Fatal Poisonings Associated with New Psychoactive Substances

Abstract

This chapter describes how new psychoactive substances (NPS) have been involved in fatal intoxications from 2010 and onwards. It summarizes the circumstances, antemortem symptoms, and adverse effects that have led to death after ingestion of one or more NPS and tabulates concentrations, and postmortem findings from these intoxications.Consumption of NPS exerts health problems and unknown risks for the users. Data on toxicity of many NPS are scarce or nonexistent and long-term toxicity and risks are still largely unknown. In addition, purity and composition of products containing NPS are often inconsistent or not known, which places users at high risk as evidenced by hospital emergency admissions and deaths.The most serious threat to drug users are the synthetic opioids that with strong central nervous depressant effects have caused numerous accidental deaths spread over the entire globe. The synthetic cannabinoids seem to be the most unpredictable with no clear toxidrome and unknown or poorly understood mechanisms of toxicity, but with adverse effects pointing toward the cardiovascular system. The toxidromes commonly encountered after ingestion of cathinones and phenethylamines are of sympathomimetic and hallucinogenic character, which includes risk of developing a serotonin syndrome, excited delirium, and life-threatening cardiovascular effects. In comparison to their conventional "parent" drug, i.e., heroin, cannabis, and amphetamine, most NPS appear to exhibit more severe adverse effects. The deaths attributed to NPS have dramatically increased in the last years. In our opinion, this is because of the shift from synthetic cannabinoids and cathinones to the even more toxic and dangerously potent fentanyl analogues.

Cannabis health knowledge and risk perceptions among Canadian youth and young adults

“…Synthetic cannabis is the term given to mixtures of synthetic compounds marketed as "herbal" mixtures (e.g., Spice, K2m, Mamba, Afghan Incense) that activate cannabinoid receptors. They are the largest, fastest-growing, and most diversified new psychoactive substances which have been observed to precipitate acute psychotic symptoms, fatal poisonings, acute myocardial infarction, delusions, renal dysfunction, among other effects [29][30][31]. Synthetic cannabinoid use among youth is an emerging phenomenon in North America, approximately 3% of young Canadians in Grades 7 to 12 have reported its use, and 12% of their American counterparts have reported the same; the Canadian Centre for Substance Abuse identified this as a substance of concern as early as 2014 [2,32,33].…”

LC‐MS/MS method for the quantification of new psychoactive substances and evaluation of their urinary detection in humans for doping control analysis

“…These substances are analogs of a broad range of drugs of abuse, such as synthetic cannabinoids, synthetic opioids, benzodiazepines, or stimulants, but in most cases with an unknown or poorly characterized pharmacology. Over the past decade, the consumption of NPS has increased dramatically and their consumption has been related to several acute intoxication and fatal cases …”

An insight into the metabolism of New Psychoactive Substances : Structural elucidation of urinary metabolites of synthetic cannabinoids and fentanyl analogues using synthesized reference standards

“…90,91 Numerous deaths have been reported globally following intoxications from different fentanyl analogues. 28,29,63,66,88,[98][99][100] However, the situation is especially troublesome in North America with the ongoing opioid epidemic. 6,66 The opioid epidemic in North America is a result of a complex combination of the accessible and dangerous fentanyl analogues, other illicitly used opioids as well as the liberal prescription of opioids for medical ailments.…”

“…15,29,73 Abuse of potent fentanyl analogues has led to numerous deaths worldwide, in particular in the United States with the ongoing opioid crisis. 28,29,63,65,66,88,[98][99][100] However, it can be complicated to attribute adverse effects to the use of a particular substance, especially with the high likelihood of polydrug abuse and the difficulties in drug detection. As a result, the number of intoxications and deaths following synthetic cannabinoid and fentanyl analogue abuse is most likely underreported.…”

“…The four analogues were in part chosen based upon their prevalence of use in Sweden. 98 As of august 2020, all of the chosen fentanyl analogues, apart from isobutyrylfentanyl, are listed under the 1961 Single Convention on Narcotic Drugs. 46 Acetylfentanyl has been implicated in the deaths of 27 people in Sweden, 262 while the use of acrylfentanyl and 4F-isobutyrylfentanyl has contributed to 43 and 16 deaths in Sweden, respectively.…”