Plan on Drugs Members Mr. Manuel Sanchís Fortea Mrs. Julia González Alonso Mrs. Elena Álvarez Martín Mr. Carlos Álvarez Vara Mr. Julio Bobes García Mrs. Begoña Brime Beteta Mr. Exuperio Díez Tejedor Mrs. Magí Farré Albaladejo Mr. Juan Flores Cid Mr. Aurelio Luna Maldonado Mrs. Amparo Sánchez Máñez Mrs. Rosario Sendino Gómez Mrs. Marta Torrens Melich Preface This sixth report by the Clinical Committee of the Government Delegation for the National Plan on Drugs analyses the wide range of effects of the so-called “emerging drugs”. This term would include other expressions such as “synthetic drugs”, “designer drugs” or “recreational drugs”, which are very commonly used but whose meaning may not be sufficiently clear and accurate. Emerging drugs are illegaly synthetized substances intended to cause, by means of some variations in the chemical structure, similar or even higher effects than classical drugs as well as to avoid the normative control that the latter are subject to. These drugs appear, reappear or emerge in the market and the mass media (which explains the term used in this monograph) in a recurrent manner. Since the analysis and review of drugs policies of the last few years, and more specifically in Spain since the National Plan on Drugs came into effect in 1985, the social perception of the issue of drug use and drug addiction has changed dramatically. The world of drug abuse and psychoactive substances with recreational purposes is constantly changing. Therefore it is vital for all those professionals involved in their clinical-therapeutic treatment and prevention to know the current trends of use, the types of substances used or the new use and toxicity patterns. Their use and abuse are linked to a festive atmosphere, mostly on weekends, among teenagers and young people, who are familiar with their stimulating effects that help relate to others, but who, most of the times, ignore their harmful effects to their health. All this is frequently exacerbated by the use of alcohol and the common fraud regarding the composition of these “pills”, which are adulterated with all kind of psychoactive or solvent products. There is an increasingly high number of these substances. The European Union informed of the emegence of around 40 new substances in 2010, including plants and fungus, vitamines, minerals, legal drugs or their copies and unauthorized chemical substances with various ways of marketing and use (pills, plant extracts, fresh or dry fungus, soaps, vegetable fertilizers, infusions, inhaling products, etc.). Moreover, their spreading has been significantly increased by the Internet, which contains a huge amount of information about their procurement, synthesis, identificacion, use, effects and marketing of this type of substances. It is pseudo-scientific information not verified or contrasted 7 frequently used to justify the promotion of the use of these substances on many websites. This is why the new trends of use and development may escape from the control and follow-up mechanisms of the State. The virtual and global nature of the Internet, the difficulty in applying legal restrictive measures and their relative anonymity and rapidity foster their trade and distribution. The Clinical Committee of the Government Delegation for the National Plan on Drugs provides professionals with a practical monography condensing the current knowledge on emerging drugs and their effects on people’s health and welfare. This volume contains updated information on the current situation of the use of this type of substances in our country and reviews some legal and social aspects related to it. Its accessible language and clear presentation make the reading and understanding easier to all those interested in this subject. I would like to express my gratitude to all the members of the Clinical Committee for the work done and encourage them to keep on this task. Leire Pajín Iraola Minister of Health, Social Policy and Equality 8 Contents I. Introduction ......................................................................... 13 II. General concepts ................................................................. 17 2.1. Definitions ................................................................... 17 2.2. Classification ............................................................... 19 2.3. Ways of presentation. Ways of use. Ways of administration ............................................... 23 2.4. Early Warning System (EWS) ..................................... 23 III. Current situation ................................................................. 31 3.1. International situation: prevalence of use, trafficking and seizures ................................................................. 31 3.1.1. Situation around the world ............................. 31 3.1.2. Situation in Europe ......................................... 37 3.2. Current situation in Spain: prevalence of use, trafficking and seizures ................................................ 45 IV. Amphetamines ..................................................................... 69 4.1. Composition ............................................................... 69 4.2. Nomenclature ............................................................. 73 4.3. Ways of administration and use ................................. 73 4.4. Pharmacology ............................................................. 75 4.5. Clinical signs ............................................................... 79 4.6. Intoxication, addiction and withdrawal symptoms ... 82 4.7. Therapeutic intervention ............................................ 83 9 4.8. Mephedrone and other synthetic cathinones ............ 87 4.9. Bromo-dragonfly ......................................................... 89 V. Piperazines ........................................................................... 93 5.1. Classification ............................................................... 93 5.2. Ways of administration and use ................................. 94 5.3. Pharmacology ............................................................. 95 5.4. Clinical signs ............................................................... 96 5.5. Therapeutic intervention ............................................ 98 VI. Pyrrolidinophenones .......................................................... 99 VII. Ketamine ............................................................................... 101 7.1. Nomenclature ............................................................. 101 7.2. Ways of administration ............................................... 102 7.3. Pharmacology ............................................................. 102 7.4. Clinical signs ............................................................... 106 7.5. Therapeutic intervention ............................................ 110 7.6. Legal situation ............................................................. 110 VIII. Spice drugs ........................................................................... 113 8.1. Nomenclature ............................................................. 113 8.2. Composition ............................................................... 114 8.3. Ways of administration. Ways of use ......................... 115 8.4. Pharmacology ............................................................. 116 8.5. Clinical signs ............................................................... 117 10 8.6. Therapeutic intervention ............................................ 118 8.7. Legal situation ............................................................. 118 IX. GHB/GBL .............................................................................. 121 9.1. Composition ..............................................................