New psychoactive substances: the burden of the modern times

Psihoaktivne tvari (PAT) su poznate ljudskoj vrsti od vremena prije nove ere kada je njihova upotreba bila nezaobilazni dio obreda starih civilizacija. Kroz iduća su se razdoblja otkrivale brojne biljne vrste čijom su se konzumacijom postizali psihotropni učinci. U posljednjem se stoljeću proizvodnja droga iz prirode preselila u laboratorije te je tako započela era sintetskih PAT-a. Početkom 21. stoljeća osobitu su pažnju privukle skupine sintetskih droga koje su se vodile kao legalne, a koje su imitirale učinke klasičnih tradicionalnih droga. Te skupine droga zajednički nose naziv nove psihoaktivne tvari (NPT), a uključuje aminoindane, derivate feniletilamina, fenciklidinu slične supstance, piperazine, sintetske kanabinoide, sintetske katinone, sintetske opioide i drugo. Moderno je društvo s jedne strane blaženo razvojem tehnologije, ali je s druge strane izloženo brojnim opasnostima koje ona nudi. Naime, Internet je djelovao kao ključna odskočna daska za popularizaciju i globalnu dostupnost NPT-a, a osobito pojava darkneta. Posljedično je proizvodnja ovih tvari doživjela zamah pa se tako svake godine bilježi pojava novih NPT-a na tržištu što iznova slama sve pokušaje njihove legislativne kontrole. Poput igre mačke i miša, čim se pojedina PAT stavi pod kontrolu, pojavi se nova usporedivog djelovanja koja zamijeni staru i probije se na tržištu te se ovaj ciklus iznova ponavlja. U ovoj se igri, nažalost, najteže posljedice odražavaju na onima koji kupljeni proizvod konzumiraju. NPT predstavljaju veliku strepnju zdravstvenim djelatnicima koji se suočavaju s akutno intoksiciranim bolesnicima. Ove se tvari ne mogu detektirati klasičnim laboratorijskim testovima na droge, stoga je osnovna terapija u akutnim stanjima isključivo simptomatska. Osim toga, NPT u usporedbi sa tradicionalnim drogama uglavnom su potentnije, a posljedično i rizičnije za korisnike. U ovome su radu opisane su NPT, kliničke slike i toksidromi (skup znakova i simptoma koji se odnosi na specifičnu skupinu NPT-a) što je važno u zbrinjavanju bolesnika u akutnim stanjima. Nadalje, prikazani su opisi slučajeva temeljem literaturnog pregleda. Konačno, ističe se potreba preventivnog djelovanja u svrhu podizanja znanja i svijesti o navedenom problemu u općoj populaciji, osobito među mladima, te potreba interdisciplinarne i multidisciplinarne suradnje u prevenciji (liječnici, psihijatri, psiholozi, pedagozi, nastavnici, sudstvo itd.).Psychoactive substances (PAS) have been known to mankind since times BC when their use was an essential part of the rituals of ancient civilizations. Throughout the following time periods numerous plant species were discovered, and psychotropic effects were achieved by consuming them. In the last century the manufacturing of drugs has moved from nature into the laboratories and thus began the era of synthetic PAS. At the start of the 21st century the spotlight was taken by groups of synthetic drugs that were considered legal, and yet they imitated the effects of classic traditional drugs. These groups of drugs have the common name of new psychoactive substances (NPS), and they consist of aminoindanes, derivatives of phenylethylamine, phencyclidine-like substances, piperazines, synthetic cannabinoids, synthetic cathinones, synthetic opioids, and others. Modern society has been blessed with the development of technology, and yet there are also dangers that it brings. Namely, the Internet has acted as a key jumping-off point for the popularization and global availability of NPS, and especially the appearance of darknet. Consequentially, the manufacturing of these substances has seen a boost, and so every year there appears a new NPS on the market that makes all the legislative attempts to regulate them futile. Like a game of cat and mouse, as soon as one PAS is regulated, there is a new one with comparable effects that replaces the old and takes the market share, thus repeating the cycle. Unfortunately, in this game, the worst consequences are suffered by the people consuming the product. NPS present a substantial challenge to the medical personnel dealing with acutely intoxicated patients. These substances cannot be detected by standard laboratory tests for drugs, so the basic therapy in acute states is strictly symptomatic. Besides that, in comparison with traditional drugs, NPS are generally more potent, and thus, riskier for users. This article describes NPS, clinical pictures and toxidromes (a set of signs and symptoms related to the specific groups of NPS) that are important in the care of patients in acute conditions. Furthermore, cases descriptions are presented based on a literature review. Finally, the need for preventive action to raise knowledge and awareness of this problem in the general population, especially among young people, and the need for interdisciplinary and multidisciplinary cooperation in prevention (physicians, psychiatrists, psychologists, pedagogues, teachers, judiciary, etc.) is pointed out