Doctoral Degree Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Food and Drug Administration, Ministry of Health and Welfare, Taiwan.
J Food Drug Anal. 2021 Mar 15;29(1):168-181. doi: 10.38212/2224-6614.3225.
Use of New Psychoactive Substances (NPS) has posed a global threat to public health and the security of the population. As of December 2019, the NPS items identified in total have outnumbered by three to one the controlled substances listed in the 1961 and 1971 UN Drug Conventions. However, most of these NPS have not been scheduled by the United Nations because of their easy modification on the chemical structures to shun control. Currently, the scheduling and control of NPS is mostly at the national level and a rational scheduling of NPS by objective assessments is essential but often lacking. To rationally schedule NPS, the NPS misuse situation was firstly estimated with the Taiwanese Substance Misuse Monitoring and Reporting Systems (SMMRS) from 2006 through 2019. Then, the assessment of drug-related harms with an expert Delphi procedure for drug scheduling was performed. The epidemiological analysis revealed that among 37 substances commonly misused in Taiwan, heroin posed the highest risk, followed by (meth)amphetamine and ketamine. Of note, misuse of NPS, such as ketamine, synthetic cannabinoids (JWHs, AM-2201, XJR-11), synthetic cathinones (MDPV, bk-MDMA, 4 -MMCetc.), phenethylamines (PMMA, FMA, 2C-B, 2C-E etc.), piperazines (BZP, TFMPP) and tryptamines (5-MeO-DIPT) has been on the rise. Though perceived drug-related harms differed among experts with different professional backgrounds, the differences were not significant. Four dimensions of drug-related harms- addiction, misuse, social harm and physical harm- integrated from Nutt's model and scheduling criteria of Taiwan's Statute for the Prevention and Control of Illicit Drugs (SPCID), were further divided into 11 indicators and applied to assess harms of the 37 substances. Among the 11 indicators that corresponded to the four dimensions, 7 had significant prediction capabilities. Additionally, prevalence of misuse nationally was an important predictor of harm assessment. These indicators of harm assessment of drug misuse can help develop a proper scheduling system for the management of controlled/illicit drugs. In conclusions, drug scheduling is the first step toward proper management of drug use problems. Facing the threats of NPS, it is imperative to implement a rational and effective scheduling system for appropriate management. This study provides a mechanism to scrutinize, and improve, the current evaluation process for NPS scheduling.
新精神活性物质（NPS）的使用对全球公众健康和人口安全构成了威胁。截至 2019 年 12 月，已鉴定的 NPS 项目数量是 1961 年和 1971 年《联合国麻醉品公约》管制物质的三倍多。然而，由于这些 NPS 很容易修改其化学结构以逃避管制，因此大多数都未被联合国列入附表。目前，对 NPS 的管制和列管主要在国家层面进行，对 NPS 进行客观评估的合理列管十分必要，但往往缺乏这种评估。为了合理地对 NPS 进行列管，本研究首先利用 2006 年至 2019 年台湾地区物质使用监测与报告系统（SMMRS）来估计 NPS 的滥用情况。然后，通过专家 Delphi 程序对与药物相关的危害进行评估，以进行药物列管。流行病学分析显示，在台湾地区常见的 37 种滥用物质中，海洛因风险最高，其次是（甲基）安非他命和氯胺酮。值得注意的是，氯胺酮、合成大麻素（JWHs、AM-2201、XJR-11）、合成卡西酮（MDPV、bk-MDMA、4-MMC 等）、苯乙胺（PMMA、FMA、2C-B、2C-E 等）、哌嗪（BZP、TFMPP）和色胺（5-MeO-DIPT）等 NPS 的滥用呈上升趋势。尽管不同专业背景的专家对药物相关危害的看法存在差异，但差异并不显著。从 Nutt 模型和台湾地区《预防和控制非法药物条例》（SPCID）的列管标准中整合了与药物相关危害的四个维度——成瘾、滥用、社会危害和身体危害，并进一步细分为 11 个指标，用于评估 37 种物质的危害。在对应四个维度的 11 个指标中，有 7 个指标具有显著的预测能力。此外，全国滥用的流行程度是危害评估的一个重要预测因素。这些药物滥用危害评估指标有助于建立适当的管制/非法药物管理制度。总之，药物列管是妥善管理药物使用问题的第一步。面对 NPS 的威胁，必须建立一个合理有效的列管制度，以进行适当的管理。本研究提供了一种机制，可以对 NPS 列管的现行评估程序进行审查和改进。
