Forensic toxicology perspectives and trends on abused drugs in Adana, Turkiye: A five-year overview (2019-2023)

Monitoring toxicological findings in forensic cases offers valuable data on substance use patterns. This study aims to characterise long-term trends in illicit drugs and new psychoactive substances (NPS) in a strategically important transit region of Turkiye and to evaluate their implications for forensic intelligence and public health surveillance. In this retrospective study, we analyzed toxicological results from than 100,000 forensic cases examined between 2019 and 2023 at the Council of Forensic Medicine, Adana. Biological samples such as blood, urine, and hair etc. collected from both antemortem and postmortem cases were analyzed using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) techniques. The findings revealed a significant change in the regional drug landscape, characterised by substantial increases in amphetamines, NPS, and gamma aminobutyric acid (GABA) derivatives, particularly pregabalin and gabapentin. In contrast, opioids showed a declining trend. Antemortem cases predominantly reflected stimulant and NPS use, whereas postmortem cases were associated with higher proportions of benzodiazepines and opioids. This study is among the most comprehensive toxicological analyses conducted in Turkiye so far. The results revealed changing trends in drug use, especially the increase in NPS and prescription medications, and emphasize the importance of continuous forensic and public health monitoring. Incorporating toxicological data into national substance surveillance systems is advised to enhance prevention efforts and policy development.