Slavica Vučinić, Vesna Kilibarda, Snežana Đorđević, Dragana Đorđević, Nataša Perković-Vukčević, Gordana Vuković-Ercegović, Biljana Antonijević, Marijana Ćurčić, Evica Antonijević, Gordana Brajković, Slavica Vučinić, Vesna Kilibarda, Snežana Đorđević, Dragana Đorđević, Nataša Perković-Vukčević, Gordana Vuković-Ercegović, Biljana Antonijević, Marijana Ćurčić, Evica Antonijević, and Gordana Brajković
A rising number of patients are being treated for overdosing with new psychoactive substances (NPS) available at the illegal drug market in Serbia. The aim of this study was to report clinical and analytical experience of the National Poison Control Centre of Serbia (NPCC) with synthetic cannabinoids (SCs) and point to the NPS available at the illegal drug market in our country. From January 2013 to December 2016, 58 patients (aged between 14 and 25) were treated for the effects of synthetic cannabinoids at the NPCC. Tachycardia was established in 53, mydriasis in 31, somnolence, nausea, vomiting, and agitation in 16, dizziness in 10, disorientation in 9, dyspnoea and chest pain in 4, and loss of consciousness, pallor, paraesthesia, muscle twitches, and short-term memory impairment in 2 patients. After receiving symptomatic and supportive treatment in the emergency ward, all patients had fully recovered within 8 h and were discharged shortly afterwards. Another part of the study was focused on the analysis of the products known under their local street names as “Biljni tamjan” (herbal incense), “Beli slez”, and “Rainbow Special” and the analysis of urine sampled from the patients with gas chromatography - mass spectrometry and high performance liquid chromatography. The detected synthetic cannabinoids were AB-PINACA, JWH-018, JWH-122, JWH-210, 5F-AKB48, and MDMB-CHMICA in herbal products and AB-FUBINACA, AB-CHMINACA, and MDMB-CHMICA in the urine samples. Our findings have shown the great capacity of NPCC to I) monitor NPS abuse in Serbia, II) reliably detect SCs in illicit products and biological samples, and III) clinically manage the adverse effects in their users. Future commitments of the NPCC will include systematic collection of relevant data on SCs and their adverse effects, detection of changes in purity and composition of the controlled NPS-based products, and raising the public awareness of NPS to improve the effectiveness of the national Early Warning Sys, U porastu je broj pacijenata koji se zbrinjava zbog predoziranja novim psihoaktivnim supstancijama (NPS), dostupnima na ilegalnom tržištu droga u Srbiji. Cilj je ovog rada prikazati klinička i analitička iskustva Nacionalnog centra za kontrolu trovanja (NCKT) sa sintetičkim kanabinoidima (SC) i upozoriti na NPS-ove dostupne na ilegalnom tržištu droga u Srbiji. Od siječnja 2013. do prosinca 2016. u NCKT-u je zbog učinaka sintetičkih kanabinoida zbrinuto 58 pacijenata u dobi od 14 do 25 godina. Njihova je klinička slika uključivala: tahikardiju (53 od 58 pacijenata), midrijazu (31), pospanost, mučninu, povraćanje i agitaciju (16), nesvjesticu (10), dezorijentaciju (9), dispneju i bol u prsima (4) te gubitak svijesti, bljedilo, parestezije, grčeve u mišićima i kratkotrajni gubitak pamćenja (2). Nakon odgovarajuće simptomatske i suportivne terapije u hitnoj službi, svi su se pacijenti potpuno oporavili u roku od osam sati i ubrzo nakon toga otpušteni. Drugi dio rada fokusiran je na analizu preparata poznatih pod nazivima “Biljni tamjan”, “Bijeli sljez”, “Rainbow Special”, “Herbal incense” itd., i na analizu uzorka urina pacijenata metodom plinske kromatografije s masenom spektrometrijom i tekućinske kromatografije visoke djelotvornosti s masenom spektrometrijom. Detektirani su sljedeći sintetički kanabinoidi: ABPINACA, JWH-018, JWH-122, JWH-210, 5F-AKB48 i MDMB-CHMICA u biljnim proizvodima i AB-FUBINACA, AB-CHMINACA i MDMB-CHMICA u uzorcima urina. Rezultati tih analiza pokazali su da NCKT ima veliki kapacitet za I) praćenje zloporabe NPS-a u Srbiji, II) njihovu učinkovitu detekciju u biljnim proizvodima i biološkim uzorcima i III) kliničko liječenje toksičnih učinaka u korisnika tih supstancija. Kako bi pridonio učinkovitosti nacionalnog sustava ranog upozoravanja, NCKT će u budućnosti sustavno prikupljati relevantne podatke o sintetičkim kanabinoidima i njihovim štetnim učincima, detektirati promjenu čistoće i sastava kontroliranih psihoaktivnih supstancija i preparata