National Early Warning System Functioning and brief results Istituto Superiore di Sanità Dipartimento del Farmaco Fondazione “S. Maugeri” IRCCS Centro Antiveleni Pavia Giovanni Serpelloni – Dipartimento Politiche Antidroga Elisabetta Simeoni – Punto Focale Nazionale, Dipartimento Politiche Antidroga Teodora Macchia – Istituto Superiore di Sanità, Dipartimento del Farmaco Carlo Locatelli – Fondazione «S. Maugeri», Centro Antiveleni Pavia Claudia Rimondo – Sistema Nazionale di Allerta Precoce, Dipartimento Politiche Antidroga Origin Decision of European Council 2005/387/JHA: build up Drugs Early Warning Systems in all the Member States. Coordination by EMCDDA. Initial approach of the Instituto Superiore di Sanità. In 2007 the Verona Addiction Department developed a national EWS model. In 2009, that was adopted and implemented by the Department for Antidrug Policies at national level Aims • Early detection of potentially dangerous phenomena in relation to the appearance of new drugs and new patterns of consumption. •Activation of rapid response actions through the active and well-timed involvement of organizations aimed at protecting and promoting public health. 2 Presidency of the Council of Ministers Department for Antidrug Policies National Early Warning System National Focal Point DPA EMCDDA Staff Information Communication Technology (ICT) Coordination and management group ULSS 20 VR S. Maugeri Fundation Clinical-toxicological aspects Operative aspects, internal communication system, field survey ISS Bio-toxicological aspects Early Expert Network (EEN) Informal consultants Collaborative INPUT units Collaborative OUTPUT units 53 EEN ‐ Collaborative Centres U.O. U.O. U.O. U.O. Double function U.O. U.O. U.O. 3 Informative network Response network NOTIFYING UNITS NOTIFICATIONS’ PROCESSING AND EARLY ALERT ACTIVATION MEANS OF COMMUNICATION Emergency units Input Law enforcement agencies Laboratories PHENOMENON Users RAPID RESPONSE Reitox Focal Point Outreach mobile units MULTICHANNEL COMMUNICATION Schools Places of entertainment Mass media Body school Newspapers Information to citizens Health units, law enforcement agencies, labs 4 www.allertadroga.it 5 Data in short - 2010 106 notifications by June 2010: inclusion of JWH-018, JWH-073 and mephedrone in the Italian list of controlled substances 9 national alerts May 2011: inclusion of JWH122 and JWH-250 and their analogues in the list of controlled substances. Also inclusion of MDPV. input units: + 73,8% than 2009 (15 in 2009) New procedure between the DPA and the Ministry of Health to shorten the time to put new drugs under control 6 22 CASES OF ACUTE INTOXICATIONS DUE TO SYNTHETIC CANNABINOIDS CONSUMPTION REQUIRING ADMISSION TO EMERGENCY DEPARTMENTS (2010‐ 2011) COLOR PRODUCT’S NAME nJoy (JWH‐018) Spice Artic Synergy (JWH‐018; JWH‐073) Bonzai (JWH‐018; JWH‐081; JWH‐122) Forest Green (JWH‐122; JWH‐250) Jungle Mistic Incense (JWH‐122) Orange Alesya News (JWH‐122) Source: Italian National Early Warning System 2011 7 Smart shop operation Localization of smart shop control operations carried out by law enforcement agencies and fostered by the Department for Antidrug Policies 21 Cities where seizures have been carried out 85 Cities where controls have been performed with no violations found Attività di controllo e No violations verifica degli smart shop locali senza found; 85; 79,4% esito; 85; 79,4% Sequestro di merce e Seizure of chiusura dello smart shop; 12; 11,2% smart shops; Seizure of wholesale dealer Seizure of smart shops Source: Italian National Early Warning System, 2011 Seizure of products and waiting for results No violations found 12; 11,2% Sequestro grossista; Seizure of 1; 0,9% wholesale dealer; 1; 0,9% Sequestro di prodotti Seizure of products and venduti senza chiusura dello smart shop; 9; waiting for results; 9; 8,5% 8,5% 8 Web monitoring and rave party prevention Objective: to prevent or reduce the high risk of drug and alcohol related mortality and disability during illegal musical events (rave parties) 1 36 33 21 23 11 34 37 17 31 38 19 29 39 40 13 415 13 2 3 9 13 41 3516 3 24 12 5 26 8 632 20 22 25 30 28 18 27 42 10 43 14 9 Analytical issues Identification of new compounds: a crucial point Commercial products/seizures Biological samples Reference materials Analytical standards supplied to the NEWS laboratories JWH-018 JWH-073 JWH-200 JWH-250 CP 47,497 4-Fluroamphetamine Mephedrone MDAI 10 N.E.W.S. Collaborative Centres Network 30 22 8 36 38 37 43 Laboratories 1 3 (forensic toxicology, clinical toxicology, hospital unit, university, health unit, research, law enforcement, custom) 11 46 And 10 Clinical units SYNTHETIC CANNABINOIDS DETECTED IN ITALY Label Cannabinoids content Label Cannabinoids content Label Cannabinoids content Label Cannabinoids content Genie JWH-018 Forest Green JWH-122 B 52 Plus Intensive Shot N-Joy JWH-018 Intensive Shot JWH-250 Ketam a Gold JWH-250 Lucy Spice Silver JWH-018 JWH-073 Ketam a Gold JWH-250 Jungle Mistic Incense JWH-122 Karm a Spice Gold JWH-018 JWH-073 Jungle Mistic Incense JWH-122 Orange alesya new JWH-122 Orange Julia Spice Gold Spirit JWH-018 JWH-073 Jam aican Spirit JWH-250 Rasta Weed JWH-073 Katy Plus Spice Original Diam ond JWH-018 JWH-073 Start of Fire JWH-250 Ketam a Gold JWH-122 Orange Katy New JWH-081+AM-694 Spice Original Diam ond Spirit JWH-018 JWH-073 Bonzai JWH-250 Bonzai JWH-081 Orange Darya New JWH-081+AM-694 Spice Tropical JWH-018 JWH-073 Bonzai Citrus JWH-018 Orange Darya New Spice Artic Synergy JWH-018 JWH-073 Blaze JWH-018 Karm a Am azonas JWH-250 Sm oke JWH-018 Orange lilia JWH-018 JWH-073 Blaze JWH-210 JWH-081+AM-694 JWH-081 JWH-122+JWH-018 (traces) Katy Plus JWH-081+AM-694 Original Diam ond Spirit JWH-073 JWH-018 Orange Alesya New JWH-081+JWH-073 Spice Artic Synergy Bonzai JWH-018 Orange Julia JWH-018 Bonzai Citrus JWH-081 Orange Katy New Jam aican Spirit JWH-250 JWH-081 Crem e Suprem e Incense JWH-250 Alesya Plus Mojo JWH-018 Gejnie JWH-018 Lucy New Infinity JWH-073 Jam aica Spirit JWH-081 JWH-250 Lucy Bonzai JWH-018 King B JWH-081 JWH-081+JWH-019+AM694 JWH-073 Jam aican Gold Bonzai Citrus JWH-081+JWH-073+AMBonzai 694 JWH-081+AM-694 Original Diam ond JWH-073 delta-9-THC (traces) JWH-073 methyl derivative Orange Alesya New JWH-210 Orange Oxana Sencation JWH-250 + JWH-122 Spice Gold Spice Tropical Synergy JWH-073 +JWH-073 methyl derivative CP 47,497 (C8) JWH-081 JWH-081+AM-694 Spice Diam ond JWH-018 + CP 47,497 (C8) CP 47,497 (C8) Spice Diam ond Spirit JWH-018 JWH-081 Blaze JWH-250 JWH-081 Jam aican Spirit JWH-200+JWH-081 Forest Green JWH-250+JWH-122 (traces) JWH-081+AM-694 Alesya Plus JWH-081 Blaze JWH-081 Bonzai Winter Boost JWH-250 Yucatan Fire JWH-018 JWH-081 Afghan Incense JWH-018 JWH-018 + CP 47,497 New Jam aican Gold (C8) Synthetic cathinones 3-Fluoromethcathinone (3-FMC) Butylone (bk-MBDB) 3,4-dimethylmethcathinone (3,4-DMMC) 3,4-Methylenedioxypyrovalerone (MDPV) Mephedrone 13 1. Analytical database 2. What do we know about the spread of use ? For each molecule: Physical and chemical data Figures of commercial products containing such as molecules Analytical data (GC-MS, LC-MS/MS, NMR,FT-IR, ESI-TOF MS, ESI-ION TRAP MS,..) also for derivatives. Evaluation of “legal highs” in terms of use is very hard. Screening methods and devices to detect “legal highs” in users are lacking Every effort to fill this gap is helpful Our working out approach (oral fluid, transpirate) 3. Not only new drugs… Heroin with high percentage of active principle Heroin with new cutting agents/adulterants: sedatives, paracetamol, caffeine, metorphan Cocaine with new cutting agents/adulterants: tetramisole/levamisole, phenacetine, lidocaine, diltiazem mCPP 14 Acknowledgements to Collaborative Centres • • • • • • • • • • • • • • • • • • • • • • • • • • • Istituto Superiore di Sanità Ministero Interno UTG Trieste- Nucleo Operativo Tossicodipendenze Ministero della salute Centro Antiveleni Pavia, Centro Nazionale di Informazione Tossicologica - IRCSS Fondazione Salvatore Maugeri Centro Antiveleni – Azienda Ospedaliera Universitaria Careggi, Firenze Centro Antiveleni Bergamo, Az. Ospedali Riuniti Centro Antiveleni Milano - Az. Osp. Ospedale Niguarda Cà Granda Centro Antiveleni Policlinico Umberto I - Roma Centro Antiveleni Policlinico Gemelli - Roma Centro Antiveleni, Ospedale Cardarelli - Napoli Centro Antiveleni, Ospedale Gaslini - Genova Centro Antiveleni, Ospedali Riuniti - Foggia Laboratorio di Tossicologia Analitica - IRCCS Policlinico San Matteo - Pavia Tossicologia forense Università degli studi di Firenze Tossicologia forense Università degli studi di Bologna Tossicologia forense II Università degli studi di Napoli Tossicologia forense Università degli studi di Bari Tossicologia forense Università Cattolica del Sacro Cuore Roma Tossicologia forense Università degli studi di Padova Tossicologia forense Università “La Sapienza” - Roma Tossicologia forense Università degli studi di Verona Tossicologia Forense - Università degli studi di Perugia Tossicologia Forense - Università degli Studi di Modena e Reggio Emilia Laboratorio di Tossicologia - Azienda Sanitaria Provinciale di Catanzaro Laboratorio Generale Azienda Ospedaliero Universitaria Careggi Dipartimento di Scienze Farmaceutiche - Università degli Studi di Pisa Dipartimento di Scienze Farmaceutiche - Università degli Studi di Milano • • • • • • • • • • • • • • • • • • • • • • University of Heartfordshire - Department of Pharmacy – United Kingdom Dip. di Scienze anatomiche, istologiche, medico-legali e dell’apparato locomotore - Università “La Sapienza”, Roma Direzione Centrale Servizi Antidroga - III Servizio Direzione Centrale Anticrimine - Polizia di Stato - Servizio Polizia Scientifica Servizio Polizia Scientifica - Sez. Indagini sulle droghe d’abuso - Polizia di Stato Arma dei Carabinieri - Reparto Investigazioni Scientifiche Reparto Carabinieri Investigazioni Scientifiche di Parma Arma dei Carabinieri - Laboratorio Analisi Sostanze Stupefacenti Verona Agenzia delle Dogane - Laboratorio chimico di Roma Laboratorio e Servizi Chimici dell’Agenzia delle Dogane di Napoli Polizia di Stato – Squadra mobile di Bologna Presidenza del Consiglio dei Ministri Laboratorio Antidoping - Torino ARPAC - Dipartimento tecnico di Benevento AIFA - Agenzia Italiana del Farmaco - Ufficio Valutazioni e Autorizzazioni U.O. Biochimica clinica e tossicologia - Az. Sanitaria USL2 Lucca U.O.Chimica e Clinica Tossicologica ASP Catania - Regione Sicilia Laboratorio di Sanità Pubblica - Area Vasta Toscana Centro Azienda Sanitaria di Firenze Laboratorio di Igiene Ambientale e Tossicologia Forense Dipartimento di Prevenzione ULSS12 Veneziana - Regione Veneto Laboratorio Ospedale “S. Anna“ - Como Istituto di Medicina Legale -Dipartimento Neuroscienze Università Politecnica Marche Procura della Repubblica - Torino Direzione Politiche Sociali Servizio promozione e inclusione sociale - Comune di Venezia 15
Scarica
