Commentary Article - (2022) Volume 8, Issue 12
Received: 30-Nov-2022, Manuscript No. ipjda-22-15244; Editor assigned: 02-Dec-2022, Pre QC No. ipjda-22-15244 (PQ); Reviewed: 16-Dec-2022, QC No. ipjda-22-15244; Revised: 21-Dec-2022, Manuscript No. ipjda-22-15244 (R); Published: 28-Dec-2022, DOI: 10.36648/2471-853X.22.8.134
Aim: Explanation and exploration of the illicit drug use situation in Athens, Greece.
Design: Short Report.
Setting: The financial crisis in Greece lead to a new drug, called “Sisa” rising as the main drug abuse in those affected the by the economic hardships of the time. This drug causes serious medical, psychological and economic effects.
Intervention: Investigation into the drug effects in the homeless population in Athens, Greece whilst working there with Medical Volunteers International e.V.
Findings: This synthetic drug, made from crystal methamphetamine mixed with battery acid, engine oil, shampoo, salt or other additives, leads serious physical and psychological effects that are difficult to manage in a population that is largely living on the streets and outside the safety of the healthcare system, meaning they persist and deteriorate. There is a risk that use of this cheap street drug will spread from Greece, given its use in the immigrant population, and given the economic downturn currently felt throughout Europe.
Conclusion: Tackling this problem will require investigation into its scale, as well as a multi-faceted management approach undertaken by European drug addiction monitoring organizations.
It is at times of austerity and intense social strife that new drugs of abuse are formed and their use spread. At the time of peak financial crisis (2010) the new drug ‘Sisa’ appeared amongst the drug abusing community in Greece. In the homeless community in central Athens this drug has become the favored choice due to its cheap price, however the devastating effects both physically, mentally, and socially are far reaching [1].
‘Sisa’ is a synthetic drug made of crystal methamphetamine (meth) cut with additives primarily battery acid, but also engine oil, shampoo, and salt [1]. Its name derives from the Farsi word for glass pipe: ‘Shisha’ which are normally used in the practice of smoking flavored tobacco, a common practice in many Middle Eastern countries [2]. However, in this case the utilization of glass pipes (often made from discarded glass light bulbs) is for the melting down and inhalation of the drug ‘Sisa’ [3].
This dangerous mixing of synthetic drugs with dangerous substrates has been seen as part of a global trend, as a bid for cheapness and potency. Other examples include the skin ulcerating opiate based “krokodil” in Siberia, the anti-retroviral highs seen in South Africa, as well as bath-salt use in America and the UK [3].
The effects of the drug are like cocaine but longer lasting and the side effects are worse including insomnia, delusions, anorexia, palpitations, heart attacks and anxious/aggressive behavior [4]. The allure to this drug is its cost, at only one to two euros per hit, it is attractive to the poor and homeless affected by austerity and seeking a temporary escape from grim realities.
The effects of this drug have been seen by homelessness charities and NGO’s alike working with the homeless and refugees in Athens. What has been seen are both the usual wounds associated with drug use: Injection site infections, ulcers, track marks and soft tissue infections, as well as the effects related to the main ingredient being methamphetamine, namely face asymmetry, lesions from skin picking (as an effect of the drug on the mental state), and drug induced cardiomyopathy that seem specific to ‘Sisa’ use and small transitory superficial wounds that appears anywhere on the body [5]. Management of these lesions is necessary to avoid secondary infection and tissue breakdown.
In the case of the other authors and I, the setting of my encounter with these lesions was whilst working with Medical Volunteers International e.V a humanitarian organization working in Athens, helping to treat primary care level problems in the refugee and homeless community [6].
Awareness of this problem is key, since there is very limited literature or data studies into ‘Sisa’ as a problem and since the drug is a cheap alternative to other drugs of abuse and having spread from Iran [5] to Greece and down other refugee routes, its use could easily spread to other locations in Europe [7].
The Effects
In a medical outreach context, the effects of the drug on addicts’ health physically, mentally and behaviourally are significant. The alterations in a meth users appearance, often dubbed “meth face”, are related to a combination of damage to the users skin from impaired healing, toxic meth exuding from the pores when sweating, secondarily infected wounds, and the damage from skin picking due to formication and dysesthesia (as a common side effect of meth). In addition, there can be significant oral disease from ulceration and the formation of dental cavities (Figure 1).
Figure 1: Pictures of ‘Sisa’ induced wounds: a) Chronically infected leg ulcer, b) Skin picking and superficial skin wounds, c) Deep ulcer over the medial malleolus. All pictures has been taken and shared with patient consent.
The physiological effects of meth are increased breathing rate, rapid/irregular heartbeat, raised blood pressure, elevated temperature, heightened alertness, and decreased appetite. The psychological effects include anxiety and confusion, insomnia, violent behaviour, and hallucinations. Such behavioural changes put addicts at risk of wound re-infection, drug related overdoses, long term addiction and contracting blood borne viruses such as HIV, Hepatitis B and Hepatitis C [8]. The immunosuppressive effect on the body can mean even quicker development of AIDS and susceptibility to opportunistic infections [9].
To tackle these effects wound care and early empirical antibiotic management is key to prevent further skin damage and infection spread. Unfortunately, there are many barriers to effective treatment, including: Discrimination against hospital admission, distrust in authority and poor compliance with treatment. This often means that wounds persist and don’t heal properly before re-infection occurs. Good dental care and close monitoring are also important, in order to prevent the deterioration of oral disease.
Ultimately awareness of the problem is key, given those suffering from often outside the safety net of national healthcare and seldom is charity care enough to counter the number affected by these problems. The healthcare system needs to be sympathetic to and aware of the severity of the situation, and the patients need to be compliance and take responsibility for their treatment, for this approach to be successful.
The Cost
Initial although it is known as Greece’s “Austerity” drug, the population addiction does not simply go away now economic conditions have improved for the country. The costs on the people affected by the drug are not just physical, for there are psychological manifestations as well as the economic implications of these. When a person doesn’t have the mental faculties to identify danger and irresponsible behavior, this can lead to the damage of a larger population with chronic conditions that put a strain on healthcare services (as with HIV, hepatitis, and repeated wound infections.)
Moreover, there is a direct effect on the psychological wellbeing of these drug addicts, which can lead to long term mental illness. In these states people are unable to work and are unable to get out of the dire situations they find themselves in.
These are all set to rise the longer the recession continues, and it has been seen that the prevalence of methamphetamine metabolites is high across Europe (in Germany and Eastern Europe, often along the routes of refugees into Europe (Figure 2). So along with the physical effects, we shall see the psychological and therefore economic implications of this drug also.
Figure 2: Relative distribution of methamphetamine metabolite as detected in European cities.
Not addressing this, even with more awareness and research into the subject (of which there is very limited knowledge [3]) could lead to undeterred spread of the drug’s use and all the negative effects that comes with it. Tackling this problem will require a multi-faceted approach, as suggested in the Greece Country Drug Report 2019 (by the European Monitoring Centre for Drugs and Drug Addiction). It suggests:
• Demand reduction by; prevention, information and awareness, early detection and intervention, harm reduction and social rehabilitation.
• Supply reduction.
• Coordination.
• Training, monitoring and research, evaluation.
• International cooperation, as the best method to approach the spread of illicit drug use [10,11].
Described Times of austerity and economic difficulties often lead to new dangerous street drugs rising in use in poor communities. Communities already seriously impacted by living costs are then driven into a spiraling damaging lifestyle by these drugs of abuse.
‘Sisa’ is a dangerous synthetic drug with damaging cardiovascular, dermatological, infectious, and psychological consequences. Spreading rapidly in Athens, with many migrants affected, the spread of refugees across Europe could lead to the spread of this drug and its devastating effects. To prevent the significant cost of the aftermath of the spread of such a drug it is important primarily to gauge the extent of the problem, investigate into how and where its use has spread, and then devise how we can tackle this problem in a thorough but compassionate programme to help those affected by it.
None.
The authors have no conflict of interest to declare.
Citation: Crilly D, Patel P, Fernandez PL (2022) â??Sisaâ??: The Spread of Cheap Methamphetamine. J Drug Abuse. 8:134.
Copyright: © 2022 Crilly D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
