cece lesson

ce lessonPharmacy Practice national continuing education programStreet drugs: an overview of trends, availability, toxicity and managementDesigner drugs is a term used todescribe psychoactive drugs that havebeen designed or synthesized by modifyingtheir original molecular structure toavert existing drug laws. 6 The term initiallyreferred to a wide range of opioidderivatives that were being sold as heroinon the black market. It later becamewidely popularized in the mid-1980swhen MDMA became available. In theU.S., the Controlled Substances Act wasamended to become the Controlled SubstanceAnalogue Enforcement Act, whichattempted to ban designer drugs, makingit illegal to manufacture, sell or possesschemicals that were substantially similarin chemistry and pharmacology toSchedule I or Schedule II drugs of theU.S. Controlled Substances Act. 6-8Drug abuse has a wide range of definitions,as there is great controversy as towhat constitutes drug use, dependenceand abuse. One definition is the use ofany illegal drug or the misuse or overuseof a psychoactive drug or performanceenhancingdrug for a nontherapeutic ornonmedical effect. 9 The American PsychiatricAssociation uses the Diagnosticand Statistical Manual of Mental Disordersto provide diagnostic criteria fordefining the substance abuser. 10 Drugs ofabuse can include nonprescription, prescriptionand illicit drugs.The street drug userThe phenomenon of illicit drug use is stillpoorly understood and largely influencedby cultural factors. Users are an extremelyheterogeneous group. 11 Street drugs affectnot only the individuals who use them,but society as a whole. Use of street drugsmay lead to criminal involvement in additionto possible physical, social and psychologicalharm. 12People use illicit drugs for many reasons:curiosity, pleasure, peer pressure ormedical purposes (e.g., pain relief). 13 Patternsof use can range from recreationaluse (e.g., MDMA) to habitual use forpowerfully addictive drugs like heroin. 14Street drug trendsThe 2004 Canadian Addiction Surveyrevealed that about one in six Canadianshas used an illicit drug other thanmarijuana during his or her lifetime. Thesurvey also found that, excludingmarijuana, the most commonly used streetdrugs are hallucinogens (PCP and LSD),CE2 pharmacypractice | october 2007followed closely by cocaine, methamphetamine,and MDMA. 15The Royal Canadian Mounted Police(RCMP) 2005 Drug Situation Report identifiedthat an estimated 29 clandestinecrystal methamphetamine labs wereseized in Canada that year. The numberof production sites in Ontario rank secondonly to British Columbia and many noware being discovered in Alberta. Of the51 drug laboratories seized in 2005 inCanada, 17 were MDMA laboratories.GHB availability in Canada is largelydependent on domestic production. However,there have been very few reports ofseizures of GHB. GHB traffickers haveobtained the necessary chemicals fromdomestic or foreign sources, such as GHBmanufacturing kits via the Internet. 16Current, published Canadian informationon street drugs availability, cost andtrends is limited. Drug abuse patterns arenot static; illicit substances and theirmethods of use constantly change. 17 Trendscan also vary from province to province,within a province and even from rural tourban areas. One example is regional differencesin the number of injection drugusers across Canada (Table 1). 18Law enforcement agencies can providerecent trend information based on policeintelligence and drug seizures. 19 Twoinformative websites in this regard arethat of the RCMP (www.rcmp-grc.gc.ca)and the Canadian Centre on SubstanceAbuse (www.ccsa.ca).Pharmacy regulatory bodies may alsobe a source of information on local prescriptiondrug thefts and forgeries. Likewise,poison centres can often providedata on drug abuse trends, since calls areoften received about the management oftoxicity from street drugs.The value of street drugsJust as drug abuse patterns are not static,the value of street drugs is also not static.One study in downtown Vancouverattempted to determine which prescriptiondrugs have street value and what thatvalue is. The study identified that someprescription sedatives and narcotics havea wide range in pricing when sold on thestreet. 20The difference in markup from theactual pharmacy cost can be considerable.Factors that influence pricing includeexperience/inexperience of the buyer, theavailability of illicit narcotics, the currentstreet supply of prescription medicationsand the time of month (before or afterpayday).table 1Estimates of injectiondrug users acrossCanada 18Greater Vancouver 12,000Downtown Eastside Vancouver 4,700Edmonton 5000Calgary 3000Ottawa region 3000-8000New Brunswick 450Clandestinedrug manufactureA clandestine laboratory is simply definedas a place where the preparation of illegalsubstances takes place. One of the mostcommon illicit drugs produced by clandestinelaboratories is crystal methamphetamine.21,22The supply of drugs to the illicitmarketplace is subject to the demand forsuch commodities and obeys laws ofeconomics just like any other business. 14Clandestine laboratories can be largescaleoperations, also referred to as “superlabs,” capable of producing up to 5 kg ofcrystal methamphetamine in 24 hours. 23Law enforcement agencies have also seena substantial rise in the number of smalllabs often referred to as “small toxiclabs.” 18,23 Individuals in these small homelabs use “recipes” often found on theInternet to create small amounts of a drugfrom legitimate household products. 23There is a lack of quality control atillicit drug laboratories. As a particulardrug synthesis process becomes knownto law enforcement authorities, the saleof a required chemical becomes restricted.Often, illicit drug chemists will modifytheir method of synthesis, sometimes withunpredictable results. 14 Clandestine druglaboratories may produce an undesiredchemical as a result of a sloppy synthesis. 9For example, the improper manufactureof GHB can lead to a mixture of GHB andsodium hydroxide, a strong causticchemical. If aspirated, the corrosivechemical can cause severe damage to thelung tissue. 5Contaminants are byproducts of theanswer online at pharmacygateway.ca