Mkati mwa European Union mumsika wa mankhwala osokoneza bongo mothandizidwa ndi kugwiritsa ntchito malo ochezera a pa Intaneti kapena malonda a intaneti ndi ntchito, zikuwoneka kuti pali vuto linalake la mankhwala osokoneza bongo, ndi kuwonjezeka kwa kuitanitsa, kupanga ndi kumwa kwa mankhwala osalamulirika opangidwa ndi mankhwala otchedwa new psychoactive substances (NPS). Chinthu cha psychoactive "imakhudza kachitidwe ka maganizo, mwachitsanzo, kuzindikira, kuzindikira kapena kutengeka maganizo".
Malinga ndi Upangiri Wochenjeza Woyamba Pazinthu Zatsopano za Psychoactive (EWA-2022), NPS imatanthauzidwa ngati "zinthu zankhanza, kaya mwanjira yoyera kapena yokonzekera, zomwe sizikulamulidwa ndi Msonkhano Wokha wa 1961 wa Mankhwala Osokoneza Bongo kapena Mgwirizano wa 1971 pa Zinthu Zamaganizo, koma zomwe zingayambitse thanzi la anthu".
NPS ndi mankhwala osiyanasiyana omwe adapangidwa kuti atsanzire mankhwala oletsedwa omwe adakhazikitsidwa ndipo amawayika molingana ndi zotsatira zake.
Kumapeto kwa 2022, European Monitoring Center for Drug and Drug Addiction (EMCDDA) inali kuyang'anira pafupifupi 930 NPS, 41 idanenedwa koyamba ku Europe mu 2022.
Ku Ulaya, kugwiritsidwa ntchito kwa opioids (morphine, codeine, heroin, fentanyl, methadone, tramadol ndi zinthu zina zofanana) kwayamba kuwonjezeka kuyambira chiyambi cha 21st zaka zana. M'zaka zaposachedwa, pakhala kukwera kwakukulu kwa chiwerengero cha opioids atsopano a psychotropic synthetic opioid omwe 74 adanenedwa ku EU Early Warning System (EWS).
Zindikirani: Opiates ndi mankhwala achilengedwe ochokera ku chomera cha opium poppy; Opioid ndi mawu odziwika monga opiates, semi-synthetic (monga oxycodone) ndi synthetic (monga fentanyl) opioid.
Ma opioid atsopano opangidwa ndi okhazikika bwino m'misika yamankhwala ku Europe komwe amagulitsidwa motchipa m'malo mwa opioid monga heroin. Zotsatira za opioid ndizokwera kwambiri ngakhale pamlingo wochepa.
Malingana ndi European Drug Report 2023, m'mayiko ambiri a ku Ulaya, kugwiritsa ntchito mankhwala opioid opangidwa ndi opioid kukukulirakulira monga momwe chiwerengero cha khunyu chinanenedwa ndi EMCDDA. Panthawiyi, European Commissioner for Home Affairs, Mayi Ylva Johansson, ndi Mtsogoleri wa EMCDDA, Bambo Alexis Goosdeel, adachenjeza za kuwonjezereka kwa kugwiritsa ntchito imodzi mwa opioids yoipa kwambiri: Fentanyl. Iye anati: "Tiyenera kuwonetsetsa kuti panopo ku America sikhala tsogolo la Europe". Zowonadi, chaka chatha ku USA, anthu 109,000 adamwalira ndi mankhwala opangira ambiri a iwo kuchokera ku fentanyl.
Kuchuluka kwa kudalira opioid pakati pa akuluakulu a ku Ulaya akadali otsika, amasiyana kwambiri pakati pa mayiko ndipo amagwirizana ndi matenda opatsirana, mavuto a zaumoyo, kusagwirizana ndi anthu, kusowa ntchito, kusowa pokhala, umbanda, ndi imfa. Mwa anthu opitilira zaka 40 omwe amagwiritsa ntchito opioid, kuchuluka kwa zovuta zomwe zimachitika chifukwa cha mankhwala osokoneza bongo zomwe zimaphatikizapo kugwiritsa ntchito mankhwala ozunguza bongo komanso kudwaladwala kwa zaka zambiri zikupangitsa kuti anthuwa atengeke mosavuta ndi matenda, kumwa mopitirira muyeso komanso kudzipha.
Fentanyl (C22H28N2O) idapangidwa koyamba kuchokera ku benzyl-piperidone mu 1959 (yovomerezeka mu 1964) ndi katswiri wamankhwala Paul Janssen ku Belgium. Njira zina zitatu zinapangidwa:
-Uwu et al. 1998: njira ndi kuphatikiza kwathunthu.
-Siegfried koyambirira kwa 2000 ndipo amagwiritsidwa ntchito m'ma lab osaloledwa;
-Gupta PK et al. 2005: kaphatikizidwe ka mphika umodzi womwe unagwiritsidwa ntchito mosaloledwa mu 2021 koma ndi ukhondo wochepa;
Fentanyl chifukwa cha kusungunuka kwake kwa lipids imalowa mosavuta m'katikati mwa mitsempha yamkati ndi zotsatira zochepetsera komanso zochepetsera ululu komanso nthawi yayitali. Mayamwidwe ake ndi othamanga ndi mucosa pakamwa (15/30 min-4 hrs) koma amathanso kuperekedwa ndi jekeseni (2min-30 min), transdermal (chigamba) kapena kugwiritsidwa ntchito mu mpweya wa mpweya monga kupopera (10min-60min).
Mphamvu ya fentanyl analgesic imakhala yamphamvu nthawi 100 kuposa morphine komanso nthawi 50 kuposa heroin. Pansi pa mawonekedwe ake azachipatala ovomerezeka, opioid yopangidwa iyi imagwiritsidwa ntchito pochiza ululu wopweteka kwambiri komanso wosamva. Kuyambira 2021 wakhala mbali ya "mankhwala ofunikira" a World Health Organisation ndipo adayikidwa pandandanda wachitatu wokhala ndi morphine ndi oxycodone.
Kuchokera pakuwona kwa ziweto, mphamvu yayikulu ya fentanyl imagwiritsidwa ntchito pochepetsa ululu, kuphatikizika ndi mankhwala oletsa kupweteka kwa nyama komanso kuchiza kupsinjika ndi kusokonezeka kwa nyama.
Koma, fentanyl yapatutsidwanso kuti isagwiritsidwe ntchito ngati mankhwala opweteka kuti atengedwe ngati mankhwala, opangidwa mosavuta m'ma laboratories achinsinsi popanda kukhala ndi vuto la kulima ndi kukolola kwa zomera! Wopangidwa ku China, Mexico ndi India, fentanyl amatchedwanso China White, Apache, Jackpot, Murder 8,… idakhala vuto lalikulu pazomwe zikuchitika ku Europe. Kilo imodzi ya ufa wa fentanyl ukhoza kukhala ndi mlingo wa 50,000.
Pakalipano, pakati pa 1,400 fentanyl zotumphukira, 700 zotumphukira zadziwika ku Ulaya, ena nthawi 1,000 mphamvu kuposa heroin. 3-methyl fentanyl ndi yamphamvu nthawi 3,200 kuposa morphine ndi zotumphukira zake., carfentanyl, ndi mphamvu 10,000 kuposa morphine.
Fentanyl ndi poizoni kwambiri ngakhale kukhudzana ndi khungu. Ma milligram 2 okha ndi omwe amatha kupha munthu wamkulu. Choopsa ndi chakuti akawonjezedwa ku mankhwala ena ndi ogulitsa, anthu amawagwiritsa ntchito osadziwa. Zowonadi, fentanyl nthawi zambiri imasakanizidwa, kudulidwa, ndikulowetsedwa pamodzi ndi mankhwala ena, kuphatikiza cocaine ndi heroin. Jobski K et al. (2023) adachita kafukufuku wosangalatsa pakuzunza, kudalira, kusiya komanso njira yake yoyendetsera ku Europe. Fentanyl ndi yamphamvu kwambiri kotero kuti sizingatheke kudulidwa molondola motero kuonjezera chiopsezo cha overdose.
Fentanyl yadziwika kuti ndi mankhwala osokoneza bongo padziko lonse lapansi kuyambira 1964, chifukwa cha zoopsa zake paumoyo, kuopsa kogwiritsa ntchito molakwika, komanso kuthana ndi zovuta. Mwa anthu, mlingo wakupha (LD50) wa fentanyl umayerekezedwa kwa munthu wamkulu pa mamiligalamu awiri (2mg).
Chidziwitso: Chigamba cha fentanyl (chomwe nthawi zambiri chimatafunidwa ndi ogwiritsa ntchito mankhwala osokoneza bongo) ndi amodzi mwamankhwala ochepa omwe amatha kukhala ovulaza, ndipo nthawi zina amapha, ndi mlingo umodzi wokha, ngati atagwiritsidwa ntchito molakwika ndi mwana (Food and Drug Administration, 2022). Zotsatira zimatha kukhala pakati pa mphindi 30 ndi maola 4 kutengera zomwe zimagwiritsidwa ntchito. Koma popanda kuyang'ana m'mbuyo ndi maphunziro asayansi, nthawi ya zotsatira zake sichidziwika bwino.
mobwerezabwereza ntchito fentanyl kapena zotumphukira zake, ngakhale achire, kungachititse kuti chiwopsezo chodalira ndipo ngati kumwa kwambiri, pali chiopsezo cha bongo ndi kupuma maganizo ndi zotheka ziwalo za thoracic minofu, mantha, hypotension kwambiri, kulimba kwa minofu kapena chikomokere chomwe chingayambitse imfa. Kuopsa kwa kupuma kumawonjezeka pamene kumwa fentanyl (kapena zotumphukira zake) kumalumikizidwa ndi mowa, benzodiazepines ndi ma opioid ena. Kugwiritsiridwa ntchito kwawo kosaloledwa kulinso kowopsa ngati ali ndi pakati kwa mayi ndi mwana wosabadwayo.
Fentanyl ndi zotumphukira zomwe si zachipatala zimadziwika mpaka pafupifupi maola 48 mumkodzo komanso mpaka maola 12 m'magazi.
Kugwiritsa ntchito kosaloledwa kwa fentanyl ndi zotumphukira kwafotokozedwa mwachidule ndi J. Botts (2023): Mwachangu, Wotsika mtengo komanso Wakupha.
Njira yochitira:
M'thupi muli ma neurotransmitters 20 opangidwa mwachilengedwe opioid osankhidwa ndi kuchuluka kwa ma amino acid. Iwo amaphatikizapo mitundu yosiyanasiyana ya:
- ma endorphins,Mapetogeous morphine), ma polypeptides opangidwa ndi hypophyse ndi hypothalamus. Amabisa ululu kwa nthawi yochepa (zomwe zimathandiza kuti munthu apulumuke) komanso amachititsa kuti azikhala omasuka (anxiolytics), ubwino kapena nthawi zina, euphoria monga beta-endorphins.
-Enkephalins (kuchokera ku Greek enkephalos = mutu) ndi zolepheretsa kufalitsa uthenga wa ululu ku ubongo kupanga analgesia yochepa; amathanso kusintha kuchuluka kwa dopamine (mankhwala a mphotho) opangidwa ndikuwongolera magwiridwe antchito a minofu yosalala.
- Ma dynorphins (kuchokera ku Greek mphamvu = mphamvu) yopangidwa mu hypothalamus, hippocampus ndi msana zimayang'anira ndikuwongolera ntchito zofunika monga kutentha kwa thupi, kukumbukira kwanthawi yayitali, njala, ludzu, kugona, komanso kukonza chidziwitso chamalingaliro.
Kukhalapo kwa opioid-enieni ma transmembrane receptors muubongo kudawonetsedwa nthawi imodzi mu 1973 ndi Pert CB. ndi al., Simon EJ et al. ndi Terenius L. Ma receptor a neurotransmitter awa amapezeka mu ubongo, msana ndi m'mimba. Ndi ma G-protein ophatikizika ma receptor ndipo akayatsidwa amathandizira kusintha kuyankha kwa ululu, mayendedwe, kupsinjika komanso kudalira thupi.
Pali mitundu itatu ya zolandilira opioid: mu, delta ndi kappa, zomwe zimagawidwa kwambiri muubongo. Ngati kukhudzika kwa ma opiates kumawongoleredwa ndi mu ndi delta receptors, kuyambitsa kwa kappa zolandilira, kwenikweni ndi njira ya homeostatic koma kugwiritsa ntchito mankhwala osokoneza bongo kwanthawi yayitali kumabweretsa kusokonezeka kwamisala komanso madera osakhudzidwa (Tejeda HA & Bonci A. 2019) .
Zotsatira za opioid zimagwirizana ndi kuyambitsa kwa endogenous opioid system mu ubongo pamlingo wa Nucleus Accumbens (NAc) ndi Ventral Tegmental Area (VTA) ya limbic system. Chifukwa chake, ma opioid ndi fentanyl amachulukitsa kutulutsidwa kwa dopamine mu limbic system mwa kuyambitsa mu ndi delta receptors mu NAc (Yoshida Y. Et al. 1999 - Hirose N. et al. 2005). Makhalidwe okakamiza kugwiritsa ntchito mankhwala osokoneza bongo amabwera chifukwa chakusintha kosatha kwa mesolimbic dopamine system chifukwa chokondoweza mobwerezabwereza kwa dopamine komwe kusefukira kwa Nervous System ndiko maziko a chizoloŵezi.
Izi zinapangitsa kugwiritsa ntchito ma opioid poyamba kukhala kosangalatsa koma vuto ndiloti pakufunika kufunikira kowonjezereka kofanana ndi dopamine surges kuti musangalale, chisangalalo ndipo potsiriza ichi chinakhala chosowa chofunikira chomwe chimatsogolera mofulumira ku kuopsa kwa fentanyl ndi zotumphukira.
Mankhwala a naloxone amagwiritsidwa ntchito kubwezeretsa zotsatira za opioid overdose. Mankhwalawa mu 2-3 min pambuyo jekeseni amakhala ngati wotsutsana ndi mpikisano wogwirizana kwambiri ndi mu-opioid receptor, kulola kusinthika kwa zotsatira za opioids (Jordan MR ndi Morrisonponce D., 2023) kuledzera kwambiri ndi heroin, fentanyl. , codeine, morphine, oxycodone, hydrocodone, etc.
Zasonyezedwa kuti fentanyl ndi ma analogue ena amathanso kukhudza machitidwe a psychomotor pa ntchito za tsiku ndi tsiku za anthu zomwe zimayang'ana kwambiri pakuyendetsa (Bilel S. et al. 2023). Kuphatikiza apo, Gasperini S. et al. (2022) adawonetsa kuti ma analogue osaloledwa osagwiritsa ntchito mankhwala a fentanyl adapezeka kuti ndi a genotoxic, omwe amapangitsa kusinthika kwapang'onopang'ono kwa chromosomal.
Zizindikiro za kusiya kwa fentanyl zimawonekera patangotha maola 12 mutangomaliza kumwa mlingo womaliza ndikulakalaka kwambiri, nseru, kusakwiya, kupweteka m'mimba, kutopa, ndi zina zambiri, ndipo zimatha pafupifupi sabata imodzi kapena kuposerapo. Kafukufuku waposachedwapa wasonyeza kuti ngakhale magawo omaliza osiya kusuta atatha, khalidwe lofunafuna mankhwala likhoza kubwezeretsedwa ngati litakhudzidwa ndi mankhwala osokoneza bongo kapena mankhwala osokoneza bongo.
Mu 2016, pansi pa ndondomeko ya WHO/UNODC Program on Drug Dependence Treatment and Care, the "Lekani Kugwiritsa Ntchito Mowa Motetezeka (SOS)" Chiyambi chinayambika, kuti apereke maphunziro pa kuzindikira kuopsa kwa mankhwala osokoneza bongo komanso kupereka chithandizo chadzidzidzi. Tsoka ilo, ngakhale kuti pali malamulo ndi njira zomwe zimathandizira kuti ma opioid ndi zotumphukira asachoke m'manja olakwika, mamiliyoni a anthu amadalirabe mwakuthupi ndipo akusowa thandizo.
Pomaliza, m'dera lomwe likuchitira umboni nthawi zambiri kuchepa kwa luntha lovuta kwambiri komanso movutikira kupanga kuchotsera koyenera, momwe mungathanirane bwino ndi mliriwu wamankhwala? Wanthanthi Socrates (470-399 BC) anali atalozera kale funso ili pa umbuli: "Koma ngati tikuwona ngati udindo wofunafuna zomwe sitikudziwa, timakhala ochita bwino, amphamvu kwambiri, opanda ulesi m'malo mongoona ngati zosatheka komanso zachilendo pantchito yathu kufunafuna chowonadi chosadziwika, ndingayerekeze kuthandizira izi motsutsana ndi aliyense... ".
Ponena za opioids, fentanyl ndi mankhwala ena osokoneza bongo, zambiri zimanenedwa m'misewu, kusukulu, kudzera pa intaneti, m'mafilimu, ndi pa TV; zina nzowona ndipo zina si zoona. Kutsatsa kwanzeru nthawi zambiri sikufanana ndi zotsatira zake ndi zotsatira zomwe mankhwalawa amakhala. Maphunziro a anthu onse - ndi kusinthidwa kwa achinyamata - ayenera kuchitidwa mwamphamvu ndi mfundo zenizeni ndi zasayansi kuti apereke zenizeni pa dziko losadziwika bwino ndi lonyozeka la mankhwala osokoneza bongo ndikupewa kukopeka nawo: "Maphunziro ndi kutulukira kwapang'onopang'ono kwa umbuli wathu" anatero Will J. Durant (1885-1981).
Popeza moyo ndi thanzi ndi zamtengo wapatali kwambiri kuti zisawonongedwe, pezani zowona za mankhwala osokoneza bongo kuti mupewe msampha wawo wakupha. Kuti mupange chisankho chodziwikiratu pazamankhwalawa komanso osasokoneza moyo wanu, yambani kuwona mndandanda wa timabuku ndi makanema. Zoona Zake Zokhudza Mankhwala Osokoneza Bongo(*) chifukwa ndikosavuta kupewa kuposa kuchiza!
Zothandizira:
https://www.emcdda.europa.eu/publications/mini-guides/
https://www.emcdda.europa.eu/publications/topic-overviews/eu-early-warning-system_en
https://www.emcdda.europa.eu/publications/european-drug-report/2023/heroin-and-other-opioids_en
https://www.unodc.org/unodc/en/scientists/global-smart-update-2017-vol-17.html
https://www.reuters.com/graphics/mexico-drugs/fentanyl/
https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
https://www.cdc.gov/opioids/basics/fentanyl.html
(*) Zoona Zake Zokhudza Mankhwala Osokoneza Bongo, timabuku ndi mavidiyo akupezeka m’zinenero 20 pa:
www.drugfreeworld.org
www.fdfe.eu - Maziko a Europe Yopanda Mankhwala
