Natural opium products in the modern structure of drug poisoning (literature review and results of drug screening for 1990-2020)

Abstract

Despite the rapid increase in synthetic drug use in the United States, the European Union, and many other parts of the world, narcotic and psychoactive substances of natural origin remain relevant to toxicologists. Aim. To analyze the results of drug screening of opium drugs in 1990-2020 and their impact on the formation of acute unintentional poisoning among the adult population of Kyiv. Materials and Мethods. A retrospective analysis of the reports of the toxicological laboratory of the Kyiv City Clinical Emergency Hospital for 1990-2020 on the results of chemical-toxicological screening for drug content in persons diagnosed with "Acute drug poisoning" (ICD-10: T40.0-T40.3). Methods used: Immuno-chromatographic analysis (ICA), thin layer chromatography (TLC) and gas-liquid chromatography with mass spectral detection (GC/MS). Results. According to official data in Ukraine in 2019, the substances that caused people to seek medical help are distributed as follows: opioids – 68.53%; cannabinoids – 6.84%; cocaine – 0.08%; hallucinogens – 0.04%; other drugs – 24.51%. Among those who died as a result of drug poisoning, the proportion of opiates T40.2 (codeine, morphine) was 16%; opium T40.0 – 4%; methadone T40.3 – 23%; other drugs T40.4 (pethidine) – 2%, which together is 45%. According to the results of chemical-toxicological screening for opiate content, it was found that the first step in the average annual growth rate is occupied by: buprenorphine (+7.95%), morphine (+7.6%) and heroin (+6.04%). The number of positive tests decreased in the group of opiates –"shirka" (–9.38%) and opium alkaloids (–2.55%). Over the last 10 years, there has been a progressive increase in the annual number of positive tests for methadone content (+39.3%) at R 2 =8904, which indicates a high stability of the growth rate. Conclusions. Opiates continue to occupy an important segment in the structure of drugs, where their positions for the period 1990-2020 strengthened buprenorphine, morphine and heroin against the weakening of the position of opium ("shirka") and opium alkaloids; at the same time there is a rapid increase in the proportion of semisynthetic and synthetic opioids. These changes necessitate continuous improvement of methods of chemical and toxicological studies of opium products, clinical diagnosis and prevention of related poisonings.