Analiza zasegov in zastrupitev z novimi sintetičnimi opioidi v državah Evropske skupnosti med leti 2008 in 2021 : magistrski študijski program Laboratorijska biomedicina

Hriberšek, Anja (avtor), Sollner Dolenc, Marija (mentor)

Sintetični opioidi so nove psihoaktivne snovi (NPS), katerih glavna značilnost je, da posnemajo učinke klasičnih prepovedanih drog. Gre za zelo heterogeno skupino snovi, ki vključuje fentanil in njegove analoge ter nefentanilne snovi. Vsem je skupen mehanizem delovanja, saj delujejo kot agonisti opioidnih receptorjev v centralnem živčevju. Ob izpostavljenosti pride do psihoaktivnih učinkov, ki so podobni učinkom heroina, zato se fentanil in njegovi analogi uporabljajo kot njegov nadomestek in nadomestek drugih prepovedanih opioidov. Drugi razlog za uporabo sintetičnih opioidov pa je protibolečinsko delovanje, saj so opioidi kar nekaj desetkrat močnejši od morfina. Vendar je negativni učinek ta, da povzročajo odvisnost. Tega se niso dovolj zavedali v ZDA, ko so v 90. letih prejšnjega stoletja množično predpisovali opioidna protibolečinska zdravila na recept. To je privedlo do množične uporabe opioidnih zdravil, kasneje tudi do uporabe novih sintetičnih opioidov. Zato trenutno stanje imenujejo opioidna kriza. Na evropskem prostoru do tovrstne krize ni prišlo, se pa vsako leto pojavijo primeri novih sintetičnih opioidov, zaradi katerih pride do več zastrupitev in tudi smrtnih primerov. Zato je namen te naloge pregledati pojavnost posameznih sintetičnih opioidov v državah Evropske skupnosti in analizirati njihove zasege ter zastrupitve. Za izhodišče naše naloge smo uporabili podatke, ki so zbrani v Evropski bazi novih drog (European Database on New Drugs (EDNDII)), ki je pod okriljem Evropskega centra za spremljanje drog in zasvojenosti z drogami (European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)). Zaradi resnih posledic uporabe opioidov se vse od leta 2003 spremlja pojavljanje NPS v Evropi. S pomočjo preglednic in grafov smo prikazali sintetične opioide, ki so se pojavili v Evropski skupnosti med letoma 2009 in 2021 in navedli vse informacije, ki smo jih o njih dobili v bazi EDNDII ter v ostalih literaturnih virih. Za analizo smo uporabili metodo opisne statistike. Na seznamu EDNDII je 72 sintetičnih opioidov, ki so se začeli v večjem številu pojavljati po letu 2016. Od takrat jih pride na trg v povprečju deset na leto. Največ na novo pojavljenih sintetičnih opioidov je bilo v Nemčiji in sicer 16. Slovenija je na tem področju na tretjem mestu s številom 11. Prav tako je bilo v Nemčiji zabeleženo najvišje število različnih opioidov, saj so jih zabeležili 38, medtem ko so jih v Sloveniji 31. Izmed vseh opioidov, ki so v bazi EDNDII, jih je 33 uvrščenih na seznam Uredbe o razvrstitvi prepovedanih drog v Sloveniji. Sintetični opioidi, ki lahko predstavljajo resno tveganje za javno zdravje, so deležni intenzivnega spremljanja. Na tem seznamu je trenutno osem snovi, nobena od njih nima izdane ocene tveganja. Jo pa ima izdano kar deset drugih snovi, ki so nevarne za zdravje ljudi, saj so povzročile več smrtnih primerov. Zadnja je bila izdana za izotonitazen. Pregled prijavljenih poročil je pokazal, da je bilo največ prijavljenih primerov leta 2017 ter da se sintetični opioidi najpogosteje pojavljajo v zaseženih vzorcih. Države si prizadevajo, da se omeji uporaba sintetičnih opioidov, vendar zaenkrat še ni uspeha. Bo pa k manjši umrljivosti pripomogel program nalokson za domov, saj je ta snov najučinkovitejši opioidni antidot, ki ob pravočasni in pravilni uporabi zmanjša tveganje za smrt. Še vedno pa ima glavno vlogo Sistem za zgodnje opozarjanje na pojav NPS, ki poskrbi, da so države pravočasno obveščene o novem pojavu opioidnih snovi.

• Jezik: Slovenski jezik
• Ključne besede: nove psihoaktivne snovi, sintetični opioidi, EDNDII, evropska baza novih drog, EMCDDA, evropski center za spremljanje drog, fentanil
• Vrsta gradiva: Magistrsko delo/naloga
• Tipologija: 2.09 - Magistrsko delo
• Organizacija: FFA - Fakulteta za farmacijo
• Kraj izida: Ljubljana
• Založnik: [A. Hriberšek]
• Leto izida: 2022
• Št. strani: X, 67 str.
• PID: 20.500.12556/RUL-138838
• UDK: 615.214+615.212.7(043.3)
• COBISS.SI-ID: 115109635
• Datum objave v RUL: 23.08.2022

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Analysis of confinements and poisonings with new synthetic opioids in the countries of the European Community between 2008 and 2021

Izvleček

Synthetic opioids are new psychoactive substance (NPS), that can imitate the effects of classic illegal drugs. The group of new psychoactive substances is highly heterogeneous and contains fentanyl and its derivates among with the non-fentanyl substances. They all have the same mechanism of activity as they work as an agonist opioids receptors in the central nerve system. The exposure to those substance can cause psychoactive effects, that are similar to the effects of heroin, that is why fentanyl and its derivates are used as the heroin compensation/substitute or the compeensation/substitute for other prohibited opioids. Another use of the synthetic opioids is due to their analgesic activity – they are a few decades times stronger than morphine. But it has the a highly negative downside, since it can lead to addiction. The adictive effect of opioids was poorly considered in the USA, where the prescriptions for opioid analgesic in the 90s were common. That reflected in the massive use of opioid medicine and latter on to the production of new synthetic opioids. The current era could therfore be called Opioid Crisis (or even U. S Opioid Epidemic). In Europe, the similar crisis is not known, but there are records of the occurrence of new synthetic opiods that cause toxication or even death, each year. That beeing the case we wanted to present in this work the review of appearance of some specific synthetic opiods in the countries of European Communities and analyse the cases of drug seizure and/or toxication. As the base of the analysis we took the data collected in European Database on New Drugs (EDNDII) from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The use of the NPS is monitored since 2003, hence their serious consequences. The results of our work are showed in tables and graphs, where we analyse all the appearance of the opiods in the European Communities between the years 2009 and 2021. We also considered all the information gained from the EDNDII Database and other accessible references. The analysis was made with the use of descriptive statistics. On the EDNDII list is 72 synthetic opioids, which use rapidly emerge after the year 2016. Since than there is annualy 10 new products on the market. The highest number of new synthetic opioids was introduced in Germany, with the number of 16. Slovenia is in the third place with 11 opioids. Germany also has the highest number of all opioids, they recorded 38 different opiod substances, as in Slovenia there were 31. Among all opioids listed in EDNDII Database there are 33 listed in in the Regulation on the Classification of Illicit Drugs. Synthetic opiods, that can pose a serious threat to public health are under intense monitoring. Among those are 8 substances, but none of them have the Risk assessment. On the other hand the Risk assessment was made for 10 other substances that are dangerous/unsafe to peoples health, since they cause numerous death cases. The latest was the release for Isotonitazene. The review of the final reports showed, that the year of the most reported cases was 2017 and that syntetic opioids are mainly found in the seized samples. Countries struggle to limit/restrict the use of Synthetic opioids, but for now the attempts rather unsuccessful. To decrease the mortality the programme Take-home naloxone was established, as the naloxone is the most effective opiod antidote. With the timely and correct use it can importantly lower the risk of death. Still the great importance goes to Early Warning System on NPS, which is committed to report the detection of the new opioid substance recorded to the government/country in time.