New trends
in substance
use among
heroin users
in Greece Chara Spiliopoulou
Professor Forensic Medicine and
Toxicology, Athens University
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
Diversion of pharmaceuticals
• Buprenorphine (Subutex)
• Suboxone (buprenorphine+naloxone)
• Fentanyl
All these deaths
are not presented
in the SMR, are
absorbed by opioids
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
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