New Psychoactive Substances in Taiwan: the Current Situation and Initiative for Rational Scheduling

Abstract

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 e MMC etc.), phenethylamines (PMMA, FMA, 2CeB, 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.

Mifepristone (RU-486®) as a Schedule IV Controlled Drug—Implications for a Misleading Drug Policy on Women’s Health Care

“…Drug scheduling is an essential tool adopted in the UN conventions for addictive drug control. In Taiwan, both the Act for Prevention and Control of Illicit Drug Hazard and the Controlled Drugs Act follow this basic principle of scheduling [ 73 , 74 ]. It is clear that mifepristone is not an addictive substance and should not be placed on the list of the three UN conventions on narcotics and psychotropic agents [ 33 , 34 , 35 ].…”

“…First, classifying a non-addictive mifepristone as a schedule IV drug “misuses” the controlled drug policy/laws meant to protect public health. In conjunction with other studies on rational drug scheduling [ 75 , 76 ], it also implies that the current evaluation system for drug scheduling, both nationally and internationally, may need a comprehensive and objective remodeling or reshuffle to improve the clarity and safety for public health [ 74 ]. Second, the current restriction policy on mifepristone-assisted abortion prevents some pregnant women from receiving legitimate health care, which is similar to the punitive policy on illicit drug use that deters some illicit drug users from seeking timely addiction treatment.…”

Interpol Review of Drug Analysis 2019-2022

“…2019 Review of the scheduling of Cathinones and other amphetamine analogues [ 1087 ]; 2021 considerations and unintended consequences of a class-wide ban on fentanyl analogues [ 1088 ]; the importance of a class-based scheduling strategy [ 1089 ]; the current situation and initiative for rational scheduling of NPSs in Taiwan [ 1090 ]; study aimed to identify changes in codeine supply before and after the February 2018 implementation of up-scheduleding over-the-counter codeine products to prescription only in Australia [ 1091 ].…”

Spontaneous pneumomediastinum as a rare complication of new psychoactive substance

“…There are 37 commonly misused substances in Taiwan, and heroin has the highest risk, followed by (meth) amphetamine and ketamine. [1] The increase of illicit substance misuse raises concern about the danger to public health and the related complications, which may be encountered in the clinical practice of physicians.…”

“…A buse of illicit substances has been a worldwide problem recently, and the incidence in Taiwan has also increased. [1] Spontaneous pneumomediastinum (SPM) is a rare clinical scenario with an estimated incidence of approximately 0.001% to 0.01% in all adult patients. Spontaneous pneumomediastinum commonly presents with shortness of breath, chest pain, and subcutaneous emphysema, and young males have higher chances than other adult patients.…”