Ngaphakathi kweManyano yaseYurophu kwimarike yeziyobisi ngokuguquguquka ngokupheleleyo kuncediswa ngokusetyenziswa kweendaba zentlalo okanye ukuthengiswa kwe-intanethi kunye nezicelo, kubonakala imeko eyongezelelweyo yeziyobisi, kunye nokunyuka kokungeniswa kweziyobisi, ukuveliswa kunye nokusetyenziswa kweziyobisi ezingalawulwayo ezibizwa ngokuba yi-psychoactive substances (NPS). Into esebenza kwengqondo "ichaphazela iinkqubo zengqondo, umz. ukuqonda, ukuqonda, ukuqonda okanye imo kunye neemvakalelo".
NgokweNgcebiso yeSilumkiso kwangethuba kwiZinto eziNtsha zeNgqondo (EWA-2022), iNPS ichazwa njenge. "izinto zokuxhatshazwa, mhlawumbi ngendlela ecocekileyo okanye ukulungiswa, ezingalawulwa yiNgqungquthela ye-1961 eSingle yeZiyobisi zeNarcotic okanye iNgqungquthela ye-1971 ye-Psychotropic Substances, kodwa enokuthi ibeke isoyikiso kwimpilo yoluntu".
I-NPS luluhlu lwamachiza ayilelwe ukulinganisa amachiza asele emiselwe kwaye ahlelwa ngokweziphumo zawo.
Ekupheleni kuka-2022, iZiko laseYurophu lokuJonga iChiza kunye neDrug Addiction (EMCDDA) lalibeke iliso malunga ne-930 NPS, engama-41 yaqala ukuxelwa eYurophu ngo-2022.
EYurophu, ukusetyenziswa kwe-opioids (i-morphine, i-codeine, i-heroin, i-fentanyl, i-methadone, i-tramadol kunye nezinye izinto ezifanayo) sele iqalile ukunyuka ukususela ekuqaleni kwe-21st kwinkulungwane. Kwiminyaka yakutshanje, kukho ukunyuka okuphawulekayo kwinani le-psychotropic synthetic opioids entsha kunye ne-74 echazwe kwi-EU Early Warning System (EWS).
Phawula: Ii-opiates ngamachiza endalo asuka kwi-opium poppy plant; I-opioid ligama eliqhelekileyo eliquka i-opiates, i-semi-synthetic (njenge-oxycodone) kunye ne-synthetic (njenge-fentanyl) i-opioids.
Ii-opioids zokwenziwa ezintsha zisekwe ngokufanelekileyo kwezinye iimarike zamachiza zaseYurophu apho athengiswa rhoqo ngexabiso eliphantsi njengotshintsho lweopioids efana neheroin. Iziphumo zokulutha kwe-opioid ziphezulu kakhulu nakwidosi ephantsi.
Ngokutsho kweNgxelo yeDrug yaseYurophu ye-2023, kumazwe amaninzi aseYurophu, ukusetyenziswa kwe-opioids yokwenziwa kukhula njengoko kuboniswe ngenani lokubanjwa okuchazwe yi-EMCDDA. Okwangoku, uMkomishinala waseYurophu weMicimbi yezeKhaya, uNksz Ylva Johansson, kunye noMlawuli we-EMCDDA, uMnumzana Alexis Goosdeel, walumkisa ngokunyuka kokusetyenziswa kwe-opioids embi kakhulu: I-Fentanyl. Uthe: "Kufuneka siqinisekise ukuba iMelika yangoku ayibi likamva laseYurophu". Ewe, kulo nyaka uphelileyo e-USA, abantu abayi-109,000 babulawa ngamachiza okwenziwa uninzi lwabo kwi-fentanyl.
Ukuxhaphaka kokuxhomekeka kwe-opioid phakathi kwabantu abadala baseYurophu kusephantsi, kuyahluka kakhulu phakathi kwamazwe kwaye kuhambelana nezifo ezosulelayo, iingxaki zempilo, ukukhutshelwa ngaphandle kwentlalo, ukungabikho kwemisebenzi, ukungabi namakhaya, ulwaphulo-mthetho kunye nokufa. Kubantu abangaphezulu kweminyaka engama-40 abasebenzisa i-opioids, iziphumo ezongezelekayo zobungozi obunxulumene neziyobisi ezibandakanya ukusetyenziswa kweziyobisi ezininzi kunye nempilo enkenenkene kwiminyaka emininzi zenza aba bantu babe sesichengeni sosulelo, ukugqithisa ngokweqile kunye nokuzibulala.
I-fentanyl (C22H28N2O) yaqala ukwenziwa kwi-benzyl-piperidone ngo-1959 (ilungelo elilodwa lomenzi ngo-1964) ngusokhemisti uPaul Janssen eBelgium. Ezinye iindlela ezintathu zenziwa:
-Suh okqhubekayo. 1998: indlela ngokudibanisa ngokupheleleyo.
-Siegfried ekuqaleni kuka-2000 kwaye isetyenziswe kwiilebhu ezingekho mthethweni;
-Gupta PK okqhubekayo. 2005: imbiza enye isetyenziswe ngokungekho mthethweni ngo-2021 kodwa ngokucoceka okuphantsi;
I-fentanyl ngenxa yokunyibilika kwayo okuphezulu kwe-lipid ingena ngokulula kwinkqubo ye-nervous ephakathi kunye nemiphumo yokuthomalalisa kunye nokukhawuleza kwe-analgesic kunye nexesha elifutshane lesenzo. Ukuxutywa kwayo ngokukhawuleza kwi-mucosa yomlomo (i-15/30 min-4 hrs) kodwa inokulawulwa nge-injection (2min-30 min), i-transdermal (i-patch) okanye isetyenziswe kwisimo se-gaseous njenge-spray (10min-60min).
I-fentanyl analgesic effect imalunga namaxesha angama-100 anamandla ngaphezu kwe-morphine kunye namaxesha angama-50 ngaphezu kwe-heroin. Ngaphantsi kwefomu yonyango yomthetho, le opioid yokwenziwa isetyenziselwa unyango lweentlungu ezibuhlungu ezingapheliyo kunye nezinganyangekiyo. Ukusukela ngo-2021 ibiyinxalenye “yamayeza ayimfuneko” oMbutho wezeMpilo weHlabathi kwaye yahlelwa kwishedyuli III nge-morphine kunye ne-oxycodone.
Ngokwembono yonyango lwezilwanyana, ukusebenza okuphezulu kwe-fentanyl kusetyenziselwa i-analgesia, i-sedation kunye ne-anesthesia kwizilwanyana kunye nokunyanga ukudakumba kunye nokuphazamiseka kwizilwanyana.
Kodwa, i-fentanyl iye yaphambukiswa ekusetyenzisweni kwayo njengeyeza lokuthomalalisa iintlungu ukuba ithathwe njengechiza, iveliswe lula kwiilebhu ezifihlakeleyo ngaphandle kokuba nengxaki yokulima nokuvuna izityalo! Iveliswe e-China, eMexico nase-Indiya, i-fentanyl ikwabizwa ngokuba yi-China White, i-Apache, iJackpot, i-Murder 8,… ibe ngumba omkhulu kwindawo yangoku yeziyobisi yaseYurophu. Ikhilogram enye ye-fentanyl powder inokuqulatha iidosi ezingama-50,000.
Okwangoku, phakathi kwe-1,400 ye-fentanyl derivatives, i-700 derivatives ichongiwe eYurophu, ezinye zihlala zinamandla ngamaxesha angama-1,000 kune-heroin. I-3-methyl fentanyl ngamaxesha angama-3,200 anamandla njenge-morphine kunye ne-derivative., i-carfentanyl, yomelele izihlandlo ezili-10,000 kunemorphine.
I-fentanyl inetyhefu kakhulu nangokudibana ngokulula nolusu. Iimiligram ezi-2 kuphela ezinokubulala umntu omdala. Ubungozi xa bongezelelwa kwezinye iziyobisi ngabathengisi, abantu bazisebenzisa bengazi. Enyanisweni, i-fentanyl ihlala ixutywa, isikwe, kwaye ifakwe kunye namanye amachiza, kubandakanywa cocaine kunye neheroin. Jobski K okqhubekayo. (2023) wenze isifundo esinomdla malunga nokuxhatshazwa, ukuxhomekeka, ukuhoxiswa kunye nendlela yokulawula eYurophu. I-Fentanyl inamandla kangangokuba akunakwenzeka ukuba inqunywe ngokuchanekileyo ngaloo ndlela yandisa umngcipheko wokugqithisa ngokweqile.
I-Fentanyl iye yahlelwa njenge-narcotic yamazwe ngamazwe ukususela ngo-1964, ngenxa yeengozi zayo zempilo, ubungozi bokusetyenziswa kakubi, kunye nobunzima bokuphatha. Kubantu, idosi ebulalayo (LD50) ye-fentanyl iqikelelwa kumntu omdala kwiimiligram ezimbini (2mg).
Qaphela: Ipatch ye-fentanyl (ehlala ihlafunwa ngabasebenzisi beziyobisi) lelinye lamayeza ambalwa anokuba yingozi ngakumbi, kwaye kwezinye iimeko abulale, ngedosi enye nje, ukuba isetyenziswe kakubi ngumntwana (Ulawulo lokuTya kunye noLawulo lweZiyobisi, ngo-2022). Iziphumo zingahlala phakathi kwemizuzu ye-30 kunye neeyure ze-4 kuxhomekeke kwimveliso esetyenzisiweyo. Kodwa ngenxa yokungabikho kokujonga emva kunye nezifundo zesayensi, ixesha labo leempembelelo alaziwa kakuhle.
Ukusetyenziswa ngokuphindaphindiweyo kwe-fentanyl okanye i-derivatives yayo, kunye nonyango, kunokukhokelela kumngcipheko wokuxhomekeka kwaye kwimeko yokusetyenziswa kakhulu, kukho umngcipheko wokugqithisa ngokweqile ngokudakumba kokuphefumula kunye nokukhubazeka okunokwenzeka kwemisipha ye-thoracic, ukothuka, ukuqina kwe-hypotension, ukuqina kwemisipha okanye isiqaqa oko kunokukhokelela ekufeni. Umngcipheko wokubanjwa kokuphefumula uyanda xa ukusetyenziswa kwe-fentanyl (okanye i-derivatives yayo) kuhambelana notywala, i-benzodiazepines kunye nezinye i-opioids. Ukusetyenziswa kwazo ngokungekho mthethweni kukwayingozi kwimeko yokukhulelwa kowasetyhini nakwimveku engekazalwa.
I-Fentanyl kunye ne-non-medical derivatives zibonwa ukuya kuthi ga kwiiyure ezingama-48 kumchamo kwaye ukuya kuthi ga kwiiyure ezili-12 egazini.
Ukusetyenziswa ngokungekho mthethweni kwe-fentanyl kunye ne-derivatives kuye kwashwankathelwa kakuhle ngu-J. Botts (2023): Ukukhawuleza, kutshiphu kwaye kuyabulala.
Indlela yokwenza :
Emzimbeni kukho ii-neurotransmitters ezingama-20 ze-opioid eziveliswa ngokwendalo ngokwendalo ezihlelwa ngenani le-amino acids. Zibandakanya iintlobo ezahlukeneyo ze:
Ii-endorphins,isiphelogeneous moirphine), iipolypeptides ezenziwe yi-hypophyse kunye ne-hypothalamus. Bazigquma iintlungu ixesha elifutshane (elinegalelo ekusindeni) kwaye kwakhona babangele imvakalelo yokuphumla (i-anxiolytics), intlalontle okanye kwezinye iimeko, uvuyo njenge-beta-endorphins.
-I-enkephalins (ukusuka kwisiGrike enkephalos = intloko) zii-inhibitors zokusasazwa komyalezo wentlungu kwingqondo edala i-analgesia emfutshane; bayakwazi ukumodareyitha isixa se-dopamine (ikhemikhali yomvuzo) eveliswayo kunye nokulawula ukusebenza kwezihlunu ezigudileyo.
Iidynorphins (ukusuka kwisiGrike i-dynamis = amandla) eveliswa kwi-hypothalamus, i-hippocampus kunye nentambo yomgogodla ilawula kwaye inefuthe kwimisebenzi ebalulekileyo efana nobushushu bomzimba, inkumbulo yexesha elide, indlala, ukunxanwa, ukulala, kunye nokucubungula ulwazi lweemvakalelo.
Ubukho be-opioid-specific transmembrane receptors kwingqondo yaqala ukuboniswa ngaxeshanye kwi-1973 yiPert CB. okqhubekayo., USimon EJ okqhubekayo. kunye noTerenius L. Ezi receptor ze-neurotransmitter zifumaneka kwingqondo, intambo yomgogodla kunye nenkqubo yokugaya. Ziyi-G-protein edityanisiweyo ye-receptors kwaye xa ivuliwe inegalelo ekumodareyitheni impendulo yeentlungu, isimo sengqondo, uxinzelelo kunye nokuxhomekeka ngokomzimba.
Kukho iintlobo ezintathu ze-opioid receptors: i-mu, i-delta kunye ne-kappa, isasazwe ngokubanzi kwingqondo. Ukuba impembelelo ye-euphoric ye-opiates ilawulwa yi-mu kunye ne-delta receptors, ukusebenza kwe-kappa receptors, ngokusisiseko yindlela ye-homeostatic kodwa ukusetyenziswa kweziyobisi ezingapheliyo kukhokelela kulawulo lwayo oludala ukuphazamiseka kwengqondo kunye neemeko ezingathandekiyo (Tejeda HA & Bonci A. 2019) .
Imiphumo ye-opioids idibaniswa nokusebenza kwenkqubo ye-opioid engapheliyo kwingqondo kwinqanaba le-Nucleus Accumbens (NAc) kunye ne-Ventral Tegmental Area (VTA) ye-limbic system. Ke, i-opioids kunye ne-fentanyl zonyuka ngokugqithisileyo ukukhutshwa kwe-dopamine kwinkqubo ye-limbic ngokusebenza kwe-mu kunye ne-delta receptors kwi-NAc (Yoshida Y. okqhubekayo. Ngowe-1999 - uHirose N. okqhubekayo. 2005). Ukuziphatha okunyanzelekileyo kokuthatha iziyobisi kusisiphumo sotshintsho olusisigxina kwinkqubo ye-mesolimbic dopamine evela kuvuselelo oluphindaphindiweyo lwe-dopamine olukhukula kwiNervous System sisiseko sokulutha.
Oku kwenze ukusetyenziswa kwee-opioids ekuqaleni kwabamnandi kodwa ingxaki kukuba kukho isidingo esingakumbi sokufumana i-dopamine efanayo yotyando lolonwabo, ulonwabo kwaye ekugqibeleni le yaba sisidingo esisisiseko esikhokelela ngokukhawuleza kwi-overdose ebulalayo ye-fentanyl kunye nezinto eziphuma kuyo.
Iyeza le-naloxone lisetyenziselwa ukubuyisela imiphumo ye-opioid overdose. Eli chiza kwi-2-3 min emva kokutofa lisebenza njengomchasi okhuphisanayo kunye nobudlelwane obuphezulu be-receptor ye-mu-opioid, evumela ukuguqulwa kweempembelelo ze-opioids (uJordan MR kunye noMorrisonponce D., 2023) ekuxilisweni kwe-heroin, fentanyl. , codeine, morphine, oxycodone, hydrocodone, njl.
Kuye kwaboniswa ukuba i-fentanyl kunye nezinye ii-analogues zinokuchaphazela ukusebenza kwengqondo kwi-psychomotor kwimisebenzi yemihla ngemihla egxininisekile ekuqhubeni (Bilel S. et al. 2023). Ukongeza, uGasperini S. et al. (2022) ibonise ukuba i-analogues engekho semthethweni ye-fentanyl ifunyenwe njenge-genotoxic, ikhuthaza ukungahambi kakuhle kwe-chromosomal yesakhiwo kunye namanani.
Iimpawu zokurhoxa kwe-fentanyl zivela ngokukhawuleza kwiiyure ze-12 emva kwedosi yokugqibela kunye nokunqwenela okunzulu, isicaphucaphu, ukucaphuka, isisu esibuhlungu, ukudinwa, njl njl kwaye kugcina malunga neveki enye okanye ngaphezulu. Uphando lwakutsha nje lubonise ukuba nasemva kokuba izigaba zokugqibela zokurhoxa zidlulisiwe, indlela yokuziphatha yokufuna iziyobisi inokubuyiselwa ukuba ibonakaliswe kwiziyobisi okanye iziyobisi ezinxulumene neziyobisi.
Kwi-2016, phantsi kwesikhokelo se-WHO / iNkqubo ye-UNODC yoNyango lokuXhomekeka kweziyobisi, “Yeka Ukugqithisela Ngokukhuselekileyo (SOS)” I-Initiative yaqaliswa, ukubonelela ngoqeqesho malunga nokuqaphela umngcipheko wokugqithisa ngokweqile kunye nokubonelela ngononophelo olungxamisekileyo. Ngelishwa, nangona imimiselo kunye neenkqubo zokugcina i-opioids kunye ne-derivatives ngaphandle kwezandla ezingalunganga, izigidi zabantu zisaxhomekeke ngokwenyama kwaye zifuna uncedo.
Ukuqukumbela, kuluntu olunikela ubungqina ngokufuthi kakhulu ukuhla kobukrelekrele obubalulekileyo kunye nobunzima bokwenza utsalo-mali olusengqiqweni, indlela yokujongana ngokufanelekileyo nesi sibetho seziyobisi? Isithandi sobulumko uSocrates (470-399 BC) wayesele esalatha kulo mbuzo wokungazi: "Kodwa ukuba sithathela ingqalelo njengomsebenzi wokufuna into esingayaziyo, siba ngcono, sinamandla ngakumbi, singonqeni kunokuba sithathelwe ingqalelo njengento engenakwenzeka kwaye yangaphandle kumsebenzi wethu wokukhangela inyaniso engaziwayo, ndinokuba nobuganga bokuxhasa oku ngokuchasene nawo wonke umntu... ".
Malunga ne-opioids, i-fentanyl kunye nezinye iziyobisi, kuninzi kuthethwa ezitratweni, esikolweni, nge-Intanethi, kwiimuvi, nakwiTV; ezinye ziyinyani ukanti ezinye aziyonyani. Intengiso ebukhali kaninzi ayihambelani nobunyani beziphumo kunye neziphumo amachiza ngokwenene anazo. Imfundo yabemi ngokubanzi - kwaye ilungiselelwe ulutsha- kufuneka yenziwe ngokungqongqo ngedatha eyinyani kunye nenzululwazi ukubonelela ngenyani kweli lizwe lifihlakeleyo neliphantsi leziyobisi kwaye kuthintelwe ukukhotyokiswa zizo: "Imfundo yinto ehamba phambili yokufumanisa ukungazi kwethu" watsho uWill J. Durant (1885-1981).
Njengoko ubomi nempilo zixabiseke kakhulu ukuba zingachithwa, fumana iinyani eziyinyani malunga neziyobisi ezingekho mthethweni ezisebenza ngengqondo ukunqanda umgibe wabo obulalayo. Ukwenza isigqibo esinolwazi malunga nala machiza kwaye ungenzi isiphithiphithi ebomini bakho, qalisa ukubonisana noluhlu lweencwadana kunye neevidiyo. Inyaniso Ngeziyobisi(*) kuba kulula ukuyinqanda kunokuyinyanga!
Iingxelo:
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
(*) Inyaniso Ngeziyobisi, iincwadana neevidiyo zifumaneka ngeelwimi ezingama-20 ku:
www.drugfreeworld.org
www.fdfe.eu – iSiseko seYuropu eSimahla iziyobisi
