Novel Psychoactive
Substances’Epidemic as a
‘Glocal’ Phenomenon
Duccio Papanti,
University of Trieste, Italy
• The word ‘glocalization’ could be defined as the
adaptation of an index market specifically for a given
locality/culture where it is being proposed.
• The local experience of global phenomena.
• International and contemporary issues but strongly
grounded in local, cultural aspects.
• Means the simultaneity and the co-presence of both
universalizing and particularizing tendencies.
• Implies spatial integration of opposites, whatever their
referential boundaries may be, over the vector of time.
• The case of ‘Junk food’
Epidemic and Syndemic
• An Epidemic refers to “a disease that affects a
large number of people, with a recent and
substantial increase in the number of cases”
(CDC, 2000).
• Syndemic refers to a dynamic relationship
involving two or more epidemic diseases or
other disorders and the socioenvironmental
context that promotes their interaction.
From ‘Junk food’ to ‘Junk drugs’
PACO: Argentina, South-America
SISA: Greece
KROKODIL: Russia, Eastern Europe
How the crisis can drive the
market/demand of drugs in poors
Non Poverty
Low-cost drugs
Higher-cost drugs
Easily available
Not easily available
Analogues/new derivatives
Established substances
Legal or illegal
‘Dirty’ drugs
More pure drugs
More harmful/toxic
Less harmful/toxic
Higher addictive liability
Lower addictive liability
Daily repeated intake
Less frequent intake
Cocaine Base Paste (CBP)
CBP is the first consumable
extract or by-product of the
process of manufacturing
and refining cocaine
South America: Argentina,
Perù, Bolivia, Uruguay,
Ecuador, Colombia, Chile,
Costa Rica, Brazil
Europe: Barcelona and
Cocaine Base Paste
Components : base cocaine (up to 70% of the content), alcohol (rum or superalcoholics and beer),
phosphorus, kerosene, gasoline, sulfuric acid
• CBP pure aka ‘palo de rosa’
• CPB impure (adulteraded with starch, chalk, sugar, aspirine, calcium sulfate, benzocaine, caffeine,
sodium bi/monocarbonate, glass powder, cement powder)
• CBP cleaned
Addicted consumers smoke an average of 20 impure paco+tobacco/cannabis cigs per die (1.9 g cocaine
and 80 mg nicotine) up to 50 cigs per die, (4.7 g cocaine and 200 mg nicotine).
This kind of dependence is considered as double (at least, users are usually polyabusers) and different
from the cocaine chlorhidrate’s one (Llosa, 1994).
Very High addictive potential and rapidly induced addiction !
The high lasts only 5-10 minutes.
Large scale production and low-cost drug.
Poorer the users are and more impure is CBP: in hyspanic slang impure CBP is also called ‘POCAina’
(10%-50% of cocaine) and highly adulterated ‘NOcaina’ (less than 10% of cocaine).
South-American Cocaine Base Paste
local sub-products
‘PACO’ Argentina
‘BASUCO’ Colombia
‘OXI’ Brazil
CBP aka ‘Paco’ (PAsta de COca)
• In Argentina, also defined by the users and
the media as ‘cocaine waste’, it is the residue
that remains in the pot after cocaine
hydrochloride is made from base paste or
cocaine base; this residue is then
• Strong increase in the use since the 2001
economic crisis hit the ‘new poors class’ in Ar.
• Highly toxic!!
‘El Paco’
Colombia, similar in effect to its more expensive relative crackcocaine, its estimated to be smoked by up to 100,000 users in a
country of 31 million people and commonly used among the
street kids of Bogota who smoke it from make shift pipes.
Its effect is a euphoric high at a lower price than other street
drugs like heroin or cocaine which all started from traffickers
selling the by-product at such a minimal cost.
• In Lima, Perù the coca paste is being mixed with
seaweed, which is in turn smoked with cannabis and
tobacco to produce the drug ‘Tristo’, coming from the
dark backwaters of Lima the cocaine derivative is
blended with a dried seaweed giving users a hit
described as a ‘peaceful, happy and ‘trippy’
hallucinogenic rush.
• Details on its origin are not fully known but it is
believed that the ‘Paracas’ culture among the people
of South Lima first used the seaweed in their
ceremonies. This itself has raised issues over the
toxicity levels of the Lima Ocean where the seaweed is
• Brazil, new street drug derived from the manufacture of cocaine paste. In
appearance similar to crack cocaine it offers a ridiculously mad high for a
fifth of the cost of crack.
• Oxi, a short formfor ‘oxidation’, is made of leftovers of cocaine paste,
cooked with variable amounts of gasoline or kerosene and ‘raw’ (‘virgem’)
lime (CaO). The proportion of such addictives seems to determine whether
oxi stones will be coloured purple (roughly similar proportions of
gasoline/kerosene and lime), whitish (when lime is the main contaminant)
or yellow (where gasoline/ kerosene is the predominant contaminant).
• Oxi is a home-made substance, that could be prepared in domestic
kitchens, sold at a very low price, even compared to the low prices of coca
paste and crack stones.
• Said to be twice powerful than crack, it is smoked in pipes improvised
from cans, pieces of piping and metal taps.
• Perù : 1 gr CBP costs 0.5-1 Sol ( 20-40
• Brazil: Oxi costs R$2 (around 65 Eurocents) a
rock compared to R$10 for a rock of crack .
• Argentina: one dose of Paco costs between 5
and 20 pesos argentinos (60 eurocents to 2
‘Home-cooked’ and DIY Injectable
South-East Asia
Liquified injectable opium aka
‘Blackwater’ or ‘yen pox’
• Afghanistan, Brunei, Darussalam, Cambodia,
China, Iran, Laos, Pakistan and Vietnam
• Blackwater opium is a residual product from
smoking prepared opium, recollected in the
cleaning of the opium pipe, boiled and filtered
several times.
‘Homebake’ injectables from
pharmaceutical opioids
• New Zealand
• Morphine sulphate tablets (‘misties’), Codeine
based tablets , Opium Poppy Papaver
• Misties have simple conversion process
• Readily available on the black market in NZ
‘Kompot’ (homemade polish
heroin) and ‘cheornaya’
• POLAND: end of the 1970s, chemical students in Gdansk, Poland,
boiled down the chemical process to prepare heroin to its basics:
they ‘cooked’ the dried poppy heads into an injectable
concoction of opium alkaloids, using readily available household
and industrial chemicals.
• RUSSIA and East Europe : 1980s a simplified version of the
process, which can be conducted on an ordinary kitchen stove,
spread through the FSU under names, such as ‘cheornaya’ and
‘shirka’ obtained from opium gum .
‘Krokodil’– homemade injectable
also called
‘russian heroin’
Krokodil production may have first emerged in Siberia and the Russian Far East some ten years back
Russia, Ukraine, Georgia and Kazakhstan: in Ukraine in 2012 60% among polydrug PWID used
Krokodil and in Russia 5% of PWID is using krokodil.
Mortality and injuries related to the use seem to be much more higher for Krokodil users than
other injectable drugs.
UNAIDS reports that 1.8 million Russians are PWID, together with Ukraine, Russia has one of the
highest growth of HIV infection in the world, outside of Sub-Saharan countries and near one million
people in Russia are now living with HIV.
Majority of new HIV infections in Russia (up to 80 % or more) are transmitted by injecting drug use .
Registered HIV cases are doubling every 12 months (Russian Federal AIDS Center).
Analgesic potency of desomorphine is 8–10 times higher compared to morphine (and thus stronger
than heroin), it shows a faster onset of action and a shorter elimination half-life, the high only lasts
between 90 minutes and two hours may lead to rapid physical dependence and frequent
Europe: Germany (Bochum, Berlin, Frankfurt), Norway (Tromsø).
Rumors about UK, Czech Republic, France, Belgium .
DIY Desomorphine
(Dihydrodesoxymorphine) ?
In the last three to five years in Russia, Ukraine and other countries PWID no
longer using poppies or raw opium as their starting material using med like
codeine (Solpadeine, Codterpin or Codelac)
Homemade in the “kitchen laboratory” : 5–10 codeine tablets boiled with a paint
thinner (that may contain heavy metals like lead, zinc, ferric or ferrous agents,
and antimony) and gasoline, hydrochloric acid, strong alkalis, high concentrations
of iodine, and red phosphorous, which are scraped from the striking surfaces on
matchboxes .
Codeine pills sold in Russia may also contain ingredients such as caffeine,
paracetamol, ordiphenhydramine (coincidentally an opioid potentiator); while
chemicals such as tropicamide , found in over the counter eyedrops, may also be
added to the mixture in attempt to prolong or enhance the experience
The putative end product of the kitchen chemistry is often more likely to include
other compounds than desomorphine (e.g. iodocodeine or morphine derivates).
The production does not result in a powdered or crystalline drug, but in a liquid
drug often not filtered and directly consumed.
Different regions of Russia “desomorphine is synthesized under different
conditions and by different procedures”.
Why is Krokodil used?
• Higher price of heroin, ingredients are easy
• Shortage of injectable poppy straw, lacking of
opioid substitution treatment (in Russia it is
banned through existing legislation, while in
Ukraine <2% of PWID receive OST) .
• Very hard withdrawal syndrome keep users on
Krokodil and Poverty
• Low-cost: around 5 euros for one dose of Krokodil
while one dose of heroin costs around 30-50 euros.
«While heroin is the drug of choice, krokodil is the drug
of need» Jean-Paul Grund, 2013.
The number of Russians living in poverty rose 1.1% in
2011 to a total of around 13% in 2012; in 2002 it was
around 8.5%, according to the World Bank, and it started
to rise from the 2008 financial global crisis (Repoza,2012).
Harms related to the use
Grund et al., 2013
• Highly toxic !! Very dirty production process!!
‘Sisa’ or ‘Shisha’ as a ‘cocaine of
the poor’
The word derives from the Persian word ‘shishe’ that
means glass , used by dealers from Pakistan who started
push the drug.
‘Shisha’ can be smoked or injected!
From 2010 a rapid expansion of ‘Shisha’ production at
home-based crystal meth ‘shake and bake' laboratories.
‘Sisa’ or ‘Shisha’
the “cocaine of the poor”
Greece: €1 - €2 a hit (and only €1.50 for a pipe) compared to €8‐20/gram of brown heroin and
€40‐100 /gram of cocaine.
Monodose crystal methamphetamine type drug, according to local users it often contains cheap
and harmful additives hydrochloric acid, ethanol and car battery fluid, engine oil, shampoo and
cooking salt.
Severe side effects have been described, such as insomnia, aggressions, psychotic symptoms,
emaciation…and increased drive for sex- usually unprotected intercourses!
Drug treatment centers in Greece are being shut down for lack of funds.
Without methadone treatment or needle exchange programs, addicts are tempted to reuse and
share hypodermic needles to inject heroin or sisa.
Needle exchange programs ran out of clean syringes. The number of syringes for PWID per user
recommended by the while Greek PWID are getting three needles per year each while WHO
recommend 200 syringes per user/year (Struchler, 2013).
Authorities registered a 1500% increase in HIV infections among PIWD from 2010 to 2012.
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