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

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


Journal of Analytical Toxicology, April 2022


Amanda L A Mohr | Center for Forensic Science Research and Education
Barry K Logan | Center for Forensic Science Research and Education
Melissa F Fogarty | Center for Forensic Science Research and Education
Alex J Krotulski | Center for Forensic Science Research and Education
Donna M Papsun | NMS Labs
Sherri L Kacinko | NMS Labs
Marilyn A Huestis | Center for Forensic Science Research and Education
Jeri D Ropero-Miller | RTI International


An important role of modern forensic and clinical toxicologists is to monitor the adverse events of novel psychoactive substances (NPS). Following a prior review from 2013-2016, this critical literature review analyzes and evaluates published case reports for NPS from January 2017 through December 2020. The primary objective of this study is to assist in the assessment and interpretation of these cases as well as provide references for confirmation methods. Chemistry, pharmacology, adverse events, and user profiles (e.g., polypharmacy) for NPS are provided including case history, clinical symptoms, autopsy findings, and analytical results. Literature reviews were performed in PubMed and Google Scholar for publications using search terms such as 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 drug 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 providing 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 benzodiazepine, and NPS opioid cases. Fifty of these NPS were reported for the first time in January 2017 through December 2020 as compared to the previous four years surveyed. This study provides insight and context of case findings described in the literature and in digital government surveillance databases and websites during a recent four-year period. This review will increase awareness of adverse events associated with NPS use to better characterize international emerging drug threats.

Funding for this article was provided by the Forensic Technology Center of Excellence and the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice.

The opinions, findings, and conclusions or recommendations expressed in this article are those of the author(s) and do not necessarily reflect those of the U.S. Department of Justice.

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