Novel Psychoactive Substances’Epidemic as a ‘ Glocal ’ Phenomenon

1. Novel Psychoactive Substances’Epidemicas a ‘Glocal’ Phenomenon Duccio Papanti, University of Trieste, Italy

2. Glocalization • The word ‘glocalization’ could be defined as the adaptation of an index market specifically for a given locality/culture where it is being proposed. • The localexperience of global phenomena. • International and contemporaryissuesbutstronglygrounded in local, cultural aspects. • Means the simultaneity and the co-presence of both universalizing and particularizing tendencies. • Impliesspatialintegration of opposites, whatevertheirreferentialboundariesmay be, over the vector of time.

3. Glocalization • The case of ‘Junk food’

4. Epidemic and Syndemic • An Epidemic refers to “a disease that affects a large number of people, with a recent and substantial increase in the number of cases” (CDC, 2000). • Syndemicrefers to a dynamic relationship involving two or more epidemic diseases or other disorders and the socioenvironmental context that promotes their interaction.

5. From ‘Junk food’ to ‘Junk drugs’ SISA: Greece PACO: Argentina, South-America KROKODIL: Russia, Eastern Europe

6. How the crisis can drive the market/demand of drugs in poors

7. Cocaine Base Paste (CBP) CBP is the first consumable extract or by-product of the process of manufacturing and refining cocaine hydrochloride. South America: Argentina, Perù, Bolivia, Uruguay, Ecuador, Colombia, Chile, Costa Rica, Brazil Europe: Barcelona and Catalunya

8. Cocaine Base Paste Components : base cocaine (up to 70% of the content), alcohol (rum or superalcoholics and beer), phosphorus, kerosene, gasoline, sulfuricacid Types: • CBP pure aka ‘palo de rosa’ • CPB impure (adulteradedwith starch, chalk, sugar, aspirine, calciumsulfate, benzocaine, caffeine, sodium bi/monocarbonate, glasspowder, cementpowder) • CBP cleaned Addicted consumers smoke an average of 20 impure paco+tobacco/cannabis cigs per die (1.9 g cocaine and 80 mg nicotine) up to 50 cigs per die, (4.7 g cocaine and 200 mg nicotine). This kind of dependence is considered as double (at least, users are usually polyabusers) and different from the cocaine chlorhidrate’s one (Llosa, 1994). • Very High addictive potential and rapidly induced addiction ! • The high lasts only 5-10 minutes. • Large scale production and low-cost drug. • Poorer the users are and more impure is CBP: in hyspanic slang impure CBP is also called ‘POCAina’ (10%-50% of cocaine) and highly adulterated ‘NOcaina’ (less than 10% of cocaine).

9. South-American Cocaine Base Paste local sub-products ‘PACO’ Argentina ‘BASUCO’ Colombia ‘TRISTO’ Perù ‘OXI’ Brazil

10. CBP aka ‘Paco’ (PAsta de COca) • In Argentina, also defined by the users and the media as ‘cocaine waste’, it is the residue that remains in the pot after cocaine hydrochloride is made from base paste or cocaine base; this residue is then commercialised. • Strong increase in the use sincethe 2001 economiccrisis hit the ‘new poorsclass’ in Ar. • Highly toxic!!

11. ‘ElPaco’

12. Basuco Colombia, similar in effect to its more expensive relative crack-cocaine, its estimated to be smoked by up to 100,000usersin a country of 31 million people and commonly used among the street kids of Bogota who smoke it from make shift pipes. Its effect is a euphoric high at a lower price than other street drugs like heroin or cocaine which all started from traffickers selling the by-product at such a minimal cost. 

13. Tristo • In Lima, Perùthe coca paste is being mixed with seaweed, which is in turn smoked withcannabis and tobacco to produce the drug ‘Tristo’, coming from the dark backwaters of Lima the cocaine derivative is blended with a dried seaweed giving users a hit described as a ‘peaceful, happy and ‘trippy’ hallucinogenic rush. • Details on its origin are not fully known but it is believed that the ‘Paracas’ culture among the people of South Lima first used the seaweed in their ceremonies. This itself has raised issues over the toxicity levels of the Lima Ocean where the seaweed is found.

14. ‘Oxi’ • Brazil,new street drug derived from the manufacture of cocaine paste. In appearance similar to crack cocaine it offers a ridiculously mad high for a fifth of the cost of crack. • Oxi, a short formfor ‘oxidation’, is made of leftovers of cocaine paste, cooked with variable amounts of gasoline or kerosene and ‘raw’ (‘virgem’) lime (CaO). The proportion of such addictives seems to determine whether oxistones will be coloured purple (roughly similar proportions of gasoline/kerosene and lime), whitish (when lime is the main contaminant) or yellow (where gasoline/ kerosene is the predominant contaminant). • Oxi is a home-made substance, that could be prepared in domestic kitchens, sold at a very low price, even compared to the low prices of coca paste and crack stones. • Said to be twice powerful than crack, it is smoked in pipes improvised from cans, pieces of piping and metal taps.

15. Prices • Perù : 1 gr CBP costs 0.5-1 Sol ( 20-40 Eurocents). • Brazil: OxicostsR$2 (around 65 Eurocents) a rock compared to R$10 for a rock of crack . • Argentina: one dose of Paco costsbetween 5 and 20 pesos argentinos (60 eurocents to 2 euros).

16. ‘Home-cooked’ and DIY InjectableOpiates ‘HOMEBAKE’ NZ ‘KOMPOT’ Poland ‘BLACKWATER’ South-East Asia ‘KROKODIL’ Russia

17. Liquifiedinjectableopiumaka ‘Blackwater’ or ‘yen pox’ • Afghanistan, Brunei, Darussalam, Cambodia, China, Iran, Laos, Pakistan and Vietnam • Blackwateropium is a residual product from smoking prepared opium, recollected in the cleaning of the opium pipe, boiled and filteredseveraltimes.

18. ‘Homebake’ injectables from pharmaceutical opioids • New Zealand • Morphinesulphatetablets (‘misties’), Codeine basedtablets , OpiumPoppyPapaverSomniferum. • Mistieshavesimpleconversionprocess • Readily available on the black market in NZ

19. ‘Kompot’ (homemadepolishheroin) and ‘cheornaya’ POLAND: end of the 1970s, chemical students in Gdansk, Poland, boiled down the chemical process to prepare heroin to its basics: they ‘cooked’ the dried poppy heads into an injectable concoction of opium alkaloids, using readily available household and industrial chemicals. RUSSIA and East Europe : 1980s a simplified version of the process, which can be conducted on an ordinary kitchen stove, spread through the FSU under names, such as‘cheornaya’ and ‘shirka’ obtained from opiumgum.

20. ‘Krokodil’– homemadeinjectableDesomorphinealsocalled‘russianheroin’ • Krokodil production may have first emerged in Siberia and the Russian Far East some ten years back • Russia, Ukraine, Georgia and Kazakhstan: in Ukraine in 2012 60% among polydrugPWID used Krokodil and in Russia 5% of PWID is using krokodil. • Mortality and injuries related to the use seem to be much more higher for Krokodil users than other injectable drugs. • UNAIDS reports that 1.8 million Russians are PWID, together with Ukraine, Russia hasone ofthe highest growth of HIV infection in the world, outside of Sub-Saharan countriesand near one million people in Russia are now living with HIV. • Majority of new HIV infections in Russia (up to 80 % or more) are transmitted by injecting drug use . • Registered HIV cases are doubling every 12 months (Russian Federal AIDS Center). • Analgesicpotency of desomorphine is 8–10 times higher compared to morphine (and thus stronger than heroin), it shows a faster onset of action and a shorter elimination half-life, the high only lasts between 90 minutes and two hours may lead to rapid physical dependence and frequent administration. • Europe: Germany (Bochum, Berlin, Frankfurt), Norway (Tromsø). Rumorsabout UK, Czech Republic, France, Belgium .

21. DIY Desomorphine (Dihydrodesoxymorphine) ? • In the last three to five years in Russia, Ukraine and other countries PWID no longer using poppies or raw opium as their starting material using med like codeine (Solpadeine, Codterpin or Codelac) • Homemade inthe “kitchen laboratory” : 5–10 codeinetablets boiled with a paint thinner (that may contain heavy metals like lead, zinc, ferric or ferrous agents, and antimony) and gasoline, hydrochloric acid, strong alkalis, high concentrations of iodine, and redphosphorous, which are scraped from the striking surfaces on matchboxes . • Codeine pills sold in Russia may also contain ingredients such as caffeine, paracetamol, ordiphenhydramine(coincidentally an opioid potentiator); while chemicals such as tropicamide, found in over the counter eyedrops, may also be added to the mixture in attempt to prolong or enhance the experience • The putative end product of the kitchen chemistry is often more likely to include other compounds than desomorphine (e.g. iodocodeine or morphine derivates). • The production does not result in a powdered or crystalline drug, but in a liquid drug often not filtered and directly consumed. • Different regions of Russia “desomorphine is synthesized under different conditions and by different procedures”.

22. WhyisKrokodilused? • Higherprice of heroin, ingredients are easy available. • Shortage of injectablepoppystraw, lacking of opioidsubstitutiontreatment (in Russia it is banned through existing legislation, while in Ukraine <2% of PWID receive OST) . • Very hard withdrawalsyndromekeepusers on it.

23. Krokodil and Poverty • Low-cost: around 5 euros for one dose of Krokodil while one dose of heroin costs around 30-50 euros. «Whileheroinis the drug of choice, krokodilis the drug of need» Jean-Paul Grund, 2013. The number of Russians living in poverty rose 1.1% in 2011 to a total of around 13% in 2012; in 2002 it was around 8.5%, according to the World Bank, and it started to rise from the 2008 financial global crisis (Repoza,2012).

24. Harmsrelated to the use • Highly toxic !! Verydirty production process!! Grund et al., 2013

25. ‘Sisa’ or ‘Shisha’ as a ‘cocaine of the poor’ The word derives from the Persian word ‘shishe’ that means glass , used by dealers from Pakistan who started push the drug. ‘Shisha’ can be smoked or injected! From 2010 a rapidexpansion of ‘Shisha’ production at home-based crystal meth ‘shake and bake' laboratories.

26. ‘Sisa’ or ‘Shisha’the “cocaine of the poor” • Greece: €1 - €2 a hit (and only €1.50 for a pipe) compared to €8‐20/gram of brown heroin and €40‐100 /gram of cocaine. • Monodose crystalmethamphetaminetypedrug, according to local users it often contains cheap and harmful additives hydrochloric acid, ethanol and car battery fluid, engine oil, shampoo and cooking salt. • Severe side effects have been described, such as insomnia, aggressions, psychoticsymptoms, emaciation…and increased drive for sex- usuallyunprotected intercourses! • Drug treatment centers in Greece are being shut down for lack of funds. • Without methadone treatment or needle exchange programs, addicts are tempted to reuse and share hypodermic needles to inject heroin or sisa. • Needle exchange programs ran out of clean syringes. The number of syringes for PWID per user recommended by the whileGreek PWID are getting three needles per year each while WHO recommend 200 syringes per user/year (Struchler, 2013). • Authorities registered a 1500% increase in HIV infections among PIWD from 2010 to 2012.

27. THANKS! My contactis gducciopapantip@gmail.com