Abstract
In the past decade, hundreds of new psychoactive substances (NPS) have been introduced as unclassified alternatives to the illicit drugs. The NPS represent a growing health concern by causing adverse effects and deaths but are usually undetectable by conventional drug tests. This report summarizes results and experiences from analytically confirmed drug-related acute intoxications in emergency departments (ED) and intensive care units (ICU) enrolled in the Swedish STRIDA project on NPS in 2010-2016. ED/ICU intoxications suspected to involve NPS were enrolled in the project, after initial contact with the Poisons Information Centre (PIC). Serum/plasma and urine samples, and sometimes drug products, were subjected to a comprehensive toxicological investigation, and the PIC retrieved information on associated clinical symptoms and treatment. Between January 2010-February 2016, 2626 cases were enrolled. The patients were aged 8-71 (mean 27, median 24) years and 74% were men. Most biological samples (81%) tested positive for one, or more (70%), psychoactive drugs, including 159 NPS, other novel or uncommon substances, classical recreational and illicit drugs, and prescription medications. When first detected, most NPS or other novel substances (75%) were not banned in Sweden, but they usually disappeared upon classification, which however often took a year or longer. Some NPS were found to be especially harmful and even fatal. The STRIDA project provided a good overview of the current drug situation in Sweden and demonstrated a widespread use and rapid turnover of many different psychoactive substances. The accomplishment of the project can be attributed to several key factors (close collaboration between the PIC and laboratory to identify suspected poisonings, free analysis, continuous updating of analytical methods, evaluation of adverse effects, and sharing information) that are useful for future activities addressing the NPS problem. The results also illustrated how drug regulations can drive the NPS market.
Highlights
New psychoactive substances (NPS) that are not covered by current drug legislation have emerged since the 1960s
The STRIDA project provided a good overview of the current drug situation in Sweden and demonstrated a widespread use and rapid turnover of many different psychoactive substances
After discussions on Internet drug chat forums in 2006 regarding which herbal ingredients were accountable for the psychoactive effects, it was demonstrated in 2008 that the products had been laced with synthetic cannabinoid receptor agonists (SCRA) originally developed as therapeutic drug candidates and pharmacological tools to probe the endocannabinoid system [1,2,3]
Summary
New psychoactive substances (NPS) that are not covered by current drug legislation (previously commonly called “designer drugs”) have emerged since the 1960s. The SCRA additives were banned in some countries but soon replaced by other, uncontrolled structural variants [4]. This turned out to be a starting point for the ongoing global NPS era, whereby novel substances often bearing only small structural differences are continuously introduced through open trading on the surface web ( called “Internet drugs”) to replace those becoming controlled [5]. Hundreds of new psychoactive substances (NPS) have been introduced as unclassified alternatives to the illicit drugs. This report summarizes results and experiences from analytically confirmed drugrelated acute intoxications in emergency departments (ED) and intensive care units (ICU) enrolled in the Swedish STRIDA project on NPS in 2010–2016
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