Inside Diagnostics - Summer 2015 (EN) by nal von minden GmbH

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Inside Diagnostics Summer 2015

DENGUE A developing disaster

THC Globalegalisation

EUROPEAN DRUG REPORT New Psychoactive Substances on the advance

In this issue

P R I Z E D R AW e More on pag

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Inside Diagnostics

Foreword

Dear readers In this issue, we explore some topics already previously published in your Inside Diagnostics but this time we adopt a wider view and go international. On a drug point of view, you will be delighted by an article about the legalization of cannabis, pregabalin in prison and the very recent 2015 Report of the EMCDDA. Since the legalization of cannabis in the State of Colorado, the topic comes back in Europe and even worldwide. We define and expose the facts as well as we attempt to explain what impact the legalization have based on previously experienced situations. What is pregabalin and why is that drug so popular in prisons? With our â&#x20AC;&#x153;Insiderâ&#x20AC;&#x2122;s Guide to Pregabalinâ&#x20AC;?, you will have the opportunity to dive deep into its use and danger in prison and its potential impact outside. With the recently released report of the MCDDA, we have analyzed the big tendencies and changes that actually occurred during the last year. From a medical point of view, we have written about dengue, rotavirus and pregnancy (as a follow up of our last issue).

Click here and subscribe in one easy step! Executive editor: Inside Diagnostics Nicolas Kennof Tel.: 0941 29010-36 inside-diagnostics@nal-vonminden.com

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Dengue fever, qualified as a developing disaster by the author of the article who explores the topic in South East Asia and especially in Malaysia where the situation is at its worst and claiming a lot of victims. In the last issue, we were talking about diagnoses that can be made during pregnancy. Now we are tackling the topic of the prenatal diagnosis. From the desire for a child until the a positive pregnancy test. Finally, we give a short insight of the rotavirus: what it is? What are the dangers? how to diagnose it? And before letting you go further with reading, the whole nal von minden team wishes Raffaela Seiband, writer of the gynecology articles since the beginning of the magazine, a lot of success in her maternity leave and, most important, a lot of joy for her growing family. Good luck Raffi! Best Regards Nicolas Kennof

Content

Content Themes Dengue �� 4 Ovulation �� 8 THC Legalisation �� 12 Pregabalin �� 15 European Drug Report �� 16 Rotavirus �� 18 nvm Inside Prize Draw ��10 Congresses & Trade fairs ��19 Contact/Medical Man ��20

Flag Inside Diagnostics nal von minden GmbH Customer Magazine Contact: nal von minden GmbH Nicolas Kennof Friedenstraße 32 93053 Regensburg

THC LEGALISATION | Page 12

The recent legalisation of cannabis in the US state of Colarado has opened up debate in Europe. Despite similar yet stronger examples in Europe, the legalisation is an open debate with many viewpoints being discussed. Learn more about this in our article on page 12.

Chief Editor: Nicolas Kennof Editors: Torsten Winkler, Kristina Sambs, Raffaela Seiband, Christopher Beiderbeck, Anne Kaiser, Andrea Kreuzer, Lukas Eder, Martina Kastenmaier, Frederica Swaine, Helen Murr, Ciaran Gough inside-diagnostics@nal-vonminden.com Layout: Martina Kastenmaier, Kristina Sambs

istockphoto.com © Fotomatt_hh, henrikroger, ertyo5, pagadesign

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Tropical Medicine Dengue

Dengue

A developing disaster Today ranked by the World Health Organisation as the most important mosquito-borne viral disease in the world, dengue or ´dengue fever´ is a huge concern for those countries it affects. Whilst much effort has been dedicated in the past to malaria prevention and eradication, a similar response to the dengue virus has until more recently been less focused. However with a huge increase in incidences throughout the past decade, the need to control and reduce the impact of dengue is ever more urgent. The dengue virus is transmitted via the bite of a female Stegomyia aegypti (former Aedes aegypto) mosquito, a mosquito that prefers to feed on multiple people. This and a preference for day time biting, makes the species a particularly effective transmitter of dengue, a disease that can be deadly. Whilst dengue cannot be transmitted directly from human to human, it can be spread from an infected person to an uninfected mosquito via bites, further strengthening the cycle of transmission. Characteristic of its name, infection with the dengue virus causes a sudden high fever. Other common symptoms are a rash and pain in the joints, muscles and head, referred to together as the ´Dengue Triad.´ Fortunately, in most cases dengue symptoms are mild and recovery is uncomplicated and automatic. However, in severe cases the initial symptoms can quickly progress to hemorrhagic fever or dengue shock syndrome, both of which can be fatal. Dengue is endemic in at least 100 countries, and has the potential to spread in any region where the Stegomyia aegypti mosquito can successfully live and reproduce. The Stegomyia aegypti mosquito lives at latitudes of 35° north and south of the equator, and for this reason dengue hot spots are clustered in regions close to the equator. Africa, South America, India and South East Asia have all reported increased levels of dengue in recent years, making the threat a very global problem. Dengue is of particular concern to South East Asia, where 75% of the total population exposed to dengue lives. In Malaysia, one of the worst effected countries, there were already 35,701 dengue cases reported for 2015 by 11th April. This is a hugely worrying 36% increase from the same period only last year. Yet dengue is not a new disease, so why is it spreading now more than ever before? The significant increase in dengue transmission rates has been heavily attributed to an increase in urbanization. The female Stegomyia aegypti mosquito lays her eggs in water, and requires a mere tablespoon in volume

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Tropical Medicine Dengue

Dengue Fever is endemic in at least 100 countries and has the potential to spread to all regions worldwide.

FOGGING

An insecticide harmless to humans, so-called Mosquito ‚Fogging‘ is used to kill every adult mosquito which could possibly be carrying the Dengue virus.

istockphoto.com © ertyo5

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Tropical Medicine Dengue

for a successful breeding site. Thus, the huge number of urban development sites in dengue affected regions, provide the perfect environment for stagnant water to collect. This has contributed to an increase in potential breeding grounds, where sudden downpours triggered by the humid climate, create artificial water holes. In Malaysia, the highest levels of dengue cases have been reported in the suburbs of Kuala Lumpur and densely populated state of Selangor, where construction sites, with often lax control methods, are plentiful. Furthermore, increased globalisation has also enabled dengue to enter new countries, whereby travelers unknowingly bring the disease (in the form of mosquitoes) home with them. If the new environment is home to the Stegomyia aegypti mosquito and a suitable climate, then the cycle of transmission can successfully continue. One of the largest problems associated with dengue is the lack of effective medication or any routine vaccination against the tropical disease. Instead, the only adequate prevention is to avoid becoming bitten in the first place. Once infected, treatment methods are limited, and focus on maintaining a proper fluid balance. A cost effective vaccine against dengue is the long term goal, and would be a huge advantage to countries attempting to control the disease. However, with the latest result from a stage III trial in South America, estimating the overall effectiveness of the most developed vaccine to be only 60.8% , it is not yet known when a suitable vaccine will be commercially available. With no available vaccine, the fast and effective diagnosis of new dengue cases is even more vital. Active diagnosis can decrease mortality and reduce the risk of further transmission, by pinpointing those areas where dengue cases are increasing most rapidly. RT-PCR (reverse-transcription polymerase chain reaction) is the gold standard for dengue diagnosis, with very

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high sensitivity and a fully automated procedure. In addition, in vitro diagnostic rapid tests are an increasingly favorable method of detecting dengue quickly, especially in more remote locations without fast access to laboratory services. Both antibody and antigen based tests are available, and more recently combo tests have combined the benefits of both. Antibody tests detect both IgM and IgG antibodies, enabling the differentiation between the immediate and late immune responses, and antigen tests detect the NS1 antigen, a useful direct biological marker for all dengue serotypes. A reported shift in dengue serotype dominance has also been seen to have contributed to increased transmission rates particularly across South East Asia. There are five recorded dengue serotypes (the fifth only discovered in 2013) and unfor-

Tropical Medicine Dengue

The considerable

increase in Dengue infections in the past few years is largely related to

urbanisation.

Circulation area Dengue tunately exposure to one strain does not reduce vulnerable to other strains over a long period of time. Whilst previous infection with dengue does give long term immunity to that specific serotype, only very short term immunity is gained to the four other strains. With dengue serotypes regularly shifting in dominance, its biological make up aids increased transmission rates, where reinfection with a secondary serotype, also increases the risk of complications significantly. As an attempt to control the further spread of dengue, the World Health Organisation launched its Global Strategy for Dengue Prevention and Control in 2012. Prevention and control of dengue is now seen as a priority across all those regions it affects and state and regional eradication programmes are numerous. In Malaysia, the enforcement of the 1975 Disease

Bearing Insects Act allows the inspection of premises for Stegomyia aegypti breeding, whereby fines are issued to those found to be guilty of failing to follow prevention orders. The Malaysian government is also involved heavily in vector control, and deploys control agents to deal with dengue transmission in urban areas. In Singapore, the National Environment Agency is also hard at work to educate the population regarding dengue prevention as a way of collectively overcoming the threat. An interactive map on their website even highlights current dengue cluster locations, categorized into alert levels, with different preventative recommendations for each category of risk.

FS, CG

istockphoto.com ÂŠ iconeer

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Gynaecology Ovulation

From fertility to a positive pregnancy test! What is behind the old wives‘ tales and how does it really occur? At a certain age, many women question whether they will or won’t want to have children at some point in their life. If your partner feels the same and wants one or even several children, then it is time to get things underway. According to statistics, it takes about four months for the average woman to become pregnant, assuming that both partners are healthy. If this period comes and goes without any sign of pregnancy, there is still no reason to panic, for experts say it can take up to one year for conception to occur. What about when, despite best efforts, it still doesn’t happen? Women often speak with their friends or meet fellow suffers in forums. Here one hears many theories and proverbs, which are deeply unsettling and can cloud the actual truth. Old wives‘ tales about pregnancy and conception In the preparation phase of conception, one encounters many myths and old wives tales – such as the belief that having sex with your legs high in the air can increase the chances of pregnancy or influence the gender of the child. The theory behind this is that, if the woman has her legs high in the air, the sperm has an easier journey to the egg. Scientifically, as so often, there is little truth behind this.

Can a pregnancy really be planned? Although research is currently beeing done in the field of conception, no one can really say for sure if a pregnancy will occur or not. Often there are no reasons for the lack of a pregnancy, and sometimes it just works, although there are several medical reasons why conception may not occur. Since one cannot say whether it will or won’t happen, you may as well leave no stone unturned, get informed and gather information on different ways to increase the likelihood of fertilization. Of course the first step is quite clear, to discontinue utilizing preventative methods. A once common belief was that hormonal contraceptives (also known as “the pill”) disrupted the female cycle, so that ovulation and thus fertilization was no longer possible. We now know that this is not true. Once the hormonal contraceptive is discontinued, a woman can immediately ovulate, and is thus fertile, depending on the time of her cycle. Which other facts can also be scientifically proven and how does it all work? A couple of key dates in a woman’s cycle Most women experience a 28-day cycle. This begins on the first day of their period, and ends on the day preceding their next bleed. True: Where the monthly bleed begins on the 1st of the month and the next on the 29th of the month, the 28th marks the end of the cycle. So far so good, but now what about ovulation? There is no simple answer to this – it is different for each woman. A rough estimate puts ovulation occurring between the 12th and 14th day of a woman’s cycle. Many women claim to be able to tell when they are ovulating and describe the feeling as similar to cramps experienced during their period. As the lining of the womb builds up prior to ovulation and

Tick

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Gynaecology Ovulation

Luteinizing Hormone in IU/L 100 90

Ovulation fertile phase t

80 70 60 50 40 30 20

Cycle Days

10 0

2 3 4 5 6

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

Beginning of menstrual cycle

Beginning of the next cycle

is at its most at the onset of ovulation, many women notice increased vaginal discharge at this time. Some women, on the other hand, experience no change around this time and rely on alternative aids to find out whether they are ovulating.

lation by 0.3°C to 0.8°C. It is best to measure the temperature every day at the same time (for example every morning after waking up). Both methods are used, to detect the probability of ovulation.

What happens during ovulation?

An ovulation test suggests when ovulation is imminent (within the next 12-36 hours). Here, the woman is fertile, yet the lifespan of the sperm in the uterus is up to 5 days! It is therefore necessary to know this cycle too.

Medically speaking, ovulation is considered to be the expulsion of the unfertilized egg from the ovary. Ovulation is preceded by an increase in luteinizing hormone (LH-hormone). Approximately 12-36 hours before ovulation, the LH concentration peaks and thus signals ovulation. Following ovulation, the egg remains viable for fertilization for around 6-24 hours. By determining the LH concentration, the fertile phase is measurable and is a useful aid in determining the day of ovulation. How to recognize ovulation? On all visual ovulation tests, two lines will appear - the control line (which must always be visible) and the test line. Only a test line with the same or stronger colour intensity as the control line indicates imminent ovulation.

Let´s take a case study: The cycle is 30 days (Day 1 = first day of the period and the last day before the next menstrual period) – so ovulation will take place on around day 17 of the cycle. The fertile phase thus begins already a few days earlier and ends 1 day after ovulation. However, we should not ignore the fact that it is also very much a mental thing! Women feel better when they follow the golden rule of relaxation, which suggests that a woman remaining relaxed can lead to a positive end result. We wish you the best of luck in your pregnancy-focused endeavours.

Another indication is the so-called „basal temperature“, meaning your body temperature. This increases just before ovu-

1 http://www.spektrum.de/lexikon/biologie-kompakt/eisprung/3464

istockphoto.com © pictafolio

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nvm inside Prize Draw

Join in &

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We congratulate O. Schwabauer and we ar glad to announce that this time 15 of our readers will be able to win a prize. In this issue we will be awarding the participants with 15 USB fans to make the summer temperatures bearable.

the sexiest What‘s the name of alive? medical superhero

Good luck!

Your Inside Diagnostics team

a) Medicus b) Medical Man rd c) Dr. Derek Shephe

15x 15 USB ventilators! ✓ retractable stand ✓ On/Off rotary control to set wind intensity ✓ Dual Power (USB-cable or battery)

Participate under the following link

http://www.nal-vonminden.com/ gewinnspiel.html or send an Email to

gewinnspiel@nal-vonminden.com Closing date is 11.09.2015

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nvm inside Prize Draw

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Signature Conditions of Participation 1. The Promoter is nal von minden GmbH. 2. To enter simply fill in your details on the form here above and fax it to +49 941 290 10-50 or send it by post to: nal von minden GmbH, Christopher Beiderbeck, Friedenstrasse 32, 93053 Regensburg, Germany. Participation is also possible by email; please send an email with your answer and your complete address with the subject line as “Prize Draw” to gewinnspiel@nal-vonminden.com. You also can participate online: http://goo.gl/QruV82. The winner will be chosen at random and be drawn from those who have entered the correct answer. 3. This prize draw is open to European residents aged 18 years or over, with the exception of employees of the Promoter, their families, agents and anyone else connected with this promotion. Only one entry per person. No entrant may win more than one prize. 4. No purchase necessary to enter the prize draw and the participation is free. By entering the prize draw each entrant agrees to be bound by these terms and conditions. Entries must be received by the 11th September 2015. 5. The winner will be notified via email or post and will receive the prize by post. 6. Prizes are subject to availability. In the event of unforeseen circumstances, the Promoter reserves the right (a) to substitute alternative prizes of equivalent or greater value and (b) in exceptional circumstances to amend or foreclose the promotion without notice. No correspondence will be entered into. 7. The prize is one of 15 USB ventilators. No cash or prize alternatives will be offered. The winner‘s entitlement to the prize is not transferable. 8. The Promoter shall not be responsible for damages, losses or liabilities of any kind, including without limitation, direct, indirect or consequential loss or damages arising out of or in relation to the prize draw. 9. Any liability for damages of nal von minden GmbH and their officers, employees and agents in connection with the competition, irrespective of the legal reason, is, as far as legally permissible, limited to cases of intent or gross negligence. 10. The promoter’s decision in respect of all matters to do with the competition will be final and no correspondence will be entered into. Legal recourse is excluded. Data protection 1. Being a responsible entity as defined by the German Federal Data Protection Act, nal von minden GmbH collects, processes, and uses personal data (first name and last name, date of birth, street address, postal code, place, country, and email address) disclosed to nal von minden GmbH in connection with the Prize Draw only in compliance with the applicable laws and regulations referring to data protection. nal von minden GmbH will not disclose your personal data to any third party. Your personal data will be collected, processed and used exclusively for the purpose of carrying out the Prize Draw. The promoter is allowed to send future issues of the “Inside Diagnostics” by e-mail. Unsubscribe at any time by sending an informal e-mail to gewinnspiel@nal-vonminden.com 2. You are entitled by law to request free information about the personal data nal von minden has stored in relation to your person, and to request that nal von minden GmbH corrects, blocks or deletes these personal data. Please contact nal von minden GmbH if you want to claim any of these rights referred to above. 3. If you request that your personal data be deleted before the Prize Draw is completed, your entry into the Prize Draw is deemed to be terminated as well. In that case, you are no longer eligible for a prize.

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Society THC

Marijuana

Globalegalisation? The recent full legalization of cannabis in the State of Colorado in the US has once again raised the debate about the issue in Europe. Despite similar but softer European examples, legalization is still an open debate and has opposing extremes in Europe. This article doesn’t pretend to give a “yes, we should legalize” or “no, we shouldn’t” answer but rather tries to present the facts. What is the law? What is medical marijuana? What impact could legalization have?

Nowadays, the biggest issue with the use of recreational marijuana is actually the constantly growing THC potency in recent years. The European Monitoring Center for Drugs and Drug Addiction (EMCDDA) reports a maximum average potency of 13% of THC. This number is put in context when we know that in the early 70’s the average potency was about 2% . The cannabis of today is about 6 times stronger than what earlier generations were smoking!

Medical use vs. recreational use of Marijuana

Different levels of cannabis acceptance in the law

In order to completely and fully define the use of cannabis in this article, we need to highlight the difference between the medical use and the recreational use of cannabis.

In general, we can classify the national laws of countries regarding their acceptance of cannabis into 4 different levels:

•

Medical Marijuana

“Medical Marijuana“ refers to the use of cannabis or marijuana, including constituents of cannabis, THC and other cannabinoids, as a physician-recommended form of medicine or herbal therapy.” •

Recreational Marijuana

“A drug taken for pleasure rather than for medical reasons or because of an addiction” The biggest difference between these two types of marijuana is that the medical strains of the medical marijuana have a higher level of Cannabidiol (CBD) and less Tetrahydrocannabinol, commonly known as THC and responsible for the psychoactive effects of marijuana.

1. Marijuana is illegal: in this case, cannabis is completely prohibited. The possession, sale and growing of cannabis are all completely prohibited and punishable by law. There is a zero tolerance approach. A good example of this is in Finland. Ex. If you are arrested smoking, selling or in possession, you risk going to jail.

2. Medical Marijuana is legal: the sale and possession of Marijuana for medical use is legal but strictly controlled by the government authority in charThe ge. Germany is the example for this situation. Ex. If you are arrested smoking, selling or in surrounding the possession and not authorized by the state, you risk going to jail. consumption of

biggest problem marijuana today is the constantly-

3. Marijuana is decriminalized: here the possession and the growth (not exceeding certain amounts) are punished but will not lead to imprisonment. The misdemeanour is Cannabidiol (CBD) comparable to a parking violation. Sales and of THC CBD has many medical properties and is not a trafficking are prohibited. The examples here concentration. psychoactive substance, unlike THC. According are Luxembourg and Portugal (which even to some studies, CBD helps by reducing nausea extended the decriminalization to all drugs). and vomiting, suppressing seizure activity, combating psychoEx. If you are arrested smoking or in possession, you risk sis, inflammatory, neurodegenerative, anxiety and depressive getting a fine. If you are arrested selling Marijuana, you risk disorders as well as combating tumour and cancer cells. going to jail.

increasing levels

THC THC acts on the body using a different pathway to CBD but it does have similar properties. However, THC has an intoxicating side effect and is known to cause memory problems and paranoia for example.

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4. Marijuana is legalized: under a strict and well regulated legal framework, cannabis is legal. Possession and growth are allowed but rules have to be strictly followed. Sale is allowed with a license. Regulations and controls differ from country to country. Here, of course, the most famous European example would be the Netherlands (growth is decrimina-

Society THC

lized but not legalized) and the state of Colorado in the US. Ex. If you are arrested smoking or in possession, you are at no risk at the moment that you respect the place where you can smoke and the amount you can possess. Selling is legal with a license. Those 4 levels of acceptance are of course more theory than practice. In practice, it is really hard to classify country regulations within one of those 4 levels. It is rather a mix of levels that is applied following that we are talking about the possession, the growth or the sale. For example, the Netherlands legalized the possession and the sale but growth is decriminalized. If you grow fewer than 5 plants in a single household, you risk getting a fine. If more, you risk going to jail. The state of Colorado is a great example of our 4 levels of acceptance because of its impact in the US and even in Europe. Colorado passed through these different levels of acceptance on its way to legalization: •

Until 2001, cannabis is strictly illegal and heavy sanctions apply when found in possession of cannabis, selling or growing

•

2001: medical use of marijuana is legalized

•

2005: recreational use of marijuana is allowed

•

2012: recreational use of marijuana is legalized

Legalization: Medical Marijuana Some countries/states (e.g.: Czech Republic, Israel, California) have made legal only the medical use of cannabis, recognizing its curing properties and the benefits it gives to people suffering from spasticity, movement disorders or anorexia for ex-

ample. In those countries, reports mention no impact of the cannabis legalization on behaviours and did not increase the consumption of the drug as the regulations are very strict. Other countries are against the legalization of cannabis for medical use. In most cases, the governments disapprove of it, fearing the potential negative impacts like the widespread use of the drug in the population, a higher addiction rate that can occur in young consumers and the long term unknown side effects... In order to illustrate and understand this fear, we can simply give the example of Great Britain in the 60’s, when the country allowed doctors to prescribe heroin to some patients. Those doctors started selling heroin on the black market and then even the patients started selling heroin on the black market. Great Britain’s government had prevent it being legal for doctors to prescribe heroin quickly and take a step back with this policy. The Gateway Theory The Gateway hypothesis states that there is a causal sequence through classes of drugs, whereby the use of “less harmful” substances is a risk factor leading to the use of “harder drugs”. Alcohol, tobacco and cannabis are often classified as gateway drugs. The theory is based on the observation that the majority of cocaine and heroin users who previously consumed cannabis also previously consumed tobacco and alcohol. The fear in the context of legalization is to legalize the third and last step before consuming harder drugs like cocaine, methamphetamine or heroin. Unfortunately, the theory is not proven and can rather depend on factors like availability and attitudes toward drugs than a causal factor.

Illegal (until 2001)

Legal (from 2001)

Decriminalised (from 2005)

Legal (from 2012)

• •

•

No medical use No recreational use

istockphoto.com © Yarygin

Medical use of Marijuana

Recreational adult use of marijuana is decriminalized

Recreational adult use of marijuana is made legal

Page 13

Society THC

Legalization: Economical impact

Employment

Cannabis related crimes

One of the consequences of the previous reported points would be more investment from the governments in educational areas and job creation. Moreover, jobs would be created with the many cannabis shops (coffee shops) or dispensaries as well as all the other related jobs in security companies, construction and remodelling companies or farming jobs for example.

The 2015 report of the EMCDDA informs that cannabis related crimes are the most prevalent in the war on drugs. In Europe, no less than 63% of the drug offences are related to cannabis. If those are reduced by legalizing cannabis, the load on the whole justice system would be lightened and more time and money could be allocated to other types of crime. Prison overcrowding If 63% of the drug related crimes concern cannabis, the number of offenders in jails would considerably decrease and with it the associated costs. The EMCDDA estimated that the EU governments spend around 3,7 to 5,9 billion Euros per year on drug-related imprisonment. If we use the hypothesis that the cannabisrelated costs are about 50% of the amount, the European Union could save about 2 billion Euros a year.

Cannabis consumption

Drug related medical costs

can lead to both

Of course, all the money saved by reducing prisons prices, taxes on marijuana sales or from a lower rate of unemployment would also have to be used for the increased medical care costs that will most likely occur if legalization becomes reality. It has been proven that smoking cannabis can cause mental disorders but also physical ones like damage to the lungs or heart. If the consumption of cannabis increases with legalization, the healthcare costs could rise along with them. Moreover, money would also have to be injected into drug prevention and education so that young people are made aware of drugs and the risks associated with consumption.

psychological as well as physical issues, such as damage to the lungs and heart.

From black market to more fiscal revenue In the Netherlands, â&#x20AC;&#x153;statistics reveal that the retail turnover of the marijuana business is around 2 billion Euros a year, which brings more or less 400 million Euros a year in taxes to the Government.â&#x20AC;? The same rule applied to our Colorado example shows an increase of 63 million dollars in taxes after the first year of legalization.

Conclusion In these lines, you have read the most important points in this debate and you hopefully now have a better idea of what is at stake. However, to come to any decision more information from the current examples (Netherlands, Portugal, Colorado...) must be gathered. The most important information source would probably come from experts facing the issue on a daily basis, who are able to forecast the potential damages and/or benefits of legalization. They are the only people able to give a true testimony based on experience rather than numbers â&#x20AC;&#x201C; and in the end every decision will have advantages and disadvantages.

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Toxicology Pregabalin

Pregabalin

An Insider’s Guide to Pregabalin Pregabalin can be an effective and legitimate treatment for numerous conditions, ranging from pain relief to seizures and general anxiety disorders. It is also, however, a highly-tradable commodity amongst prisoners and those seeking relief from opiate withdrawal symptoms. Its widespread circulation in UK prisons in particular is becoming increasingly problematic for healthcare professionals working with prisoners, as well as in the wider community. Application areas Despite being primarily used for the treatment of neuropathic pain, the effectiveness of pregabalin in treating anxiety has lead to its prescription for prison inmates, amongst whom anxiety levels tend to be high. Statistics show that almost 3% of the UK’s prison population is prescribed either pregabalin or its analog, gabapentin – double the level of prescriptions of in the wider community (Nigel Barnes, Birmingham & Solihull MHFT, 2013). A 2013 audit of 94 UK prisons found that only 8 were not prescribing pregabalin to any inmates (Denise Farmer, 2013).

this year). In such cases the inmate tests negative and, even if the urine is sent into the lab for further analysis, results can still come back negative if pregabalin is not explicitly screened for (pregabalin is usually not included in the standard screening panel), or if the lab only used their laboratory-based immunological screening method. Dangers and risks However, the grave danger involved in pregabalin misuse is becoming increasingly apparent. Though pregabalin is not considered an addictive drug, discontinuing use abruptly can cause increased anxiety, as well as insomnia, nausea, pain and sweating (FRANK website) – unwelcome symptoms for those prescribed pregabalin and subsequently deprived of it in exchange of money, or as a result of bullying in prison. When used in conjunction with other drugs, the effects of pregabalin can be devastating, amplifying the side effects of other drugs and increasing the chance of overdose. In the period between 2008 and 2013, the mention of pregabalin on death certificates in the UK jumped from zero to 33 (Office for National Statistics (ONS), 2014). In a setting where 56% of prisoners being prescribed the drug have a history of substance abuse, this figure serves to highlight the severity of the problem (Denise Farmer, 2013).

Combined

How to proceed with the test?

with other drugs, the side effects of

pregabalin

Whilst the high level of pregabalin prescriptions within prisons is a problem in itself, it is worsened by the increase in its use by inmates who have come to possess pregabalin through illicit trade or bullying. Due to its side effects, which can include euphoria and increased feelings of calm, pregabalin is becoming increasingly sought after amongst prisoners, especially heroin addicts and those with a history of substance misuse otherwise unable to find a high. Testing for pregabalin is possible through the testing of patients’ urine samples, in which it remains detectable for 3- 5 days after intake. From an analytical point of view, the detection of pregabalin in urine is no problem with laboratory based chromatographic methods such as GC/MS. However, most prisons use immunological rapid tests as a first screening method, though these cannot pick up this analyte (a rapid test is currently under development and will be launched

are awful.

In an attempt to tackle the issue, healthcare professionals are looking to scale down on the prescription of pregabalin, as well as ensure that prisoners are supervised when taking the drug. GPs are also being advised to hesitate in their prescription of pregabalin to those who have recently been discharged from prison, in order to avoid ex-convicts bringing the problem into the wider community. NHS guidelines now warn GPs of the potential for pregabalin misuse and trade, drawing attention to the drug’s street value of as little as £1 per pill, in contrast with the cost to the UK health system of approximately £1.4 million per year.

Page 15

Toxicology European Drug Report

New psychoactive substances are on the rise again

Cannabis and Cocaine, however, remain the most consumed drugs, according to results from the European Drug Report 2015 In June of this year the latest European Drug Report from the EMCDDA (European Observatory for Drugs and Drug Addiction) was published. The EMCCDA aims to paint the most accurate picture possible of the current drug situation in Europe, as well as aiming to offer resulting political strategies in Europe. Results from 30 countries were included during the creation of the report, which are collected in the national focal points of the Reitox network in EU member states plus Turkey and Norway, together with the European Commission. Through this the importance of the global factors surrounding drug supply are made ever clearer. “Europe as a drug market” It continues to be made clear though the Drug Report that, in a global context, Europe is an important drugs market and is furthermore a stopping point for certain drug precursors which are promoted in various countries. The majority of imported drugs come from Latin America, West Asia and North

1.25 million drug seizures Other offences Other drug supplies Cannabis supply

Consumption* of other drugs

* “Consume“ encompasses offences within the context of consumption and possession for personal use.

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Cannabis consumption*

Africa. Leading on from this, Europe is the main producing region for Cannabis and synthetic drugs, meaning Cannabis is more often than not produced for the local market. “Cannabis and cocaine are still the highest consumed drugs” Cannabis still plays the central role amongst European Drug Consumption. 23% of all Europeans between the ages of 15 and 64 claim to have tried the drug at least once in their lifetime, and nearly 1% claim to consume Cannabis on a daily basis. Most drug offences also involve Cannabis, with a figure of 80% making it the most frequently-seized drug. The production and possession of Cannabis is increasingly involved in organised crime. It has also been noted that the active ingredient in the Cannabis on offer is constantly rising, partly due to technical innovation, and partly because of the competitive nature of the drug market. Known in Europe as the ‘weekend’ or ‘holiday’ drug, cocaine is the second most consumed drug. 4.6% of Europeans claim to have taken the drug at least once in their lifetime. On the contrary, the demand for heroine and other opiates seems to be declining. There are fewer first-time users, and many addicts are making use of therapy options on offer. In 2013, 175,000 Heroin addicts checked into rehab. Due to Heroin addiction treatments, health and social costs are on the rise in Europe, predominantly caused by ever older addicts and also lifelong alcohol and tobacco consumption. This is a big challenge for health authorities. A big increase in purity levels is also apparent amongst heroin. Technical innovation and an increased level of the active ingredient is also occurring in the case of MDMA. The increased spread of high purity MDMA in powder and tablet form seems to be caused by the competition within the market, in order to make this form of MDMA more attractive to the consumer. The amount of seized amphetamines has similarly increased, of which only 1/6th of seizures are methamphetamines. The average purity grade of Methamphetamines tend however to be higher than that of amphetamine samples, among which the average purity levels are still relatively low.

Toxicology European Drug Report

Der Europäische Drogenbericht

Number of Seizures 50.000

37.500

established drugs has greatly contributed to the rapid development of new substances. It remains to be seen how the increasing purity grade of the ‘old’ drugs affects the consumption of ‘new’ drugs, and whether the demand for them will decrease. Conversely, it is also conceivable that the increasing supply of new drugs will increase the competition, and that the quality of established substances will therefore also have to increase in order to keep up with the competition.

25.000

12.500

0 2005

2007 EU, Turkey and Norway

2009

2011

2013

“New psychoactive substances gain importance” With on average 2 new drugs appearing on the market ever week, the choice of drugs on offer is increasing rapidly. In 2014 alone, 101 new psychoactive substances were identified, 6 new drugs were given consumption risk ratings and 450 substances are now known. The consumption is still at a relatively low level when compared to established drugs. The harmful side effects which are triggered by the consumption of these stimulants are still difficult to foresee, but the market is continuing to increase.

Über die EMCDDA

Trends und Entwicklun

Die Europäische Beobachtun gsstelle für Drogen und Drogensucht (EMCDDA) ist die zentrale Informationsquelle und anerkannte Autorität für Fragen der Drogenproblematik in Europa. Seit mehr als 20 Jahren ist sie mit der Sammlung, Auswertung und Weiterverbreitung wissenscha ftlich fundierter Informationen zu Drogen und Drogensucht und deren Folgen befasst und vermittelt ihren Adressatenkreisen ein evidenzbasiertes Bild des Drogenphänomens auf europäischer Ebene.

Europäischer Drogenbericht

Trends und Entwicklung en

gen

Die Veröffentlichungen der EMCDDA sind eine hervorragende Informations quelle für unterschiedlichste Adressateng ruppen wie politische Entscheidungsträger und deren Berater, Fachleute und Wissenschaftler aus dem Bereich der Drogenforsc hung sowie für die Medien und die Öffentlichkeit insgesamt. Die EMCDDA hat ihren Sitz in Lissabon und nimmt ihre Aufgaben als eine der dezentralen Agenturen der Europäischen Union wahr.

doi:10.2810/91743

2015 KS

Source: European Drug Report 2015 of EMCDDA, Trends and Developments

Page 17

ISSN 2314-9051

ERICHT 2015

The consumption of these new substances is also spread across very different societal groups, among which include school children, students and party-goers, but also prisoners and needle users. The reasons for taking them are varied and include factors such as legal status, availability, cost, purity levels or a preference for particular pharmaceutical qualities. It is presumed that in the last few years the low availability of

Über diesen Bericht

Der Bericht „Trends und Entwicklungen“ bietet auf höchster Ebene einen Überblick über das Drogenphänomen in Europa und geht dabei besonders auf das Drogenangebot, den Drogenkonsum, Probleme im Bereich der öffentlichen Gesundheit sowie auf drogenpolitische Strategien und Maßnahmen ein. Zusammen mit dem online verfügbaren Statistical Bulletin, den Länderübers ichten (Country Overviews) und den Drogenpersp ektiven (Perspectives on Drugs) bildet er das Informations paket „Europäischer Drogenbericht 2015“.

EUROPÄISCHER DROGENB

The understanding on these new psychoactive substances still rests on their consumption, and these rapid new developments make the detection and seizure of such products difficult.

TD-AT-15-001-DE-N

Also contributing to this is the rapid development of the ‘virtual drugs market’. Through the use of the internet, not only is the dealing of drugs easier, but the development of new substances is promoted though the passing on of research data, all of which offers a forum for potential customers.

• The European Drug Report is published every year and gives an overview of the current drug situation and the resulting political measures and strategies. • The EMCDDA (European Observatory for Drugs and Drug Addiction) published the first Drug Report 20 years ago and uses data from more than 30 countries covering observatory systems. • Among the European partners are national experts, the European Commission, Europol, the European Pharmaceutical Agency and the European Centre for the prevention and control of diseases. • In addition, the EMCDDA uses the contributions of various European research groups and initiatives.

Infectiology Rotavirus

Rotavirus

One of the most common causes of gastrointestinal diseases Amongst children and older people, rotaviruses are one of the most common causes of gastroenteritis. We want to inform your understanding of these viruses and explain why it is important to distinguish these viruses from others. Some facts worth knowing about rotavirus Rotavirus is a leading cause of gastrointestinal disease in children and the elderly. The viruses are highly contagious and there is no available vaccine against them. Young children are at risk because the immune system takes time to develop protection against the virus. The elderly (people over 60 years of age) are at risk because this immunity also weakens with age. This makes babies, toddlers, and the elderly especially vulnerable to this type of gastrointestinal disease.

Diagnostics options The maximum viral load of rotavirus is present between the third and fifth day after initial contamination with the virus. As is common with gastroenteritis diagnosis, a stool sample is taken from the affected person. Rotaviruses are diagnosed through the direct detection of pathogens. In most cases, the stool samples are analyzed in the laboratory by EIA (enzyme immunoassay)/ ELISA or agglutination. Direct detection by electron microscopy is possible due to the distinctive morphology of the virus, but is rarely performed due to the high costs involved.

The biggest

problems

associated with

Gastroenteritis caused by a rotavirus infection usually disappears by itself after 2 to 6 days and recurrent infections can be counteracted through proper hygiene. Unfortunately, there is no special medicine that can be administered as antibiotics generally do not help with viral diseases. Regular diarrhea medicine can even be a hindrance because it can lengthen the course of the disease.

Rotavirus infections are dehydration as well as salt loss.

The biggest problems with rotavirus infections are dehydration and salt loss, which can be compensated by electrolyte replacement solutions as well as the intake of plenty of fluids. For this treatment to be best monitored, it is vital that the virus is distinguished from other causes through a specific diagnosis. This avoids the prescription of unnecessary antibiotics, and isolates the virus to prevent further contamination. To avoid unnecessary measures, a clear and early diagnosis is helpful.

Currently, the RT-PCR (reverse transcription polymerase chain reaction) is the gold standard method for the detection of rotavirus. However, since this method is very expensive and offers added value in only a few cases, PCR is applied for specific cases only.

The quickest way to examine stool samples for rotavirus is a rapid test. Similarly to EIA / ELISA, this method uses specific antibodies to detect qualitatively whether the virus is present in the stool sample or not. The test takes only ten minutes to provide a result. After adding the sample (stool diluted in buffer) to the sample pad of the rapid test, colour labeled antibodies bind specifically to the virus, if it is present in the sample. The virus-antibody complex migrates along the membrane via capillary action, and is trapped at the test region with the aid of another specific antibody against rotavirus. A red test result line appears next to the T-line in the case of the virus being present in the sample. If the stool sample does not contain rotavirus, the colour-labeled antibodies cannot adhere to the test region and no red T-line will appear.

AKr

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Sources: http://www.labor-limbach.de/Rota-Virus.144.0.html http://dgk.de/gesundheit/impfen-infektionskrankheiten/krankheiten-von-a-bis-z/rotavirus-erkrankungen/diagnostik.html MPI of article 481017

Outside Diagnostics

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The adventures of Medical Man California dreaming After all the exciting adventures, Medical Man treats himself to a nice relaxing holiday under the Californian sun.

Until… Ey bro! Throw me over a plastic bag! Let‘s have a smoke!

Infuriated, Medical man goes to have a word with The two are unfased. the pair. Yeah right! This stuff is only

Hey, chill out man. This sh*t is legal in California. If you want, you can have a drag, bro. There‘s enough to go around.

Shortly after… Uffffff! Thanks, Bro! That is really nice of you. Now we will be able to get this stuff more easily!

legal here for medical purposes.

Come on, man. Why so antsy? Come sit with us an enjoy a spliff. You might need it with your stress levels.

Hmpf! Grumble! No peace, even on holiday!

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Waaait a minute! What the..!?

Ahhh!!!!! Finally a holiday!

Tell me, are you crazy!? You can‘t smoke weed outside?!

Medical Man is shocked at this outrageous behaviour!