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Governments can address widespread fentanyl-related deaths by pursuing a harm-reduction approach involving increased transparency for users and public health and public safety organizations, harm-reduction policing, expanded naloxone use, and targeted treatment. Fentanyl, a powerful synthetic opioid, poses an increasing public health threat. Low production costs encourage suppliers to “cut” heroin with the drug, particularly white powder heroin sold in the eastern United States. 1 Fentanyl also appears as a prevalent active ingredient in counterfeit OxyContin (oxycodone) tablets. The result is that fentanyl plays a major role in rising mortality due to heroin or opioid overdose. It poses a serious overdose risk because it can rapidly suppress respiration and cause death more quickly than do other opioids. From 2012 through 2014, the number of reported deaths involving fentanyl more than doubled, from 2628 . . .

The present work describes the development and validation of a highly sensitive analytical method for the simultaneous determination of 68 compounds, including illicit drugs (opiates, opioids, cocaine compounds, amphetamines, and hallucinogens), psychiatric drugs (benzodiazepines, barbiturates, anesthetics, antiepileptics, antipsychotics, antidepressants, and sympathomimetics), and selected human metabolites in influent and effluent wastewater (IWW and EWW) by liquid chromatography coupled to tandem mass spectrometry (LC–MS/MS). The method involves a pre-concentration and cleanup step, carried out by solid-phase extraction (SPE) using the adsorbent Strata-XC, followed by the instrumental analysis performed by LC–MS/MS, using a Kinetex pentafluorophenyl (PFP) reversed-phase fused-core column and electrospray ionization (ESI) in both positive and negative modes. A systematic optimization of mobile phases was performed to cope with the wide range of physicochemical properties of the analytes. The PFP column was also compared with two reversed-phase columns: fused-core C18 and XB-C18 (with a cross -butyl C18 ligand). SPE optimization and critical aspects associated with the trace level determination of the target compounds (e.g., matrix effects) have been also considered and discussed. Fragmentation patterns for all the classes were proposed. The validated method provides absolute recoveries between 75 and 120 % for most compounds in IWW and EWW. Low method limits of detection were achieved (between 0.04 and 10.0 ng/L for 87 % of the compounds), allowing a reliable and accurate quantification of the analytes at trace level. The method was successfully applied to the analysis of these compounds in five wastewater treatment plants in Santorini, a touristic island of the Aegean Sea, Greece. Thirty-two out of 68 compounds were detected in all IWW samples in the range between 0.6 ng/L (for nordiazepam) and 6,822 ng/L (for carbamazepine) and 22 out of 68 in all EWW samples, with values between 0.4 ng/L (for 9-OH risperidone) and 2,200 ng/L (for carbamazepine). The novel methodology described herein maximizes the information on the environmental analysis of these substances and also provides a first profile of 68 drugs in a Greek touristic area.

In the area of psychotropic drugs, tryptamines are known to be a broad class of classical or serotonergic hallucinogens. These drugs are capable of producing profound changes in sensory perception, mood and thought in humans and act primarily as agonists of the 5-HT 2A receptor. Well-known tryptamines such as psilocybin contained in Aztec sacred mushrooms and N , N -dimethyltryptamine (DMT), present in South American psychoactive beverage ayahuasca, have been restrictedly used since ancient times in sociocultural and ritual contexts. However, with the discovery of hallucinogenic properties of lysergic acid diethylamide (LSD) in mid-1900s, tryptamines began to be used recreationally among young people. More recently, new synthetically produced tryptamine hallucinogens, such as alpha-methyltryptamine (AMT), 5-methoxy- N , N -dimethyltryptamine (5-MeO-DMT) and 5-methoxy- N , N -diisopropyltryptamine (5-MeO-DIPT), emerged in the recreational drug market, which have been claimed as the next-generation designer drugs to replace LSD (‘legal’ alternatives to LSD). Tryptamine derivatives are widely accessible over the Internet through companies selling them as ‘research chemicals’, but can also be sold in ‘headshops’ and street dealers. Reports of intoxication and deaths related to the use of new tryptamines have been described over the last years, raising international concern over tryptamines. However, the lack of literature pertaining to pharmacological and toxicological properties of new tryptamine hallucinogens hampers the assessment of their actual potential harm to general public health. This review provides a comprehensive update on tryptamine hallucinogens, concerning their historical background, prevalence, patterns of use and legal status, chemistry, toxicokinetics, toxicodynamics and their physiological and toxicological effects on animals and humans.

Use of synthetic cannabinoids (SCs) in the United States is increasing, as are clusters of cases of serious adverse health effects, including death. Though SC intoxication can be difficult to identify, some steps can be taken to respond more quickly to future outbreaks. Synthetic cannabinoids (SCs) were first created in the 1980s as laboratory research tools (ligands) for studying human endocannabinoid receptor systems. SC-containing products supplied by illicit manufacturers were then marketed throughout Europe as herbal incense, before arriving in the United States in November 2008. The prevalence and variety of SCs on the illicit market have steadily increased over the past 6 years, as manufacturers and distributors of SCs and dealers of SC-containing products have attempted to circumvent federal, state, and local laws. Since 2011, through actions on four separate occasions, the U.S. Drug Enforcement Administration (DEA) has placed a total of . . .

Mitragyna speciosa (Rubiaceae), commonly known as kratom, is a tropical tree with a long history of traditional use in parts of Africa and Southeast Asia. In recent years, kratom has gained popularity for use as a recreational drug across the globe. Relatively new to the illicit market and used in a manner different from its traditional applications, preparations of kratom are touted by many as a safe and legal psychoactive product that improves mood, relieves pain, and may provide benefits in opiate addiction. Available literature was reviewed for M. speciosa via PubMed, Google Scholar, CINAHL, and EBSCO to summarize its traditional uses, phytochemical composition, pharmacology and toxicology of proposed active constituents, and potential for misuse and abuse. Research has demonstrated that both stimulant and sedative dose-dependent effects do exist, but a growing concern for the drug’s effects and safety of use has resulted in national and international attention primarily due to an increase in hospital visits and deaths in several countries that are said to have been caused by extracts of the plant. The main active alkaloid substances in kratom, mitragynine and 7-hydroxymitragynine, present with a range of CNS stimulant and depressant effects mediated primarily through monoaminergic and opioid receptors. Recently, Palm Beach County, located in the southeastern corridor of Florida, has considered regulating kratom due to public safety concerns following the death of a young adult. At the local, state, and even federal levels, governments are now being confronted with the task of determining the safety and the possible regulation of kratom extracts. There are currently no standard analytical screening techniques for mitragynine and its metabolites following ingestion limiting its detection to more sophisticated techniques like liquid chromatography-mass spectrometry to determine kratom use. The growing concern of the abuse potential of kratom requires careful evaluation of its benefits and potential toxicities.

The world’s status quo on recreational drugs has dramatically changed in recent years due to the rapid emergence of new psychoactive substances (NPS), represented by new narcotic or psychotropic drugs, in pure form or in preparation, which are not controlled by international conventions, but that may pose a public health threat comparable with that posed by substances listed in these conventions. These NPS, also known as ‘legal highs’ or ‘smart drugs’, are typically sold via Internet or ‘smartshops’ as legal alternatives to controlled substances, being announced as ‘bath salts’ and ‘plant feeders’ and is often sought after for consumption especially among young people. Although NPS have the biased reputation of being safe, the vast majority has hitherto not been tested and several fatal cases have been reported, namely for synthetic cathinones, with pathological patterns comparable with amphetamines. Additionally, the unprecedented speed of appearance and distribution of the NPS worldwide brings technical difficulties in the development of analytical procedures and risk assessment in real time. In this study, 27 products commercialized as ‘plant feeders’ were chemically characterized by gas chromatography–mass spectrometry and nuclear magnetic resonance spectroscopy. It was also evaluated, for the first time, the in vitro hepatotoxic effects of individual synthetic cathinones, namely methylone, pentedrone, 4-methylethcathinone (4-MEC) and 3,4-methylenedioxypyrovalerone (MDPV). Two commercial mixtures (‘Bloom’ and ‘Blow’) containing mainly cathinone derivatives were also tested, and 3,4-methylenedioxymethamphetamine (MDMA) was used as the reference drug. The study allowed the identification of 19 compounds, showing that synthetic cathinones are the main active compounds present in these products. Qualitative and quantitative variability was found in products sold with the same trade name in matching or different ‘smartshops’. In the toxicity studies performed in primary cultured rat hepatocytes, pentedrone and MDPV proved to be the most potent individual agents, with EC 50 values of 0.664 and 0.742 mM, respectively, followed by MDMA (EC 50  = 0.754 mM). 4-MEC and methylone were the least potent substances, with EC 50 values significantly higher (1.29 and 1.18 mM, respectively; p  < 0.05 vs. MDMA). ‘Bloom’ and ‘Blow’ showed hepatotoxic effects similar to MDMA (EC 50  = 0.788 and 0.870 mM, respectively), with cathinones present in these mixtures contributing additively to the overall toxicological effect. Our results show a miscellany of psychoactive compounds present in ‘legal high’ products with evident hepatotoxic effects. These data contribute to increase the awareness on the real composition of ‘legal high’ packages and unveil the health risks posed by NPS.

In this volume, contributors employ sociological and public health perspectives to offer insights into behaviours common at raves and nightclubs. The volume provides theoretical observations on illicit club drug use and supply, helping to challenge current orthodoxies on the role of drug use within young peoples' lives. Drawing material from the USA, UK and Hong Kong, the volume allows the demystification of stereotypical presentations surrounding young people who attend clubs and/or use club drugs. This work provides a badly needed and objective analysis of youthful drug use, and a foundation from which future sociological and public studies on young people, clubs and drugs - as well as young people themselves - will benefit.

As a growing wave of designer drugs hits the streets, researchers try to forecast which will prove most popular—and dangerous. Roughly 2 years ago, recovering cocaine addict Tessa Shlaer went with a friend to the back aisles of an adult superstore in Georgia and bought three clear jars, each containing an ounce of a cloudy white substance. The jars bore different brand names—\"Meow Meow,\" \"Bolivian MDPV,\" and \"Miami Ice\"—and over the next several days, Shlaer and her friend smoked, injected, and snorted nearly all the jars' contents in a binge that ultimately landed Tessa in the hospital and rehabilitation programs after a severe psychotic break. Blood tests later revealed that Shlaer had taken a mix of stimulants called synthetic cathinones, often referred to as \"bath salts,\" which can be up to 10 times as potent as cocaine. The chemicals belong to a class of compounds called designer drugs, which mimic or increase the effects of an illegal drug, yet mostly slip past law enforcement because their formulas have been tweaked just enough to skirt existing regulations. Since 2009, more than 300 such drugs have surfaced in the United States, according to the Drug Enforcement Administration. Neuroscientist Michael Baumann at the National Institute on Drug Abuse is part of a growing fraternity of researchers working to evaluate the addictiveness of those drugs, decipher how they work in the brain, and predict which are likely to become a major threat. For Shlaer, who still experiences symptoms of withdrawal and hallucinations, the answers to such questions can't come soon enough.