Impact of Novel Psychoactive Substances on Clinical and Forensic Toxicology and Global Public Health
Marilyn A. Huestis, Simon D. Brandt, Suman Rana, Volker Auwärter, Michael H. Baumann
Clinical Chemistry June 30, 2017 DOI: 10.1373/clinchem.2017.274662 via OpenAlex
Summary
Novel psychoactive substances (NPS) have been present in clinical and forensic toxicology for over a century, with early examples including heroin, LSD, MDMA, and GHB. After synthetic cannabinoids emerged in the early 2000s, hundreds of synthetic cathinones, benzodiazepines, and opioids rapidly appeared. Toxicology laboratories, once focused on a narrow range of compounds, now face potent fentanyl derivatives mixed with or substituted for heroin, causing rising fatalities. Labs struggle to detect short-lived drug analogs, unknown urinary metabolites, and lack reference standards. Four international experts discuss what drove the global NPS market, how toxicology laboratories can address these challenges, and how public health and law enforcement can reduce NPS-related morbidity and mortality.
Study at a glance
| Characteristics | Review Peer reviewed |
|---|---|
| Topics | LSD MDMA |
| Keywords | Heroin Designer drug Forensic toxicology |
| Citations | 42 |
| Key finding | The global NPS market was fueled by rapid emergence of synthetic cathinones, benzodiazepines, and opioids after synthetic cannabinoids appeared in the early 2000s, challenging toxicology laboratories with detecting potent analogs and unknown metabolites. |
Abstract
Novel psychoactive substances (NPS) have been a part of the landscape of clinical and forensic toxicology for over a century, beginning with the introduction of a few new drugs like heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (MDMA) and gammahydroxybutyric acid (GHB). However, after the appearance of synthetic cannabinoids in the early 2000’s there was a rapid emergence of hundreds of synthetic cathinones, benzodiazepines and opioids. Toxicology laboratories previously focused on a rather narrow range of compounds including amphetamines, cannabinoids, cocaine, opioids, antidepressants, salicylate and acetaminophen. Now potent fentanyl derivatives are mixed with heroin or substituted entirely, killing unsuspecting drug users at an alarming rate. Toxicology laboratories are challenged with detecting potent drug analogs that are only present in blood for a short period of time, urinary metabolites whose chemical formula and structures are initially unknown, and no available reference standards. Here four international experts discuss what fueled the global NPS market, how toxicology laboratories can best address this challenge, and how public health and law enforcement agencies can help reduce the morbidity and mortality associated with NPS.