Emerging Agents of Substance Use/Misuse.

Area of Science:

• Pharmacology
• Toxicology
• Clinical Chemistry

Background:

• The prevalence of novel psychoactive substances (NPS) has significantly increased over the past decade.
• NPS encompass a diverse range of compounds, including plant-derived and increasingly synthetic substances like synthetic cannabinoids, cathinones, kratom, phenibut, designer opioids, and benzodiazepines.
• These substances exhibit varied potencies and effects due to differential binding affinities to targeted receptors.

Purpose of the Study:

• To highlight the growing issue of novel psychoactive substances (NPS) and their implications in clinical settings.
• To emphasize the limitations of routine drug screening methods in detecting NPS.
• To underscore the importance of clinician awareness for accurate diagnosis and patient management.

Main Methods:

• Literature review on the emergence and characteristics of NPS.
• Analysis of the chemical diversity and pharmacological actions of common NPS.
• Evaluation of the detection capabilities of standard immunoassay urine drug screens for NPS.

Main Results:

• Standard immunoassay urine drug screens frequently fail to detect a wide array of NPS.
• The varied pharmacological profiles of NPS present diagnostic challenges.
• Increased clinician awareness is crucial for identifying patients using NPS.

Conclusions:

• Novel psychoactive substances (NPS) pose a significant challenge to routine clinical toxicology.
• Enhanced awareness and potentially specialized testing are necessary for the detection and management of NPS.
• Clinicians need to be informed about NPS to ensure accurate patient assessment and care.