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Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, 2017–2020: A Review

NCJ Number
Journal of Analytical Toxicology Volume: 46 Issue: 6 Dated: 2022 Pages: e116-e185
Amanda L.A. Mohr; Barry K. Logan; Melissa F. Fogarty; Alex J. Krotulski; Donna M. Papsun; Sherri L. Kacinko; Marilyn A. Huestis; Jeri D. Ropero-Miller
Date Published
April 2022
70 pages

To assist in the assessment and interpretation of case reports for novel psychoactive substances (NPS) and provide references for confirmation method, this literature review analyzed and evaluated published case reports for NPS from January 2017 through December 2020, which followed a prior review from 2013 through 2016.



This literature review provides information on chemistry, pharmacology, adverse events, and user profiles for NPS, including case history, clinical symptoms, autopsy findings, and analytical results. Literature reviews were performed in PubMed and Google Scholar for publications, using search terms that included NPS specific names, general terms (e.g., “designer drugs,” “novel psychoactive substances”), drug classes (e.g., “designer stimulants”), and outcome-based terms (e.g., “overdose,” “death”). Government and website surveillance databases and abstracts published by professional forensic science organizations were also searched. Toxicological data and detailed case information were extracted, tabulated, analyzed, and organized by drug category. Case reports included overdose fatalities (378 cases), clinical treatment and hospitalization (771 cases), and driving under the influence of drugs (170 cases), for a total of 1,319 cases that provided details of adverse events associated with NPS. Confirmed adverse events with associated toxidromes of more than 60 NPS were reported to include synthetic cannabinoid, NPS stimulant, NPS hallucinogen, NPS benzodiazepines, and NPS opioid cases. Fifty of these NPS were reported for the first time in January 2017 through December 2020, compared to the previous 4 years surveyed. This review should increase awareness of adverse events associated with NPS use, facilitating and better characterization of international emerging drug threats. This report advises that to better understand the public health and public safety threats from NPS, the United States should continue to support and expand ongoing efforts to develop a national rapid surveillance monitoring program that will provide real-time clinical and forensic toxicology data about emerging drugs and their known toxidromes and side effect profiles. 4 figures, 4 tables, and 379 references