Transcript Jih-Heng Li, Ph.D.

Misuse patterns and trends of
new psychoactive substances
in Taiwan
Wen-Jing Yu1,2, Wen-Ing Tsay2, Jih-Heng Li1*
1.Ph.D.
Program in Toxicology and School of Pharmacy, Kaohsiung
Medical University, Kaohsiung, Taiwan
2.Food and Drug Administration, Ministry of Health and Welfare,
Taiwan
Presented at the 2015 International Conference on Global Health: Prevention and
Treatment of Substance Abuse and HIV, Hangzhou, China
April 22-24, 2015
1
Introduction



The illicit markets of New Psychoactive
Substances (NPS) have been growing
worldwide according to the 2014 UNODC
World Drug Report.
Many NPSs have not been controlled by the
UN drug conventions. Therefore, the NPS
regulation may not be fully implemented in
many countries.
In this study, the scale, patterns, and trends of
NPS misuse in Taiwan were evaluated with the
National Substance Abuse Monitoring and
Reporting Systems.
2
Demographic description about Taiwan


Area: consists of the Taiwan
Island proper and some 85
islets, with a total land area of
36,000
square
kilometers
(14,000 square miles).
Population: densely populated
with 23,315,822 people (as of
2012
census)

648
persons/km2 land a rea).
3
Methods and Design


Time periods of data collection: from 2006 through 2014.
Data collection from the National Substance Abuse
Monitoring and Reporting Systems : The data on drugrelated treatments, HIV/AIDS, arrests, seizures and laboratory
drug testing of urine for court referrals were collected monthly
by Taiwan Food and Drug Administration (TFDA) from:
 Investigation Bureau, Ministry of Justice;
 National Police Administration, Ministry of Interior;
 Headquarters of Military Police, Ministry of Defense;
 Food Drug Administration, Ministry of Health and Welfare;
 Centers for Disease Control. Ministry of Health and Welfare;
 All Local Health Departments.
4
Prevalence of illicit substance abuse

1.2% in 2005 National Household Survey:



1.4% in 2009 National Household Survey:



The top three most popular illicit drugs were Amphetamine(s), MDMA, and
Ketamine.
The first time drug use: Amphetamine(s) was most at home; MDMA and
ketamine were in clubs or KTVs.
The top three most popular illicit drugs were Amphetamine(s), Ketamine,
and MDMA.
The first time drug use was at home and clubs.
1.29% in 2014 National Household Survey:

The top three most popular illicit drugs were Amphetamine(s), Ketamine,
and Cannabis.
5
Current Substance Abuse Status in Taiwan
- the Supply side (Drug Seizures)
Ketamine
Schedule
Year
Amounts of drugs seizures in Taiwan from 2006 through 2014- by schedules
6
Current Substance Abuse Status in Taiwan
- the Demand side
Schedule
Year
Number of schedule I & II drug users sentenced to prisons
7
Class: ■1st ■2nd ■3rd ■4th ■ none
Proportions of Different Drug Mentions among Treatment
Admissions from Hospitals in Taiwan from 1999 through 2014
8
Current Status of Major Drugs of Misuse


While heroin and methamphetamine remain the two
predominant drug problems so far, ketamine misuse has
surged since 2002. A record high of 2,941 kg of ketamine
was seized in 2014. Ketamine-dependent patients
increased from 99 cases in 2006 to 1,626 cases in 2014.
Use of NPS other than ketamine was also found:
 Synthetic cannabinoids : JWHs
 Synthetic cathinones : MDPV, 4-MEC, 4-MMC, bk-MDMA
 Phenethylamines : DMA, PMMA, PMEA
 Piperazines : BZP, TFMPP
 Tryptamines : 5-MeO-DIPT
 2C-B
9
Reported drug testing positives cases of NPS by laboratories in Taiwan
Common name
AM-2201
JWH-018
JWH-073
JWH-122
JWH-250
XLR-11
Categories
2006
2007
2008
2009
2010
2011
2012
Synthetic cannabinoids
2014
7
Total
15
64
8
25
19
6
11
1
21
83
45
7
213
231
16
106
27
7
18
213
387
9
2
32
275
1442
1749
3
3
331
391
252 9165
597 11451
1174 22392
9568
12479
24190
9981 16570 19469 28786 34284
123044
7
Synthetic cathinones
MDPV (3,4Methylenedioxypyrovalerone)
2-Fluoromethcathinone (2FMC)
4-Methylethcathinone (4-MEC)
Mephedrone (4-MMC)
Methylone (bk-MDMA)
Ketmine
2013
93
22
115
Ketamine & PCP
2-Fluoromethamphetamine (2- Phenethylamines
FMA)
3-Fluoromethamphetamine (3FMA)
N,N-Dimethylamphetamine(DMA) /
2,5-Dimethoxyamphetamine
p-Methoxymethamphetamine
(PMMA)
p-Methoxyethylamphetamine
(PMEA)
1668
Piperazines
5-MeO-DIPT
2C-B
Tryptamines
3512
5890
8
45
155
202
13
254
307
50
11
9
131
140
1-Benzylpiperazine (BZP)
TFMPP
2884
2
17
233
233
12
148
159
2
2
1
2
66
1
2
102
68
19
13
4
1
46
617
4
26
5
2
76
113
106
95
26
79
1
1
4
110
68
16
12
12
5
14
14
28
3
79
46
24
24
81
272
972
6
20
1385
1436
1391
1456
3 10
3
199
538
Trend of NPS positives cases by laboratory drug testing in Taiwan
11
Trend of NPS positives cases (excluding ketamine and synthetic cathinones) by
laboratory drug testing in Taiwan
12
Scheduled New Psychoactive Substances in Taiwan
1 Synthetic
cannabinoids
201
Items
S2 S3 S4
8
-
2 Synthetic
cathinones
97
1
Categories
Items
6
3 Aminoindanes 9
4 Ketamine & PCP 12
5 Phenethylamines 124 5
1
2
6 Piperazines
22
1
1
7 Plant-based
substances
8 Tryptamines
9 Other
substances
22
1
Total
37
61
585
Items name
S2
MDPV (2012)
2-Fluoromethamphetamine(2-FMA)(2012);
3-Fluoromethamphetamine(3-FMA)(2012);
4-Fluoromethamphetamine(4-FMA)(2012);
[Item in Taiwan: Fluoromethamphetamine];
N,N-Dimethylamphetamine-(DMA)(2004);
p-Methoxymethamphetamine(PMMA)(2006)
1-Benzylpiperazine (BZP)(2014)
Peyote cactus
[Item in Taiwan: Peyote]
1 -
8 18 1
27
S3
S4
AM-2201 (2013);
CP-47,497 (2011);
HU-210 (2011);
JWH-018 (2011);
JWH-073 (2011);
JWH-122 (2013);
JWH-250 (2011);
XLR-11 (2014)
2-Fluoromethcathinone (2-FMC) (2014); 3-Fluoromethcathinone (3-FMC) (2014);
4-Fluoromethcathinone (4-FMC) (2014);
[Item in Taiwan: Fluoromethcathinone];
4-Methylethcathinone (4-MEC) (2013);
Mephedrone (4-MMC) (2010);
Methylone (bk-MDMA) (2012)
Ketamine (2002)
25B-NBOMe(2C-B-NBOMe) (2014);
p-Methoxyethylamphetamine
(PMEA)(2009)
1-(3-Trifluoromethylphenyl) piperazine (TFMPP) (2012)
-
5-MeO-DIPT (2011)
13
NPS of Natural Originn

Salvia has also been available from the internet.
14
Adverse Effects associated with NPS use




Ketamine use: 3rd cause of Fatality due to drug use, after
Heroin and Methamphetamine
Psychiatric disorders.
Co-morbidity, such as Ketamine cystitis and HCV
HIV, Unprotected sex and NPS use?
15
HRP
HIV(+)
AIDS
Reported Cases of HIV/AIDS in Taiwan by Year
Source: Center for Diseases Control, Department of Health
16
The percentage of IDUs
among all addiction
treatment admissions
increased from 34.7% in
2000 to 63.9% in 2004.
The percentage of IDUs
sharing needles increased
from 4.0% in 2000 to 15% in
2004.
Route of Administration among Treatment Admissions in
Hospitals from 1999 through 2011 in Taiwan.
17
NBCD
reported
to DOH
in 2004↓
Initiation of
Harm Reduction
By TCDC in
2005
↓
The percentage of needle sharing and non-needle sharing among
treatment admissions in Hospitals from 1999 through 2011 in Taiwan.
18
19
20
21
Cases of HIV infection by exposure category in Taiwan from 1984 through 201422
Conclusion




Seizures of NPSs, such as ketamine, GHB, MDPV, cathinone,
chloroamphetamine, methylone, phenazepam, and
mephedrone have been reported. Identification of these
NPS seizures by laboratory testing has also shown an
upward trend.
Most NPS users were younger in contrast to the users of
traditional drugs. Many NPS misusers have developed
comorbidities such as bladder cystitis and HCV.
The increased HIV-positive incidence may be associated
with unprotected sex and NPS use.
In summary, the epidemic level of NPS misuse and harms
may have been underestimated because of their
uncontrolled status.
23
Acknowledgement
The authors are indebted to the following agencies for providing
the drug-related data and information.
 Investigation Bureau, Ministry of Justice, Taiwan
 National Police Administration, Ministry of Interior,
Taiwan
 Headquarters of Military Police, Ministry of Defense,
Taiwan
 Food Drug Administration, Ministry of Health and Welfare,
Taiwan
 Centers for Disease Control. Ministry of Health and
Welfare, Taiwan
 All Local Health Departments
24
Thanks for your
attention
25
With history as the mirror, the rise or fall of a dynasty can be learned
Emperor Tang Tai Chung, China
以古為鏡，可以知興替
-唐太宗
Jih-Heng Li: “Chapter 13. From Gradual
Prohibition to Harm Reduction: The
Experience of Drug Policy and Law
Reform in Taiwan” in the book “Drug Law
Reform in East and Southeast Asia” (eds.
Fifa Rahman and Nick Crofts), Lexington
Books in October 2013
26