This study reviewed the adverse effects of intoxications with novel cannabinoids, stimulants, hallucinogens, benzodiazepines, and opioids for the period January 2013 through December 2016, as reported in emergency departments, death investigations, impaired driving cases, and other forensic contexts.
Novel psychoactive substances (NPS) represent significant analytical and interpretive challenges to forensic and clinical toxicologists. Timely access to case reports and reports of adverse incidents of impairment or toxicity is imperative for clinical diagnosis and treatment, as well as the interpretation of forensic results. Delays in identifying the presence of a novel intoxicating agent have significant consequences for public health and public safety. The current study provides a descriptive summary of the chemistry, pharmacology, and adverse events associated with novel drug classes. Adverse effects or symptoms associated with the ingestion of just over 45 NPS have been abstracted and summarized in tables, including demographics, case history, clinical or behavioral symptoms, autopsy findings, and drug confirmations with quantitative results when provided. Based on these findings and gaps in the available data, this study provides recommendations for future toxicological testing of these evolving substances. These include development and management of a national monitoring program to provide real-time clinical and toxicological data, confirmed analytically, on emerging drugs and their known toxidromes and side effects. The discussion advises that increased efforts should be made by hospitals to analytically confirm the agents responsible for clinical intoxications involving adverse events. Evidence-based community preparedness among analytical laboratories gained through active communication and sharing of toxicological findings and trends in NPS is imperative to assist in enabling early detection of new drugs in forensic and clinical populations. (Publisher abstract modified)