Insolação e hipertermia para além do Ecstasy!

Portas da Percepção

hempadao 16 novembro, 2017

Uma das principais causas de hospitalização e óbito no consumo de ecstasy, seja em balas ou MDs, são as denominadas hipertermia, hiperpirexia e, finalmente, a insolação. Tal ocorrência pode ocorrer independente se o que há no ecstasy é ou não o famoso MDMA (3,4-metilenodioximetanfetamina), em especial no contexto de festas. A hipertermia ocorre quando a temperatura corporal ultrapassa os 38ºC[1]. Já na hiperpirexia a situação é ainda mais dramática, com a temperatura ultrapassando os 40ºC.

por Fernando Beserra

Entre as causas da hipertermia presentes no consumo de balas e MDs em festas estão a exposição a ambientes de temperatura elevada (sol na testa direto), a prática excessiva de atividade física (dança, dança, dança), a desidratação (tem gente que não bebe água!) e isso tudo acompanhado do uso de substâncias que elevam a temperatura corporal. O MDMA, por exemplo, embora eleve pouco a temperatura corporal em contexto experimental e/ou clínico, também libera vasopressina, resultando na inibição da urina e retenção de líquido.

Em estudos animais não humanos aponta-se que há mais probabilidade de ocorrência de hipertermia no uso do MDMA quando os animais estão em ambientes quentes, se comparados com animais que se mantem resfriados (HOLLAND, 2001). Então, certamente uma lição no uso de MD e balas no contexto de festa é parar de dançar por vezes e repor os fluidos perdidos, bebendo água ou bebidas isotônicas (preferencialmente). A hipertermia/hiperpirexia pode conduzir a convulsões, a falência renal, a falência hepática, a rabdomiólise, a coagulação intravascular disseminada, o edema cerebral e mesmo a morte (HOLLAND, 2001; HENRY; RELLA, 2001).

É sempre bom lembrar que o fato de alguém ter usado uma “bala boa”, não significa que uma bala de mesma estampa seja idêntica a original. Isso porque as logos que estampam as balas (prensas) podem ser compradas facilmente, inclusive pelo Mercado Livre. Uma ação de redução de riscos e danos é sempre testar a amostra, mesmo que seja semelhante a uma já testada em outra ocasião. Além, é claro, com todo o cuidado com as misturas de substâncias, que muitas vezes potencializam os riscos. Um mantra na redução de danos no uso de ecstasy é “menos é mais”. Isso deve ser pensado de forma não preconceituosa e estigmatizante. Olhar com cara feia, ridicularizar, rejeitar, achar que a sua droga é boa e a do amigo não, comportamentos tão comuns, não são atitudes amparadas, filosoficamente, pela redução de danos. Pelo contrário, são grupos de policiais como o PROERD que estimulam que as crianças e adolescentes se afastem das pessoas que usam drogas.

Em uma publicação acerca da redução de danos com Emanuel Sferios e Wooldridge (s/d), os ativistas indicam que têm denominado também de insolação muitos dos agravos que, habitualmente, são imputados ao MDMA. Além disso, Sferios (2001), fundador e diretor executivo do Dance Safe, nos coloca algumas questões interessantes. Um relatório da DEA chegou a afirmar que menos de 1% das amostras de ecstasy continham adulterantes. O Dance Safe começou a observar, com testes rigorosos, outra realidade. É bem curioso que nenhum órgão governamental hoje tenha a audácia de falar um absurdo como 1% de adulteração dos comprimidos de ecstasy. A testagem é certamente uma tecnologia, utilizada hoje também pelos usuários, embora nem sempre de forma adequada, que contribui para reduzir a desinformação, inclusive aquela que vem dos Órgãos governamentais. A maior parte dos problemas, portanto, não pode ser imputada apenas aos usuários como overdose. Muitas fatalidades ocorreram também com doses médias de MDMA, em ambientes inadequados. E, claro, tais emergências médicas podem ocorrer mesmo aquela pessoa que não utilizou nenhuma substância, mas esta exposta a um calor atroz, com líquidos caros, aos quais nem sempre tem condições de acessar adequadamente, além da ausência de espaços de descanso. Acrescentar espaços de chill out, espaços de sombra, onde as pessoas possam descansar, são estratégias fundamentais de redução de riscos e danos.

Além de toda a questão da insolação e do próprio MDMA, o mercado proibicionista aumenta os riscos, devido à falta de controle sanitário, de forma dramática. Se a hipertermia é um problema central, tal quadro não é exclusividade do MDMA e pode ocorrer – de forma ainda maior – com outras substâncias com o adulterante parametoxianfetamina (PMA) (DEA, 2000; EROWID, s/d). Em 2001 já haviam sido identificadas pelo menos duas dúzias de mortes resultando de overdose de PMA. Esta substância também pode aumentar a pressão sanguínea e a frequência cardíaca de forma muito significativa. Doses ligeiramente acima da dose “razoavelmente segura” (SFERIOS, 2001), isto é, de 50mg, podem produzir riscos elevados a saúde do usuário. Uma análise interessante do Dance Safe de 16 anos atrás já era do DXM que foi correlacionado com a maioria das hipertermias encontradas nas emergências ocorridas nas cenas de uso da comunidade rave em Oakland, na Califórnia. Na testagem colorimétrica, Sférios relata que o DXM também fica preto, no entanto, sua reação é lenta, de 5 a 10 segundos, então vai ficando lentamente cinza, depois de 30 segundos, se torna preta. O DXM também pode causar síndrome serotoninérgica, especialmente com interações inadequadas.

Dentre estas questões da temperatura corporal, destaca-se que as ações de redução de danos nas festas não se limitam às questões individuais ou pessoais no momento do acolhimento de uma experiência intensa com substâncias. Trata-se da produção de uma cultura de cuidado, que incluem de forma direta os produtores das festas. O preço da água, com efeito, é um item fundamental de redução de riscos e danos. Ou melhor: água gratuita. Levar informação ao público sobre hiperteramia, insolação e hiponatremia, certamente são outros pontos fundamentais. Em última análise, como diz Sférios acerca do Dance Safe, a descrição da organização estava mudando de uma organização de redução de danos, para cada vez mais se reconhecer como organização por um uso responsável de substâncias.

Referências:

DEA (Drug Enforcment Agency). The hallucinogen PMA: dancing with death. Intelligence division. oct. 2000. Disponível em: <https://erowid.org/chemicals/pma/pma_dea_intellbrief.pdf>.

EROWID. PMA. s/d. Disponível em: <https://erowid.org/chemicals/pma/pma.shtml>.

HOLLAND, J. Risks of MDMA use In: HOLLAND, J (ed.). MDMA: a complete guide. Rochester/Vermont: Park Street Press, 2001.

SFERIOS, E. Minimizing risk in the dance community: an interview with Emanuel Sferios In: HOLLAND, J (ed.). MDMA: a complete guide. Rochester/Vermont: Park Street Press, 2001. p.159-176.

SFERIOS, E.; WOOLDRIDGE, M. Dancesafe respond to LA Weekly misinformation. s/d. Site Dancesafe. Disponível em: https://dancesafe.org/mdma-related-deaths-stop-calling-them-overdoses/.

Mais sobre redução de danos no Hempadão:

BESERRA, F. R. Redução de danos em contexto de festas. Portas da Percepção, Hempadão. 2016. Disponível em: <https://hempadao.com/reduo-de-danos-em-contexto-de-festas/>.

BESERRA, F. R. MDMA e redução de danos. Portas da Percepção, Hempadão. 2016. Disponível em: <https://hempadao.com/mdma-e-reducao-de-danos/>.

BESERRA, F. R. PMA ou 4-MA: adulterações perigosas. Hempadão, 2017. Disponível em: <https://hempadao.com/pma-ou-4-ma-adulteraes-perigosas/>.

BESERRA, F. R. Metilona: que onda é essa? Hempadão, 2017. Disponível em: <https://hempadao.com/metilona-que-onda-essa-portas-da-percepo-422/>.

BESERRA, F. R. Ecstasy: os cuidados ao abrir as portas do coração. Hempadão, 2016. Disponível em: <https://hempadao.com/ecstasy-os-cuidados-ao-abrir-as-portas-do-corao/>.

MCLEAN, K. Confie, deixe ir, esteja aberto: redução de danos de psicodélicos no deserto e além. Tradução: Fernando Beserra. Portas da Percepção, Hempadão, 2015. Disponível em: <https://hempadao.com/reducao-de-danos-com-psicodelicos-em-grandes-festivais/>.


[1] – Há controvérsia. De acordo com Henry e Rella (2001), a hipertermia é caracterizada pela temperatura corporal igual ou superior a 40ºC ou 104ºF.



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