9-year review of new psychoactive substance use in Hong Kong: A clinical laboratory perspective

Abstract

Background: New psychoactive substances are constantly evolving structural analogues of traditional drugs of abuse that have become a threat to public health worldwide and within our locality. An understanding of the local pattern of new psychoactive substance use will help guide frontline clinical management. Objectives: This study was conducted to review the new psychoactive substances detected in cases referred to the authors' laboratory (a tertiary clinical toxicology centre), as well as the associated clinical features and toxicological findings. Methods: All cases referred to the laboratory for toxicology analysis between January 2009 and December 2017, and which were analytically confirmed to involve new psychoactive substance use, were retrospectively reviewed. Demographic data, clinical features and toxicology findings were studied. Results: A total of 111 cases involving 104 patients and 22 types of new psychoactive substances were identified, with an increasing trend in the number of cases and subclass of new psychoactive substances detected. Up to half of the cases (n = 64) were related to the use of 2-phenyl-2-(ethylamino)-cyclohexanone (2-oxo-PCE, a ketamine analogue); other new psychoactive substances detected included para-methoxymethamphetamine, 4-fluoroamphetamine, phenazepam, 3-trifluoromethylphenylpiperazine, 5-methoxy-diisopropyltryptamine, 2-diphenylmethylpyrrolidine, methoxyphenidine, the N-methoxybenzyl drugs, cathinones, synthetic cannabinoids and opioids. Among the acute poisoning cases attributable to new psychoactive substance use, the severity was fatal (n = 3), severe (n = 17), moderate (n = 67) and minor (n = 17). And 11 patients required intensive care unit admission. All three fatal cases were associated with paramethoxymethamphetamine use. Conclusion: A rising trend of new psychoactive substance use is observed locally, which is associated with considerable morbidity and mortality. Continued vigilance from frontline clinicians and medical professionals is imperative in the combat against new psychoactive substance use.

Prevalence and concentrations of new designer stimulants, synthetic opioids, benzodiazepines, and hallucinogens in postmortem hair samples: A 13‐year retrospective study

“…The age and sex distribution are comparable with literature. [29][30][31] Our study further shows that 3.6% of positive cases were under 20 years of age, indicating the use of NPS in a young population. This is in line with data from the 2019 European School Survey Project on Alcohol and Other Drugs use (ESPAD), which reported a lifetime prevalence for NPS of 3.8% among 15-to 16-year-old students in Germany.…”

Presence of the ketamine analog of 2‐fluorodeschloroketamine residues in wastewater

“…Although 2F‐DCK structurally resembles existing KET, its clinical effects and toxicological profiles should be well characterized. Numerous cases of intoxication and fatalities associated with their use have been reported in a previous study 51,52 …”

“…In 2018, 148 NPS were identified by Chinese authorities 50 . Although the use of KET has declined, the emergence of its analogs and other drugs has increased the overall consumption trend for NPS 51 …”

“…51,52 4 | CONCLUSION NPS use is a growing public health problem in many countries. WBE is needed as a complementary approach to gain more insight on NPS consumption.…”

Pattern of novel psychoactive substance use among patients presented to the poison control centre of Ain Shams University Hospitals, Egypt: A cross-sectional study

“…Those differences in structure may lead to difficult detection by toxicological screening methods. This is why these substances are referred to as "legal high" ( Cohen and Weinstein, 2018 ; ElSohly et al., 2014 ; Tang et al., 2019 ; Zamengo et al., 2014 ). It is a growing problem despite the difficulty of determining the accurate prevalence of NPS use ( Carter et al., 2009 ; Madras, 2017 ).…”