Extract

Novel psychoactive substances (NPS)6 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 γ-hydroxybutyric acid (GHB). However, after the appearance of synthetic cannabinoids in the early 2000s, 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 present in the blood for only a short period of time, urinary metabolites whose chemical formulas and structures are initially unknown, and nonavailability of reference standards. Here, 4 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.

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