Investigation of drug products received for analysis in the Swedish STRIDA project on new psychoactive substances

Abstract

The web-based open sale of unregulated new psychoactive substances (NPS) has shown a steady increase in recent years. Analysis of drug products sold as NPS is useful to confirm the true chemical contents, for comparison with the substances detected in corresponding body fluids, but also to study drug trends. This work describes the examination of 251 drug products that were randomly submitted for analysis in 173 cases of suspected NPS-related intoxications in the Swedish STRIDA project in 2010-2015. Of the products, 39% were powders/crystals, 32% tablets/capsules, 16% herbal materials, 8% liquids, 1% blotters, and 4% others. The analysis involved tandem mass spectrometry and nuclear magnetic resonance spectroscopy. In 88 products (35%), classic psychoactive substances, prescription pharmaceuticals, dietary supplements, or doping agents were found; however, in none of these cases had an NPS-related intoxication been indicated from product markings or patient self-reports. Another 12 products tested negative for psychoactive substances. The remaining 151 products contained 86 different NPS (30% contained ≥2 substances). In 104 drug products, a specific NPS ingredient was indicated based on labelling (69%) or patient self-report; in 92 cases this was also analytically confirmed to be correct. Overall, the NPS products submitted for analysis in the STRIDA project showed a high degree of consistency between suspected and actual content (88%). The results of related urine and/or blood analysis further demonstrated that the patients commonly (89%) tested positive for the indicated NPS, but also revealed that polysubstance intoxication was common (83%), indicating use of additional drug products.

Relevance of published blood concentrations of new psychoactive substance for rational case interpretation

“…It is noteworthy that Brunt et al () showed by analyzing test purchases that several products were mislabeled. However, Backberg, Jonsson, Beck, and Helander () showed that there was a high degree of consistency (88%) between suspected and actual content in investigated drug products. Nevertheless, the content of branded products may be subject to variations.…”

Prediction of designer drugs: Synthesis and spectroscopic analysis of synthetic cathinone analogs that may appear on the Swedish drug market

“…This is likely due to their increased availability through a more Internet-connected society, 6 diverse domestic narcotic legislation, and a low risk for the abuser to be caught in standard urine drug tests. [8][9][10][11] A wide range of adverse side effects have also been observed with intoxications, ranging from cardiovascular and neurological to psychiatric effects, like tachycardia, arterial hypertension, hallucinations, aggressiveness, agitation, hyperthermia, and locomotor behavior alterations. Intoxications and deaths associated with the use of these substances have been reported.…”

“…32,53,54 The retention times of the investigated compounds with the methylenedioxy motif (compounds[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] were in the range of2.2-3.4 minutes when using the fast GC-MS screening method applied at the NFC (Figure S39). In this work, the hyphenated methods GC-MS and GC-FTIR were applied.…”

“…substances have been reported. [8][9][10][11] A wide range of adverse side effects have also been observed with intoxications, ranging from cardiovascular and neurological to psychiatric effects, like tachycardia, arterial hypertension, hallucinations, aggressiveness, agitation, hyperthermia, and locomotor behavior alterations. [12][13][14][15] In 2004, methylone was the first synthetic cathinone to be encountered in Swedish drug seizures.…”

“…Despite the limitations addressed, the retention time has proven to be of great value when trying to differentiate between compounds that generate similar spectroscopic data. In addition, several guidelines point out the retention time as an identification criteria that is orthogonal to spectroscopic data and that they both are required for confident identification.32,53,54 The retention times of the investigated compounds with the methylenedioxy motif (compounds[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] were in the range of2.2-3.4 minutes when using the fast GC-MS screening method applied at the NFC (Figure S39). Each compound had at least one additional compound within the commonly applied retention time window of ±0.1 minutes.…”