New trends

in substance

use among

heroin users

in Greece Chara Spiliopoulou

Professor Forensic Medicine and

Toxicology, Athens University

Greece: trends coming from Europe

with a 2 years delay

Special mortality registry, DRDs

updated June 2012

2008 2009 2010 2011 2012

Reported

deaths211 235 153 119 24

Confirmed

deaths196 196 140 22 4

Economic crisis in Greece

• Is affecting the resources

• Still under investigation many cases (for

example, 97 from 2011)

• The Police staff who work with the SMR is

decreasing

Police seizures

• 2012 (updated 31-5-2012)

– Heroin 66 kg

– Cocaine 15 kg

– Cannabis 4 kg

– Cannabis plants 6.560 kg

• 2011

– Heroin 334 kg

– Cocaine 29 kg

– Cannabis 7 kg

– Cannabis plants 123.417 kg

Therapeutic programs in Greece

• Today 56 therapeutic units are now available

to opiate users

• In Athens, 2.240 patients are in therapeutic

programs and 1643 of them started last year

• Before: long waiting list (up to 3 years)

• Now: 1 week

The new epidemic: HIV

• >10% of the IDU are HIV positive

• They are receiving special economic aid from

the government

Information collected by the Early

Warning System

• 35 chemical Labs from the entire country

• Toxicological Laboratories, biological samples

(5 in total)

Heroin in Greece

•Heroin purity 10-15% for large and <5% for

small seizures

•For the first time “Labs” for “repackaging” of

heroin

Adulterants of heroin

Caffeine, paracetamol, dextromerphane (!),

Benzodiazepines (diazepam, flunitrazepam, alprazolam)

Strychnine

Barbiturates

Cocaine

Sulpiride

Opium: large seizures

Opium + cannabis common

Diversion of pharmaceuticals

• Buprenorphine (Subutex)

• Suboxone (buprenorphine+naloxone)

• Fentanyl

All these deaths

are not presented

in the SMR, are

absorbed by opioids

Hallucinogens

LSD, Magic mushrooms, cactus: very limited

Cocaine – low purity !

Brown color

Cocaine adulterants –additives

‒Phenacetine , lidocaine‒Levamizole‒Phenobarbital ‒MDMA‒Ketamine‒Methamphetamine‒Heroin ‒Alprazolam‒Dextromethorphane

Stimulants

–BZP (benzylpiperazine)–TFMPP (trifluoromethylphenylpiperazine) –BZP + TFMPP + ketamine–TFMPP + methamphetamine–CPP (chlorophenylpiperazine)–CPP + MDMA–CPP + amphetamine–CPP + methamphetamine–MDMA +amphetamine or methamphetamine–methamphetamine + cocaine–DOB (dimethoxybromoamphetamine) –2-C-B (bromo-2,5-dimethoxyphenethylamine)–Amphetamine + caffeine + lidocaine

Shisha – ICE: powder and crystals- well known in Athens area-is smoked

Often found in heroin seizures combination:

–TFMPP–MDMA–Cocaine

Methamphetamine SHISHA

• The term Shisha, comes from the Persian word shīshe, means glass, and is used for the glass pipe in many African and Asian countries

• In Albania, Bosnia-Herzegovina is named «lula» or «lulava» and «shishe» is referred to the glass part

• In Croatia, Serbia, Bosnia-Herzegovina, Bulgaria and FYROM the pipe is called nargile and Šiša (шиша) is the tobacco that is smoked from this.

• In Athens is used mainly by the homeless users and the users that are in a substitution program, because the substance was not detected in the normal screening

Synthetic cannabinoids

•Cloud 10 : JWH-018,-122,-073,-210•Head Trip : JWH-122,-210•Freedom : JWH-250,-210•DJ, Maya, Welcome Vegas, Remix, Maya

Beyond : JWH-210

MephedroneΚΗΑΤ and synthetic kathinones

Lidocaine

• We have information from heroin/cocaine

users that they inject or drink solutions of

lidocaine in case when they are not “satisfied”

by the “quality "of the drugs

Conclusions

• All the drugs of abuse are mixed up with

strange combinations

• The main reason seems to be the low purity of

heroin and cocaine street samples

• The toxicological laboratories have to screen

the biological fluids for the whole range

• Difficult interpretation of the results

• Classification of deaths complicated