En respuesta a las recomendaciones de la Organización Mundial de la Salud (OMS), la Comisión de Estupefacientes de las Naciones Unidas aprobó la fiscalización internacional de 5 nuevas sustancias psicoactivas y un medicamento. La decisión se tomó durante el 68.º período de sesiones ordinario de la Comisión, celebrado en Viena del 10 al 14 de marzo de 2025, y responde al creciente riesgo que estas sustancias representan para la salud pública a nivel global.
Según la OMS, estas sustancias, en su mayoría opioides sintéticos de alta potencia, han sido detectadas en mercados ilegales y han causado numerosas intoxicaciones, hospitalizaciones y muertes en distintas regiones del mundo. La fiscalización busca reforzar la vigilancia y restringir su circulación para evitar un mayor impacto en la salud pública.
Opioides sintéticos: un riesgo creciente
Cuatro de las cinco sustancias incluidas en la Lista I de la Convención Única sobre Estupefacientes de 1961, enmendada por el Protocolo de 1972, pertenecen a la familia de los opioides sintéticos. Estas sustancias, fabricadas clandestinamente y sin uso médico reconocido, han sido identificadas en comprimidos falsificados y polvos utilizados como sustitutos de otros opioides. Entre ellas se encuentran:
- N-pirrolidino protonitaceno (protonitacepina): detectado en fármacos opioides falsificados, ha sido relacionado con múltiples casos de intoxicación grave y muerte.
- N-pirrolidino metonitaceno (metonitacepina): se administra por inyección y presenta un alto potencial de abuso, con efectos letales.
- Etonitacepina (N-piperidinil etonitaceno): un sólido cristalino altamente peligroso que ha generado preocupación por su uso en sustitución de otros opioides.
- N-desetil isotonitaceno (norisotonitaceno): se ha detectado en fármacos falsificados y ha causado hospitalizaciones y muertes en varias regiones.
La OMS advirtió que estos opioides sintéticos superan en potencia a la morfina y la heroína, aumentando el riesgo de sobredosis y dependencia. Su fiscalización permitirá a los Estados intensificar la vigilancia y adoptar estrategias de reducción de daños y control del tráfico ilegal.
El hexahidrocannabinol (HHC) y su impacto en la salud pública
Otra de las sustancias incluidas en el control internacional es el hexahidrocannabinol (HHC), un cannabinoide semisintético que ha ganado popularidad en diversos productos recreativos. Según la OMS, el HHC se encuentra en resinas, aceites, líquidos para cigarrillos electrónicos y productos comestibles, lo que facilita su distribución y consumo.
Los expertos han identificado efectos psicoactivos similares al THC, pero con riesgos desconocidos debido a la falta de regulación en su producción y comercialización. La fiscalización de esta sustancia responde a su uso creciente sin control sanitario y al potencial impacto en la salud mental y el comportamiento de los consumidores.
Carisoprodol: un miorrelajante con alto potencial de abuso
El carisoprodol, un miorrelajante de acción central, fue incluido en la Lista IV del Convenio sobre Sustancias Sicotrópicas de 1971. Su uso no médico ha generado alarma en varios países, ya que se ha identificado en fármacos falsificados y como sustancia de abuso en combinación con otros depresores del sistema nervioso central.
A pesar de ser un medicamento de prescripción en muchos países, su potencial adictivo ha llevado a que se impongan restricciones más severas en su comercialización y distribución. La OMS recomendó su fiscalización para prevenir su uso indebido y reducir el riesgo de sobredosis.
El papel de la OMS y la fiscalización de nuevas sustancias
Desde hace más de 70 años, la OMS, a través del Comité de Expertos en Farmacodependencia, analiza los riesgos y beneficios de sustancias psicoactivas emergentes. Su función es garantizar que las drogas con usos médicos legítimos estén disponibles y, al mismo tiempo, evitar que sustancias peligrosas circulen sin control.
Con la proliferación de opioides sintéticos y cannabinoides semisintéticos, los Estados miembros han solicitado a la OMS que refuerce los exámenes científicos de estas sustancias para tomar decisiones informadas sobre su control. La inclusión de estas seis sustancias en la fiscalización internacional es un paso clave en la lucha contra la crisis de opioides y la proliferación de drogas sintéticas.
Implicaciones para los sistemas de salud y políticas públicas
La fiscalización internacional de estas sustancias implica que los países deberán reforzar sus marcos normativos para restringir su producción, distribución y comercialización. Además, las autoridades sanitarias deberán implementar estrategias de vigilancia epidemiológica, fortalecer los protocolos de tratamiento para la dependencia a opioides y desarrollar programas de prevención enfocados en poblaciones vulnerables.
En el ámbito clínico, esta medida podría generar cambios en la formulación de guías de manejo del dolor y en el acceso a tratamientos sustitutivos, así como en la educación médica sobre el impacto de estas sustancias en la salud pública.
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