An approach to the new psychoactive drugs phenomenon / Una aproximación al fenómeno de las nuevas drogas psicoactivas

Abstract Background. The new psychoactive drugs (NPD) are those that represent a danger to public health and are not prohibited by conventions on international narcotics. The concept also includes new contexts and new routes of consumption as well as novel ways of distribution, notably Internet. The risks associated with NPD consumption are largely unknown to users and to health care providers. Objective. To integrate the existing evidence regarding the main NPD in terms of description, epidemiology, psychopharmacology, medical complications and psychoactive effects. Method. To review relevant and updated clinical information on NPD obtained from specialized books and indexed scientific journals (PubMed/Medline, Google Scholar, Scopus), as well as official documents edited by international organizations dedicated to the epidemiologic analysis of drug abuse and Internet websites and forums managed by psychoactive substance users. Results. Aspects of clinical and pharmacological interest are described comprehensively, together with epidemiological data and risks associated to the consumption of the most relevant NPD: synthetic cannabinoids, synthetic cathinones, NBOMe series, indoleamines, piperazines, hallucinogenic mushrooms (Psilocybe SP.), synthetic opioids, plant products (khat, kratom, Salvia divinorum, ayahuasca) and dissociative anesthetics. Discussion and conclusion. The emergence of the NPD is a phenomenon on the rise with important consequences for public health. Learning about new trends in drug consumption and its potential risks should be essential for the medical professional. New research is needed in order to understand the phenomenon of the NPD and its pharmacological, clinical and legal implications.

Resumen Antecedentes. Las nuevas drogas psicoactivas (NDP) son aquellas que, aun cuando representan un peligro para la salud pública, no están prohibidas por los acuerdos internacionales sobre narcóticos. La noción incluye también nuevos contextos de usos, nuevas formas de administración y nuevas vías de distribución, entre las que destaca Internet. Los riesgos asociados al consumo de NDP son en gran medida desconocidos por los usuarios y el personal de salud. Objetivo. Integrar la información existente sobre las principales NDP en cuanto a su descripción, psicofarmacología, epidemiología, efectos psicoactivos y complicaciones médicas descritas. Método. Revisión de la información actualizada de relevancia clínica sobre las NDP obtenida de libros especializados y revistas científicas indexadas (PubMed/Medline, Google Scholar, Scopus); de documentos oficiales de organismos internacionales dedicados a la epidemiología del consumo de drogas, y de portales y foros en Internet gestionados por usuarios de sustancias psicoactivas. Resultados. Se describen de manera detallada aspectos de interés clínico y farmacológico, así como datos epidemiológicos y riesgos asociados al consumo de las NDP más relevantes: cannabinoides sintéticos, catinonas sintéticas, serie de los NBOMe, indolaminas, piperazinas, hongos alucinógenos (Psilocybe sp.), opioides sintéticos, productos vegetales (khat, kratom, Salvia divinorum, ayahuasca) y anestésicos disociativos. Discusión y conclusión. El surgimiento de las NDP es un fenómeno en auge con importantes consecuencias en la salud pública. Se hace imprescindible para el profesional médico conocer las nuevas tendencias en el consumo y los riesgos potenciales del mismo. Son necesarias también nuevas investigaciones para comprender el fenómeno de las NDP y sus implicaciones farmacológicas, clínicas y legales.

Severe Psychosis, Drug Dependence, and Hepatitis C Related to Slamming Mephedrone.

Background. Synthetic cathinones (SCs), also known as "bath salts," are ß-ketone amphetamine compounds derived from cathinone, a psychoactive substance found in Catha edulis. Mephedrone is the most representative SC. Slamming is the term used for the intravenous injection of these substances in the context of chemsex parties, in order to enhance sex experiences. Using IV mephedrone may lead to diverse medical and psychiatric complications like psychosis, aggressive behavior, and suicide ideation. Case. We report the case of a 25-year-old man admitted into a psychiatric unit, presenting with psychotic symptoms after slamming mephedrone almost every weekend for the last 4 months. He presents paranoid delusions, intense anxiety, and visual and kinesthetic hallucinations. He also shows intense craving, compulsive drug use, general malaise, and weakness. After four weeks of admission and antipsychotic treatment, delusions completely disappear. The patient is reinfected with hepatitis C. Discussion. Psychiatric and medical conditions related to chemsex and slamming have been reported in several European cities, but not in Spain. Psychotic symptoms have been associated with mephedrone and other SCs' consumption, with the IV route being prone to produce more severe symptomatology and addictive conducts. In the case we report, paranoid psychosis, addiction, and medical complications are described.

[Vegetables as new psychoactive drugs: a narrative review]. / Vegetales como nuevas drogas psicoactivas: una revisión narrativa.

There is growing interest in plants with psychoactive effects among consumers with different levels of experience. This has generated a need for updated knowledge among medical professionals and other health workers. These plants, which may be used in shamanic healing ceremonies or rituals or just for traditional purposes, have emerged in the Western world as new psychoactive drugs; largely thanks to the ease of purchase, sale, cultivation and exchange of information that the Internet offers. This review summarizes the current knowledge about the most important psychoactive plants, either by their mention in Internet forums or harm-reduction portals or by their allusion in scientific texts.

Existe un interés creciente en los vegetales con efectos psicoactivos por parte de consumidores, con diferentes niveles de experiencia. Esto ha generado una necesidad de actualización de conocimientos del lado de los profesionales médicos y de otros responsables de la salud pública. Se trata, por lo general, de plantas de uso en ceremonias chamánicas con intención curativa, en rituales o simplemente de uso tradicional que han dado el salto al mundo occidental como nuevas drogas psicoactivas, en gran medida gracias a la facilidad de compra, venta, cultivo e intercambio de información que ofrece Internet. Recopilamos en este texto los vegetales con propiedades psicoactivas más relevantes, tanto por su frecuente mención en foros de usuarios o en portales destinados a la reducción de daños en el consumo de drogas, como por su aparición en textos científicos.

New Psychoactive Drugs.

Carta al editor.

Nuevas Drogas Psicoactivas / New Psychoactive Drugs

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