If earlier, when reading the police news related to violations of drug storage and use, everything was clear – what are the substances found, now the complex chemical names are not even pronounceable. We talk about what the new narcotic substances are and how dangerous they are, with Dr. Astrid the Stag.
“If in the last two years, since drugs from the synthetic opioid nitazene group have also appeared in Latvia, we found one or two such cases of use per quarter in the laboratory, then in January of this year we have had at least six cases where patients have used isotonitazen,” says Dr. Stirna . The police also report more and more cases of this dangerous drug being seized. Unfortunately, there are often cases of overdose, when emergency medical doctors fail to save a person.
What exactly are these substances and how dangerous are they?
The biggest problem has always been opiates and they have come in different forms at different times – from poppies to fentanyls, for a long time it was heroin, which is now out of circulation. The new narcotic substances are derivatives of nitazene chemically synthesized illegally in laboratories, the best-known of them is istonitazene, which usually could not be detected with the existing laboratory investigation methods in Latvia. But not only the development of new drugs, but also the methods of their detection are developing. Our RPNC laboratory can also detect them now.
Isotonitazene is a relatively new powerful synthetic opioid of the nitazene group – a particularly dangerous narcotic similar to morphine and fentanyl. In the European Union, it was classified as a narcotic substance already in July 2020, while in Latvia last July, in order to establish stricter control of the substance “isotonitazen”, the list of narcotic and psychotropic substances controlled in Latvia was supplemented “Prohibited particularly dangerous narcotic substances, psychotropic substances and plants similar to them” , the illegal circulation and misuse of which endangers health”.
The effect of this narcotic substance on the human body is particularly strong. The addictive potential is the same as that of morphine, but the substance is 100 times stronger than morphine. Since the substance is so strong, it has a very high risk of overdose, especially because the addict does not always know exactly what he is using and what is in the composition of the illegally purchased substance.
According to experts’ calculations, the half-life of isotonitazen from the blood plasma is about one hour. In the body, these compounds are broken down and metabolites are formed, which actively continue to act. So, even if the narcotic substance itself is no longer detectable in the blood, these metabolites continue to act on the central nervous system for up to 24 hours and can cause intoxication.
The use of these narcotic substances can have very serious consequences – respiratory depression, which in case of overdose can lead to respiratory arrest and death. All opioids have a high risk of dependence, with strong cravings and dependence occurring even after a few uses. In the event of an overdose, timely administration of the antidote naloxone is critical to prevent respiratory depression and death. It is especially dangerous when isotonitazine is used in combination with other opioids and/or benzodiazepines, because users
there is no experience with this class of opioids (such as dosage and exposure), which increases the risk of accidental, life-threatening poisoning.
According to the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), at least some of the isotonitazene on the European market has been produced by Chinese chemical companies. It is reported to be illegally sold as a powder and also as ready-to-use nasal sprays.
We at the Riga Psychiatry and Narcology Center also see that the number of addicted patients is increasing. There are queues for treatment programs in the country, as opioid-addicted patients are mostly prescribed long-term pharmacotherapy with methadone and buprenorphine.
Dr. Stirna: “Unfortunately, the state only finances the methadone program. Buprenorphine, which would be more appropriate for young, first-time opioid addicts who are socially stable, self-sufficient, working with less pronounced health problems, is not publicly funded, but it would be very, very necessary. Buprenorphine has less pronounced side effects, is safer to use, with lower risks of drug overdose. In Latvia, we currently have a few hundred patients in this program, because most often the patient himself or his relatives are unable to finance it. They are not only in the patient’s own interest, but also in the interest of society as a whole. Because when people become addicted, the dose needs to be taken every day, and then they will do anything to get the drugs. It would be more important for the state to finance this program than to deal with the social and criminal consequences.”
There are dangerous trends in the use of these new substances in the world, because of foreign publications and cholera
we have received information that various of these narcotic nitosene compounds are added to soap liquids; the addition of amphetamines and other psychoactive substances has also been heard of. This is a very big danger, especially considering the young generation among whom vapes are very popular. When buying vape illegally, “off the shelf”, ordering on the Internet, you can never be sure of what you have really bought and what substances are in their composition.
“I emphasize again and again that if we do not limit and control the use of tobacco products, soaps, herbal smoking products, and electronic smoking devices among teenagers, it can be said that the new generation will grow up with very big health and addiction problems. We only see the effects of using these substances in the long term. The public must understand that this is not an innocent, harmless, fragrant cloud of smoke,” emphasizes Dr. Stirna.
