From Ketamine to Fentanyl, the first department in Italy that 'disarms' new drugs opens

Patients will be recruited directly from the Emergency Room and Intensive Care Unit. Serious patients, therefore, who have taken substances, often more than one. We are talking about drugs that are unknown, that are defined as "new" because they arrive on the market via the web, commonly under the radar, camouflaged behind other products, even edible ones. For the first time, patients will be taken care of by a new department, which will treat them, examine them from a clinical and psychological point of view, and will make the collected tests the starting point of the new era of interventions against narcotics. The department, the first in Italy, was inaugurated at the Irccs Maugeri in Pavia, and is the realization of the ESOD project (Specialized hospital teams for addictions), closely linked to the Poison Control and Toxicology Center, which is located in the same institute, and whose mind is Dr. Carlo Locatelli , director of the facility for 33 years.

The new drugs department

The department that admits patients with new drugs currently has four beds and 25 employees, including 12 doctors, 6 nurses, as well as pharmacists, chemists and biologists, who will be responsible for analyzing the substances found in patients. For the ribbon cutting, which took place on June 30, there were, in addition to Locatelli, Guido Bertolaso , Councilor for Welfare of the Lombardy Region; Lorella Cecconami , General Director of Ats Pavia; Giancarlo Iannello , Social Health Director of Asst Pavia and Luca Damiani , Executive President of Maugeri. They all agreed in defining the project "a priority", "an example, which responds to the objective of protecting young people". "A project that starts in Pavia - said Bertolaso ​​-, but that sets an example because we will also take it to other areas of Lombardy, such as Milan and Brianza". For this first step, the Lombardy Region has allocated 6 million euros.

Care becomes multidisciplinary

Multidisciplinarity is the characteristic of this new hospital division. Locatelli explains what this means: “Once the patients have been taken from the Emergency Room and Intensive Care Unit, we will immediately evaluate, through a precise protocol, their state of health altered by the intake of unknown substances (therefore not cocaine, heroin, cannabis and alcohol, for which the point of reference remains the Sert, or the Drug Addiction Service). And we will do it through the contextual intervention of various specialists”.

"The patients will undergo a visit and functional MRI - continues Locatelli -. Immediately after that, the investigations will begin: several samples for the evaluation of early markers that will tell us what is being damaged in the cells of their brain. Once this is verified, we will begin the treatment and follow the patients in everything that is necessary to convince them to stop taking drugs".

Thousands of narcotics in circulation

What new drugs are we referring to? There are 1,050 of them and they manage to 'trap' 47% of young people aged 16 to 24, 50% of adults aged 30 to 65, as well as 3% of children and teenagers aged 10 to 15.

"These substances are defined as psychoactive because they act on the brain, as well as on other parts of the body - explains Locatelli -. There are 20,000 consultations, on the same number of patients, requested from our poison control center since 2010 for problems related to new psychoactive substances. We have analyzed 1,700 of them: this is the largest case study in Europe".

What are we talking about? "We often find a resurgence of substances that we have already seen, but that are part of the family of new drugs - explains Locatelli -. The trend of consumption is high for contemporary narcotics because they are low cost, also easily available and tested, with a market equivalent, if not superior to that of cocaine".

The ranking of super-drugs

Of the new substances that have arrived on the high market, the most used are five, and they are essentially part of chemical "families". "The first group is that of ketamines and derivatives - Locatelli lists -. Next are synthetic cannabinoids, for example Fubinaca, Apinaca, which can be smoked, snorted and drunk. Some, particularly powerful, are offered in the form of stamps to suck. They are widely used in prisons. In third place are synthetic cathinones, known as bath salts, which are synthetic drugs belonging to the large group of so-called designer drugs, for example Mephedrone, Mdpv. The fourth position is occupied by methamphetamines (they are dosed like amphetamines, the best known are Shaboo and Yaba), often taken, like sympamine, by students to perform better. Finally there is Exstasi (methylenedioxymethamphetamine), which is still widely used among young people". It is taken by 35% of people who use narcotic substances. Then there is muscimol, a chemical compound naturally contained in some mushrooms that is 'sold' in chocolate and sweets easily found on the web. And Fentanyl? "This is also a serious danger that we want to avoid - concludes Locatelli -. Our goal is to prevent the disaster that occurred in the USA".

In the footsteps of clinical toxicology

Given that clinical toxicology in Italy was born in Pavia, with the opening in 1967 of the first School of Specialization in Toxicology and with the establishment of the Italian Society of Toxicology, the Poison Control Center of Maugeri Pavia has established itself over time as a national point of reference also in the field of drugs for the Presidency of the Council of Ministers - Department of Anti-Drug Policies and at the service of all the hospitals in our country. For this reason it was chosen to manage the first national pilot project by Bertolaso.

Who underlined: "Intervening on young people is an absolute priority of the Welfare of the Lombardy Region -. The inauguration of the first ESOD is an important step to manage a problem of a society that is aging and must dedicate itself to the protection of young people who live in this country. We start with the implementation of a far-sighted regional law on the management of addictions and we realize a transversal project on the territory, with all the subjects involved in the health sector: institutions, universities, private entities with agreements".

The Addiction Team

“The activation of the first specialized hospital team for addictions represents a significant step in the experimental project promoted by the Lombardy Region for the development of innovative models for the care of young people with addictions to new psychoactive substances – said Cecconami -. The experiment, entrusted to ATS of Pavia and supported with a regional allocation of 675 thousand euros, allows us to systematize specialized skills and integrated pathways between hospital and territory, thus strengthening the capacity of the health system to respond to emerging clinical needs. Intercepting complex situations early, building effective therapeutic pathways and promoting recovery are priority objectives. The project we are launching today goes precisely in this direction, with the ambition of contributing to a concrete evolution of treatment pathways”.

While Iannello highlighted: "The new psychoactive substances represent a significant problem, especially for territorial penetration, whose market travels protected in the dark web and reaches every small center anonymously, in unsuspected forms. Users seek multiple effects from their intake that break the normal perceptive and behavioral patterns". "For these premises - concluded Iannello - Asst represents, through the collaboration between psychopathologists and addiction doctors, an added value for ESOD".