New psychoactive substances (designer drugs): an approach to classification

Summary

Substance use disorders remain a global public health problem. The drug market has shifted from traditional drugs to new psychoactive substances with high toxicity and addictive potential, distributed via the Internet and social media, which impedes control and increases public health risks. This review classifies modern synthetic narcotics into six groups by pharmacological mechanism: psychostimulants (amphetamine, cocaine, MDMA analogs) that increase dopamine, norepinephrine, and serotonin levels; synthetic cannabinoids (spice) that are full CB1/CB2 receptor agonists; psychedelics (LSD, DMT analogs) that are 5-HT2A receptor agonists; dissociatives (ketamine, phencyclidine analogs) that are NMDA receptor antagonists; synthetic opioids...

Study at a glance

Abstract

BACKGROUND: Substance use disorders remain a global public health problem. In recent decades, the drug market has undergone substantial changes, with traditional drugs increasingly replaced by new psychoactive substances characterized by high toxicity and strong addictive potential. Their distribution via the Internet and social media impedes control and increases risks to public health. AIM: This study aimed to classify and characterize modern synthetic narcotic substances based on their pharmacological mechanisms of action. METHODS: An analysis of publications from PubMed and Google Scholar (2015–2024) was conducted using the following keywords: new psychoactive substances, designer drugs, synthetic cannabinoids, opioids, and benzodiazepines. Relevant studies in Russian and English focusing on the non-medical use of new psychoactive substances were selected. RESULTS: New psychoactive substances were classified into six groups: 1) psychostimulants (analogs of amphetamine, cocaine, and 3,4-methylenedioxymethamphetamine), which increase dopamine, norepinephrine, and serotonin levels, leading to euphoria, anxiety, and psychosis; 2) synthetic cannabinoids (spice), full agonists of CB1/CB2 receptors, associated with severe intoxication and psychiatric disorders; 3) psychedelics (analogs of lysergic acid diethylamide and N,N-dimethyltryptamine), agonists of 5-HT2A receptors, inducing hallucinations and serotonin syndrome; 4) dissociative substances (analogs of ketamine and phencyclidine), NMDA receptor antagonists causing anesthesia and psychotic states; 5) synthetic opioids (fentanyl analogs, nitazenes), μ-opioid receptor agonists, tens of times more potent than morphine and associated with a high risk of fatal outcomes; 6) designer benzodiazepines (e.g., clonazolam, bromdihydrochlorophenylbenzodiazepine), GABA receptor modulators leading to sedation, amnesia, and dependence. CONCLUSION: New psychoactive substances pose a serious threat due to their high addictive potential, unpredictable toxicity, and the lack of effective treatments for dependence. International cooperation is required to monitor emerging substances, develop clinical guidelines, and implement preventive programs.