Psychological Medicine
July 22, 2019
Fabrizio Schifano, Flavia Napoletano, Stefania Chiappini et al.
118 citations
A novel web-crawling tool called NPS.Finder® identified several thousand new psychoactive substances (NPS)—roughly four times more than European and international drug agencies report. Synthetic cannabinoids, new synthetic opioids, ketamine-like dissociatives, novel stimulants, novel psychedelics, and certain prescription and over-the-counter medicines were most commonly linked to psychopathological consequences. The rapid proliferation of recreational psychotropics poses a challenge for psychiatry because the pharmacodynamics and pharmacokinetics of many NPS remain poorly understood. Health and mental health professionals need up-to-date information on the range of NPS, their intake methods, sought-after effects, drug combinations, and associated medical and psychopathological risks.
Experimental neurology
May 1, 2021
Fabrizio Schifano, Stefania Chiappini, Andrea Miuli et al.
49 citations
Several new psychoactive substances (NPS) can trigger serotonin syndrome, a dangerous condition of excessive serotonin activity marked by altered mental status, neuromuscular effects, and autonomic hyperactivity. A systematic review of three retrospective studies, two case series, and five case reports identified implicated substances including psychedelic phenethylamines (2C-I, 25I-NBOMe, 5-IT) and synthetic cathinones (mephedrone, MDPV, methylone, butylone, NRG3, AMT, MXP), as well as the antidepressant bupropion when misused at high doses or combined with other serotonergic drugs. Most substances were taken orally, though nasal insufflation and sublingual administration occurred. Psychiatric history was negative for most subjects. Clinicians should recognize NPS risks and diagnostic challenges due to undetectability in routine drug screenings.
Pharmacopsychiatry
April 25, 2017
Norbert Scherbaum, Fabrizio Schifano, Udo Bonnet
46 citations
Hundreds of new psychoactive substances (NPS) have been identified in Europe, mainly synthetic cannabinoids and new synthetic stimulants like cathinones. These are often developed by modifying basic chemical structures such as phenethylamine or tryptamine. Although their pharmacology and toxicology are hardly known, they are sold online as "bath salts" or "incense mixtures" and advertised as "legal highs." Little is known about the prevalence of NPS use, but some molecules may cause severe adverse reactions. Unlike cannabis, synthetic cannabinoid users may experience epileptic seizures, loss of consciousness, and persisting psychopathological disorders. Future studies should inform better-tailored management strategies.
Frontiers in Psychiatry
July 7, 2020
Michael Specka, Thomas Kuhlmann, Jürgen Sawazki et al.
42 citations
Among patients undergoing in-patient detoxification from illicit drugs in Germany, use of novel psychoactive substances (NPS) was rare. About 32% reported having tried synthetic cannabimimetics at least once in their lifetime, but usually only a few times, and nearly no one had used them in the 30 days before admission. Urine analysis confirmed the low recent use. In contrast, lifetime and current use of opiates, alcohol, cocaine, benzodiazepines, and cannabis was high. An important reason given for trying NPS was that they were not detected by drug testing in prisons or treatment facilities. A notable finding was that 18% reported regular unprescribed pregabalin use during their lifetime, and 20% had recently used it, indicating diversion of legal medications is a serious concern.
Expert Review of Clinical Pharmacology
November 2, 2023
Fabrizio Schifano, Alessandro Vento, Norbert Scherbaum et al.
30 citations
Clinicians need regular updates on novel psychoactive substances (NPS) and their acute and long-term medical, psychobiological, and psychopathological risks. Future research should combine pro-drug website analysis with computational chemistry to organize preclinical studies of new psychoactives. Psychedelic research should develop robust study designs to assess potential therapeutic benefits, as these molecules likely have limited dependence liability.
Brain sciences
April 22, 2025
Fabrizio Schifano, Stefania Bonaccorso, Davide Arillotta et al.
14 citations
Chemsex involves using drugs like synthetic cathinones, GHB/GBL, ketamine, methamphetamine, and others to enhance and prolong sexual experiences. Stimulants increase sexual arousal, performance, and social interactions; MDMA-like drugs foster emotional closeness; GHB/GBL promotes disinhibition, leading to condomless sex with multiple partners; ketamine facilitates receptive anal intercourse or fisting. Polydrug use can cause serotonergic syndrome, seizures, drug interactions, and sympathomimetic overstimulation, along with psychopathological conditions that may lead to misuse of opioids, gabapentinoids, or antipsychotics. Reducing stigma and providing multidisciplinary medical, psychological, and social support are key to managing these challenges.
Frontiers in psychiatry
January 1, 2022
Udo Bonnet, Michael Specka, Ann-Kristin Kanti et al.
4 citations
Substance-dependent users and addiction medicine experts rank the harms of traditional illicit drugs (heroin, cocaine, amphetamines) highest, with alcohol and benzodiazepines also in a top-harm tier. Both groups place methadone, nicotine, and cannabis in the midrange, and buprenorphine and psychotropic mushrooms at the lowest harm level. Users rate the benefits of traditional illicit drugs, cannabis, and nicotine more positively than experts do, while experts judge methadone as significantly less harmful than users do. Users attribute the most benefits to buprenorphine, methadone, and cannabis, likely reflecting that over 50% of the user sample sought opiate detoxification treatment. The findings inform psychoeducation and policy debates.