PMA ou 4-MA: adulterações perigosas!

Portas da Percepção

hempadao 9 fevereiro, 2017

Em um artigo que escrevi com Sandro Rodrigues, denominado: “Drogas pesadas em discussão no 1º Seminário sobre Psicodélicos do Rio de Janeiro”, pensamos a noção de drogas perigosas como aquelas que não são aquilo que prometem ser. Sandro, que já havia se emaranhado com esta definição anteriormente, o fez a partir de uma frase do crítico musical Mikal Gilmore. No auge do verão do amor: “vendiam-se e se consumiam drogas pesadas – drogas que não eram o que pareciam ser” (GILMORE apud RODRIGUES; BESERRA, 2015). O cenário de adulteração das drogas é historicamente muito antigo. No entanto, diante da ilicitude de diversas drogas sintéticas e semissintéticas, sem o controle sanitário devido e em meio à paranoia promovida pela proibição, os riscos e as adulterações se tornam elementos extremamente perigosos.

por Fernando Beserra

Um dos perigos que o usuário de ecstasy/bala ou MD pode enfrentar é deparar-se, inadvertidamente, com o adulterante parametoxianfetamina (PMA) ou com seu primo parametoximetanfetamina (PMMA). Este risco em particular também está presente, frequentemente, para o usuário de anfetaminas e metanfetamina. O PMA também é conhecido como 4-metoxianfetamina (4-MA) e produzido, tipicamente, a partir do precursor 4-metil-BMK. São fenetilaminas estimulantes com características psicodélicas. Seus efeitos julgados neutros ou positivos incluem a estimulação geral do organismo, com aumento de energia e leves alterações perceptivas, além da conhecida midríase (dilatação da pupila). Na década de 1990, o PMA passou a ser comercializado em uma bala com a estampa mitshubishi, por um produtor que possivelmente desejava fugir das implicações legais do comércio de MDMA (SFERIOS, 2001). Usada na década de 1970 na busca de novos compostos psicoativos, o PMA nunca chegou a ser uma droga popular, justamente por ser identificada como perigosa e pessoas terem morrido, possivelmente, em decorrência de seu consumo. A dose relativamente segura giraria em torno de 50mg, no entanto, doses pouco superiores podem elevar a pressão sanguínea e o batimento cardíaco de forma radical (SFERIOS, 2001) tornando este uso perigoso. O Erowid (s/d) indica que doses de 60mg já podem provocar estes efeitos, enquanto material do DEA (2000); o PMA oferece risco no aumento radical da temperatura corporal (EROWID, s/d), além de espasmos musculares, aumento da pressão arterial, aumento da frequência cardíaca, náusea, vômitos e convulsões. Material da DEA, portanto deve ser lido com cautela, indica que doses maiores podem produzir, dentre outros, arritmia cardíaca e problemas na respiração. Com efeito, quando este debate é promovido há de se considerar que o PMA ou 4-MA não é inerentemente letal, mas que a margem de segurança deste fármaco é menor que a de diversos outros fármacos. Por margem de segurança entenda-se a diferença entre a dose ativa média e a dose mortal média (ESCOHOTADO, 1997). Há manejos de alguns dos riscos do PMA no campo da redução de danos. Deixei alguns links aqui do Portas da Percepção, no final do texto, que abordam alguns dos riscos do consumo do 4-MA em contexto de festas como a hipertermia e a hiperpirexia, por exemplo.

Nos anos de 1950 o 4-MA foi estudado pelo Smith, Kline & French Laboratories como um supressor do apetite, com o nome comercial Aptrol (EMCDDA, 2012). O desenvolvimento com fármaco comercial, no entanto, foi abandonado e o Aptrol nunca chegou a ser comercializado. Cabe expor que diversas anfetaminas e fenetilaminas foram estudadas com estes proposito.

Na década de 1970, o PMA se tornou avaliável no comércio dos EUA; já em 1972 e 1973 várias mortes atribuídas ao MDA teriam sido causadas pelo PMA (BECK, 1987) e ainda em 1973 ele se tornou ilícito nos EUA com sua inclusão na Schedule I. Até 2012 haviam 21 fatalidades na Europa nas quais o 4-MA foi encontrado sozinho ou em combinação com outras substâncias (especialmente anfetamina) em analises post-mortem. Apesar disso, segundo o relatório do EMCDDA (2012) não há como afirmar o papel exato do PMA nas mortes. Há evidências de hipertermia em intoxicações fatais e não fatais nas quais o PMA está envolvido. Os riscos de PMA seriam ampliados no consumo conjunto com outras substâncias, incluindo cafeína e anfetamina (EMCDDA, 2012). De acordo com Blanckaert e outros (2013) as fatalidades envolvendo anfetaminas, que são consideradas relativamente raras, ocorrem mais comumente no uso combinado de distintas drogas (poliuso); em todas as mortes recentes envolvendo anfetaminas na Bélgica, Reino Unido e Holanda foram encontradas, na análise toxicológica, a presença de 4-MA/PMA em adição à anfetamina. De fora geral, ao consumir o PMA, os usuários acreditam estar utilizando outra coisa: uma droga perigosa, uma droga que não é aquilo que aparenta ser.

O PMA foi comercializado, no mercado desregulado, em meados da década de 1970 como galinha amarela ou pó amarelo. Stafford (1983) acreditava que o PMA tinha saído de circulação. No entanto, ele já retornou ao mercado ilícito, muitas vezes vendido como MDMA. Muitos se lembrarão das balas vermelhas com o logo do superman vendidas entre 2014 e 2016, que continham PMA. Atualmente o PMA ainda se encontra em circulação no mercado brasileiro e eu mesmo já vi um PMA vendido como MDMA em uma das testagens de drogas que realizamos pela Associação Psicodélica do Brasil com reagentes colorimétricos. Alexander e Ann Shulgin (s/d), em seu fabuloso livro Phikal, abordam o PMA (#97), sua síntese, dose (50 à 80mg), duração do efeito (curta, sem efeitos residuais após 5 horas com dose de 60mg). Shulgin e Shulgin (s/d) narram fragmentos do uso do 4-MA:

(com 60mg) Em apenas um hora houve um aumento súbito da pressão sanguínea, com a sistólica subindo em 55mm. Isso manteve-se por outra hora. Eu encontrei os efeitos remanescentes do DET, distintas pós-imagens e algumas parestesias. Eu estava sem nenhum resíduo no início da noite (depois de 5 horas).

(com 70mg) O efeito veio muito repentinamente. Me senti drogado (i had a feeling of druggedness), quase uma intoxicação de álcool e eu nunca fiquei tão alto no sentido psicodélico.

A ECDDA (European Monitoring Centre for Drugs and Drug Addiction) analisou o 4-MA em 2012. De acordo com a agência (2012) o 4-MA é predominantemente apreendido em forma de pó e pasta e ocasionalmente em líquidos. Mais raramente é encontrada em comprimidos (tablets). Grande proporção de pós e pastas continham anfetamina e cafeína, além do 4-MA/PMA. Em pequena proporção também encontraram outras substâncias com o 4-MA a exemplo do MDMA e do 4-MEC (4-metilectinona) (EMCDDA, 2012).

Acerca da farmacocinética do PMA há estudos limitados sobre o tema, com sugestão de efeitos anoréxicos com duração entre 6-10h e hipertensão significativa dose-dependente. O metabolismo é desconhecido, mas sugere-se que siga o mesmo caminho bioquímico de substâncias análogas como a mefedrona (EMCDDA, 2012). Há ainda, do ponto de vista farmacodinâmico, a hipótese de que o PMA iniba a recaptação de serotonina, dopamina e noradrenalina no encéfalo, desta forma, aumentaria a disponibilidade destes neurotransmissores em regiões do sistema nervoso. Além de ter grande efeito sobre recaptação de serotonina, o 4-MA/PMA também apresenta, em estudos animais, importante potência como inibidor da monoaminoxidase (IMAO), conduzindo a elevados níveis de dopamina e, particularmente, de serotonina (EMCDDA, 2012). Neste caso, é evidente que seu uso, assim com o uso concomitante a outras substâncias serotoninérgicas, leva a um aumentado risco de síndrome serotoninérgica (SS).

No Brasil, tanto o PMA quanto o PMMA são proibidos e listados nas atualizações da Portaria 344/98 da ANVISA, na Lista F (substâncias de uso proscrito no Brasil). O PMMA, mais particularmente, só foi incluído em uma atualização de 2016 da Portaria. Como tenho repetido sistematicamente, a proibição das drogas não é uma solução para reduzir os danos ou os riscos da mesma. Pelo contrário, sem o controle sanitário das substâncias, sem informações adequadas, sem ações de redução de danos, sem testagem, permaneceremos realizando o desastre político conhecido como Guerra às Drogas. Infelizmente, de forma tóxica, as propagandas pró-Guerra às Drogas envenenam a população fazendo crer que pessoas envolvidas com as drogas tornadas ilícitas não são sujeitos de direitos. A saúde pública, que deveria ser garantida a todos como dever do Estado, assume papéis moralistas e retrógrados. Soluções de curto prazo para minimizar os impactos nefastos do proibicionismo na saúde dos usuários, envolvem minimamente a descriminalização do porte de drogas para consumo pessoal e a valorização das equipes e ações de redução de danos, com testagens de drogas e seu aperfeiçoamento.

Referências:

BECK, J. MDMA. School of Public Health, Berkeley, CA. 1987. Disponível em: <https://www.erowid.org/chemicals/mdma/mdma_info6.shtml>.

BLANCKAERT, P; van AMSTERDAM, J. G. C. van; BRUNT, T. M; van den BERG, J. D. J; VAN DURME, F; MAUDENS, K; van BUSSEL, J. C. H. 4-Methyl-amphetamine: a health threat for recreational amphetamine users. Journal of Psychopharmacology 27(9) p. 817 –822, 2013. Disponível em: <http://journals.sagepub.com/doi/pdf/10.1177/0269881113487950>.

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

EMCDDA (European Monitoring Centre for Drugs and Drug Addiction). 4-Methylanphetamine (4-MA): risk assessments. 2012.

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

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

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

ESCOHOTADO, A. O livro das drogas: usos e abusos, desafios e preconceitos. São Paulo: Dynamis Editorial. 1997.

RODRIGUES, S. E; BESERRA, F. R. Drogas pesadas em discussão no Primeiro Seminário sobre Psicodélicos do Rio de Janeiro. Argumentum, Vitória (ES), v. 7, n.1, p. 108-125, jan./jun. 2015.

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

SHULGIN, A; SHULGIN, S. #97 4-MA Em: Phikal: a chemical love story. Disponível em: <https://www.erowid.org/library/books_online/pihkal/pihkal097.shtml>.

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/>.

COLE, K. Trabalhando com uma crise psicodélica (parte 1). Tradução: Fernando Beserra. Portas da Percepção, Hempadão, 2012. Disponível em: <http://hempadao.blogspot.com.br/2012/12/como-trabalhar-com-experiencias.html>.

COLE, K. Variedade das crises psicodélicas. Tradução: Fernando Beserra. Portas da Percepção, Hempadão, 2013. Disponível em: <http://hempadao.blogspot.com.br/2013/01/variedades-das-crises-psiquedelicas.html>.

COLE, K. Trabalhando com uma crise psicodélica (parte 3). Tradução: Fernando Beserra. Portas da Percepção, Hempadão. 2013. Disponível em: <http://hempadao.blogspot.com.br/2013/01/trabalhando-com-uma-crise-psiquedelica.html>.

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/>.



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  77. Avatar Vitor disse:

    Texto muito bom. Substâncias como a PMA e PMMA só serão seguras para os usuarios quando existir um controle sanitário, pois como foi muito bem mencionado por voce, a diferença entre a dosa ativa média e a dosa mortal média é uma linha muito tênue.

  78. Avatar sharkdiver disse:

    Tamo ai mandando brasa.

  79. Avatar Josué S Mendes disse:

    Muito bom Fernando Bezerra , esse texto é um pequeno tratado farmacológico e só vem reforçar que quanto mais se conhece as substancias psicoativas mais seguro fica quem as consomem , e o conhecimento deriva do estudo constante e o estudo só é possível com regulamentação das substancias . Como sempre vc está de parabéns e se mostra cada dia mais ” lúcido” ao discorrer sobre psicodélicos sempre abrindo as portas da nossa percepção ; Fodástico !!!

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