Next generation of novel psychoactive substances on the horizon - A complex problem to face

Determine the pharmacokinetics (half-life, volume of distribution and clearance) of AMB-FUBINACA in rats plasma using GC-MS / MS

BACKGROUND

Several novel synthetic cannabinoids, including methyl 2-(1-(4-fluorobenzyl)-1Hindazole-3-carboxamido)-3-methylbutanoate (AMB-FUBINACA), have recently surfaced on the illicit drug market. To determine the pharmacokinetic properties (half-life, volume of distribution, and clearance) of AMB-FUBINACA in rats plasma, a straightforward, quick, and highly sensitive analytical approach was developed.

METHODS

Eighteen Wistar rats were divided into two groups: one control (saline vehicle) and one treatment group (AMB-FUBINACA at 50 mg/kg). Blood samples (400 μL) were withdrawn via catheters immediately before (t = 0) and at 30, 60, 90, 120, and 240 min following injection. Samples were collected into 1 mL tuberculin syringes, then transferred to 1.5 mL plastic tubes containing 5 μL of 1000 IU/mL K3-EDTA (Thomas Scientific). Place the EDTA tubes containing samples in a centrifuge and spin at 1000 g for 10 min at 4 °C. The top layer is the plasma fraction, which is decanted into cryovials and stored at -20 °C until analysis. The gas chromatography tandem mass spectrometry (GC-MS/MS) method was optimized and validated, combined with liquid-liquid extraction, to analyze AMB-FUBINACA in rat plasma.

RESULTS

The research method successfully met the validation requirements set by the FDA, demonstrating selectivity and linear calibration curves within a concentration range of 0.5-1000 ng/ml. The correlation coefficient (r2) was determined to be 0.99, indicating a strong linear relationship. The analyte's limit of quantitation (LOQ) was determined to be 1-5 ng/mL. Subsequently, the method was successfully applied to investigate the pharmacokinetics of AMB-FUBINACA in rats' blood samples. Following oral administration, AMB-FUBINACA was rapidly absorbed, with a plasma half-life (t1/2) of 5.91 h, a volume of distribution (Vd) of 203.13 l, and a plasma clearance of 23.81122 L/h.

CONCLUSION

These findings contribute to the understanding of AMB-FUBINACA's pharmacokinetics and pharmacodynamics.

Plasma drug screening using paper spray mass spectrometry with integrated solid phase extraction

Drug overdoses have risen dramatically in recent years. We developed a simple nontargeted method using a disposable paper spray cartridge with an integrated solid phase extraction column. This method was used to screen for ~160 fentanyl analogs, synthetic cannabinoids, other synthetic drugs, and traditional drugs of abuse in over 300 authentic overdose samples collected at emergency departments in Indianapolis. A solid phase extraction step was implemented on the paper spray cartridge to enable subnanograms per milliliter synthetic drugs screening in plasma. Analysis was performed on a quadrupole orbitrap mass spectrometer using the sequential window acquisition of all theoretical fragment ion spectra approach in which tandem mass spectrometry was performed using 7 m/z isolation windows in the quadrupole. Calibration curves with isotopically labeled internal standards were constructed for 35 of the most frequently encountered synthetic and traditional illicit drugs by US toxicology labs. Additional qualitative-only drugs in a suspect screening list were also included. Limits of detection in plasma for synthetic cannabinoids ranged from 0.1 to 0.5 and 0.1 to 0.3 ng/mL for fentanyl and its analogs and between 1 and 5 ng/mL for most other drugs. Relative matrix effects were evaluated by determining the variation of the calibration slope in 10 different lots of biofluid and found to be between 3% and 20%. The method was validated on authentic overdose samples collected from two emergency departments in Indianapolis, Indiana, from suspected or known overdoses. Commonly detected synthetic drugs included fentanyl related substances, designer benzodiazepines such as flubromazolam, and the synthetic cannabinoid 5F-PB-22.

Metabolic Stability and Metabolite Identification of N-Ethyl Pentedrone Using Rat, Mouse and Human Liver Microsomes

New Psychoactive Substances (NPSs) are defined as a group of substances produced from molecular modifications of traditional drugs. These molecules represent a public health problem since information about their metabolites and toxicity is poorly understood. N-ethyl pentedrone (NEP) is an NPS that was identified in the illicit market for the first time in the mid-2010s, with four intoxication cases later described in the literature. This study aims to evaluate the metabolic stability of NEP as well as to identify its metabolites using three liver microsomes models. To investigate metabolic stability, NEP was incubated with rat (RLM), mouse (MLM) and human (HLM) liver microsomes and its concentration over time evaluated by liquid chromatography-mass spectrometry. For metabolite identification, the same procedure was employed, but the samples were analyzed by liquid chromatography-high resolution mass spectrometry. Different metabolism profiles were observed depending on the model employed and kinetic parameters were determined. The in vitro NEP elimination half-lives (t1/2) were 12.1, 187 and 770 min for the rat, mouse and human models, respectively. Additionally, in vitro intrinsic clearances (Cl int, in vitro) were 229 for rat, 14.8 for mouse, and 3.6 μL/min/mg in the human model, and in vivo intrinsic clearances (Cl int, in vivo) 128, 58.3, and 3.7 mL/min/kg, respectively. The HLM model had the lowest rate of metabolism when compared to RLM and MLM. Also, twelve NEP metabolites were identified from all models, but at different rates of production.

Simultaneous Determination and Stability Analysis of Ten New Psychoactive Substances including Synthetic Cathinones, Phenethylamines, and Ketamine Substitutes in Urine Using Liquid Chromatography-Tandem Mass Spectrometry

Knowing the stability of drugs is important to ensure accurate and reliable results of drug concentrations. This study evaluated the stability of ten new psychoactive substances (NPSs) in urine and methanol/water at different storage temperatures. Quantitative analyses were performed using liquid chromatography-tandem mass spectrometry. Three replicates of each storage condition were analyzed at day 0 and after 7, 14-, 30-, 60-, and 90 days with storage at +25°C, +4°C, and -20°C. For each analyte, the percent difference at each time interval from day 0 was calculated for each storage condition. Para-methoxyamphetamine (PMA), para-methoxymethamphetamine (PMMA), deschloroketamine (DCK), and 2-fluorodeschloroketamine (2-FDCK) were stable in urine, even when stored for 90-day periods at various temperatures. For synthetic cathinones, the concentrations declined over time at room temperature (+25°C) in urine but were relatively stable in methanol solvent with 0.1% formic acid. The significant degradation was found at +25°C, and the most excellent stability was shown by samples stored at -20°C. Phenethylamines (PMA and PMMA) and ketamine substitutes (DCK and 2-FDCK) were relatively more stable than synthetic cathinones (mephedrone, butylone, pentylone, ephylone, 4-MEAPP, and eutylone).

Prevalence of self-reported adverse effects associated with drug use among nightclub and festival attendees, 2019-2022

BACKGROUND

Research investigating adverse effects from drug use has focused extensively on poisonings and mortality. This study focuses on drug-related adverse effects not necessarily resulting in hospitalization or death among a population known for high prevalence of party drug use-electronic dance music (EDM) nightclub and festival attendees.

METHODS

Adults entering EDM venues were surveyed in 2019-2022 (n = 1952). Those reporting past-month use of a drug were asked whether they had experienced a harmful or very unpleasant effect after use. We examined 20 drugs and drug classes with a particular focus on alcohol, cannabis, cocaine, and ecstasy. Prevalence and correlates of adverse effects were estimated.

RESULTS

Almost half (47.6%) of adverse effects involved alcohol and 19.0% involved cannabis. 27.6% of those using alcohol reported an adverse effect, while 19.5%, 15.0%, and 14.9% of participants reported an effect from use of cocaine, ecstasy, and cannabis, respectively. Use of less prevalent drugs, such as NBOMe, methamphetamine, fentanyls, and synthetic cathinones, tended to be associated with higher prevalence of adverse effects. The most consistent risk factor was younger age, while past-month use of a greater number of drugs was often a protective factor against adverse effects. For most drugs, taking too much was the most common perceived reason for the adverse effect, and visiting a hospital after use was most prevalent among those experiencing an adverse effect from cocaine (11.0%).

CONCLUSIONS

Adverse drug effects are common in this population and results can inform prevention and harm reduction in this population and the general population.

New Psychoactive Substances in the Homeless Population: A Cross-Sectional Study in the United Kingdom

The last few years have seen the emergence of new psychoactive substance among the homeless population, specifically synthetic cannabinoid receptor agonists. The purpose of this study is to investigate the knowledge and experiences of new psychoactive substances amongst users from the homeless population. An explanatory research design was applied using a semi-structured questionnaire with the focus on gaining insights on the prevalence, motivations and effects. Participants were recruited through convenience sampling from support organisations and charities UK-wide. Descriptive statistics and logistic regression were applied to analyse the data obtained from participant surveys. A total of 105 participants met the inclusion criteria and were in the age range of 18 to 64 years old. Almost 70% consumed new psychoactive substance products, which “Spice” was the most prevalent substance. Homeless users had consumed new psychoactive substance to escape reality and to self-treat themselves and stopped consumption due to the adverse effects. Adverse events were reported from the majority of the participants and led to more than 20% of the participants requiring medical treatment following hospitalisation. Findings from this study can contribute to the development of guidelines and policies that specifically address the needs of the homeless population who use new psychoactive substances.

Unraveling Psychiatric Disorders through Neural Single-Cell Transcriptomics Approaches

The development of single-cell and single-nucleus transcriptome technologies is enabling the unraveling of the molecular and cellular heterogeneity of psychiatric disorders. The complexity of the brain and the relationships between different brain regions can be better understood through the classification of individual cell populations based on their molecular markers and transcriptomic features. Analysis of these unique cell types can explain their involvement in the pathology of psychiatric disorders. Recent studies in both human and animal models have emphasized the importance of transcriptome analysis of neuronal cells in psychiatric disorders but also revealed critical roles for non-neuronal cells, such as oligodendrocytes and microglia. In this review, we update current findings on the brain transcriptome and explore molecular studies addressing transcriptomic alterations identified in human and animal models in depression and stress, neurodegenerative disorders (Parkinson's and Alzheimer's disease), schizophrenia, opioid use disorder, and alcohol and psychostimulant abuse. We also comment on potential future directions in single-cell and single-nucleus studies.

Revealing the structure and mechanisms of action of a synthetic opioid with model biological membranes at the air-water interface

Synthetic opioids such as piperazine derivative called MT-45 interact with opioid receptors in a manner similar to morphine leading to euphoria, a sense of relaxation and pain relief and are commonly used as substituents of natural opioids. In this study we show the changes in the surface properties of nasal mucosa and intestinal epithelial model cell membranes formed at the air - water interface using Langmuir technique upon the exposure to MT-45. Both membranes constitute the first barrier to absorb this substance into the human body. The presence of the piperazine derivative affects the organization of both DPPC and ternary DMPC:DMPE:DMPS monolayers treated as simple models of nasal mucosa and intestinal cell membranes, respectively. This novel psychoactive substance (NPS) leads to the fluidization of the model layers, which may indicate their increased permeability. MT-45 has a greater influence on the ternary monolayers characteristic of the intestinal epithelial cells than nasal mucosa. It might be attributed to the increased attractive interactions between the components of the ternary layer, which in turn increase the interactions with a synthetic opioid. Additionally, the crystal structures of MT-45 determined by single-crystal and powder X-ray diffraction methods allowed us to both provide useful data for facilitating the identification of synthetic opioids as well as to attribute the effect of MT-45 to the ionic interactions between protonated nitrogen atoms and negatively charged parts of the polar heads of the lipids.

Fourth Generation of Synthetic Cannabinoid Receptor Agonists: A Review on the Latest Insights

BACKGROUND

Over the past few years, an emerging number of new psychoactive substances (NPSs) entered the illicit market. NPSs are designed to resemble the effects of classical drugs of abuse, reinforcing their effects and duration. Among the most abused NPS, synthetic cannabinoids are cannabinoid receptor agonists (SCRAs) that mimic the effect of the main psychotropic phytocannabinoid Δ9-tetrahydrocannabinol (THC).

METHODS

We herein reviewed the international literature to provide available information on the newest SCRAs generation.

RESULTS

Compared to the previous SCRAs generations, the structures of the last generation result in increased affinity for and efficacy at cannabinoid CB₁ receptors, which are thought to be mainly responsible for the psychoactive effects of THC and its analogues. Accordingly, these more potent cannabimimetic effects may increase the number of adverse reactions such as neurological disorders (e.g., psychosis, agitation, irritability, paranoia, confusion, and anxiety), psychiatric episodes (e.g., hallucinations, delusions, self-harm), other physical conditions (e.g., tachycardia, hypertension, arrhythmia, chest pain, nausea, vomiting, and fever) and deaths. In the last decade, more than a hundred SCRAs from different chemical classes emerged on the illicit web market. SCRAs have been thoroughly studied: they were physico-chemically characterized, and pharmaco-toxicological characteristics were investigated. The last SCRAs generations include increasingly potent and toxic compounds, posing a potential health threat to consumers.

CONCLUSION

From November 2017 to February 2021, at least 20 new "fourth-generation" SCRAs were formally reported to international drug agencies. Our understanding of the neurotoxicity of these compounds is still limited due to the lack of global data, but their potency and their toxicity are likely higher than those of the previous generations.

Rapid In Situ Detection of THC and CBD in Cannabis sativa L. by 1064 nm Raman Spectroscopy

The need to find a rapid and worthwhile technique for the in situ detection of the content of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in Cannabis sativa L. is an ever-increasing problem in the forensic field. Among all the techniques for the detection of cannabinoids, Raman spectroscopy can be identified as the most cost-effective, fast, noninvasive, and nondestructive. In this study, 42 different samples were analyzed using Raman spectroscopy with 1064 nm excitation wavelength. The use of an IR wavelength laser showed the possibility to clearly identify THC and CBD in fresh samples, without any further processing, knocking out the contribution of the fluorescence generated by visible and near-IR sources. The results allow assigning all the Raman features in THC- and CBD-rich natural samples. The multivariate analysis underlines the high reproducibility of the spectra and the possibility to distinguish immediately the Raman spectra of the two cannabinoid species. Furthermore, the ratio between the Raman bands at 1295/1440 and 1623/1663 cm^–1 is identified as an immediate test parameter to evaluate the THC content in the samples.

Does cannabis testing in the military drive synthetic cannabinoid use? Self-reported use motivations among justice-involved veterans

BACKGROUND

Though synthetic cannabinoid receptor agonists (SCRAs) were controlled after being introduced as a 'legal high,' SCRAs likely remain appealing to individuals subject to routine drug screens as not all testing programs consistently include SCRAs. Military populations have been linked to SCRAs due to the unconfirmed supposition that testing protocols led many to substitute SCRAs for cannabis. This study aimed to explore SCRA use prevalence, correlates, and use motivations among veterans, with a particular focus on whether United States military personnel substituted SCRAs for cannabis to subvert testing protocols.

METHODS

All veterans appearing in one of eight civilian criminal courts in three U.S. states were invited to answer questionnaire items related to military service, court functionality, and substance use. Of the 579 veterans eligible, 54.9% chose to participate, yielding a cross-sectional sample of 318 veterans charged with a criminal offense by civilian authorities.

RESULTS

Sixty-five (21.3%) justice-involved veterans reported lifetime SCRA use. Use while within the military was reported by 15.0% of veterans enlisting after 2008. Only eight (12.3%) reported SCRAs were used as a substitute for cannabis. Boredom (36.9%), experimentation (27.7%), and social aspects of SCRA use (32.3%) were more commonly reported motives. Logistic regression models indicated that use of cannabis (aPR=2.06, p<.05), hallucinogens (aPR=2.50, p<.01), and SCRAs (aPR=2.49, p<.05) while in the military were risk factors for SCRA use after leaving the military, whereas older age at time of military exist was a protective factor (aPR=.87, p<.01) CONCLUSIONS: Drug testing programs within the military do not appear to have the unintended consequence of routing individuals to more risky drugs; however, SCRAs appear to have been an underappreciated problem within the military. Further, use extends beyond the military with many only initiating use after discharge, suggesting SCRA use may jeopardize the health of veterans post-service.

Selective extraction of synthetic cathinones new psychoactive substances from wastewater, urine and cocktail using dummy molecularly imprinted polymers

Dummy molecularly imprinted polymers (DMIPs) for selective extraction of five common synthetic cathinones (SCs) were prepared by bulk polymerization. DMIPs materials possessed narrow diameter distribution (30-60 µm) and large specific surface area (329.6 m² g^-1). Imprinting factors for cathinone, methcathinone, mephedrone, methylone and ethylone were 1.11-1.82. DMIPs could also quickly adsorb SCs from aqueous solutions within 5 min. Therefore, the materials were used as solid-phase extraction (SPE) sorbents to selectively extract five SCs in complex samples. An accurate and sensitive analytical method based on DMIPs-SPE combined with HPLC-MS/MS was established. Under optimal conditions, the established method showed low limits of detection (0.002-0.1 ng mL^-1), satisfactory recoveries (84.1-97.7%) and good repeatability (relative standard deviation (RSD) below 9%). The method was successfully verified using wastewater, urine and cocktail samples. Recoveries of SCs at three spiking levels were in the range of 75.1-98.6%, with RSD values below 7.0%. Compared with commercial sorbents, DMIPs showed better clean-up ability with matrix effect values of -24.1%-8.3% for all SCs in wastewater, urine and cocktail samples. Therefore, the developed DMIPs-SPE-HPLC-MS/MS strategy could be used as a specific and cost-effective method for sensitive determination of SCs in complex samples.

The Illicit Supply of New Psychoactive Substances Within and From China: A Descriptive Analysis

Although China has played a significant role in the emergence and expansion of new psychoactive substances (NPS) worldwide, little research has specifically focused on the illicit supply of NPS within China and smuggling from China. In this study, data were extracted from sentencing files obtained from closed criminal cases to develop an objective understanding of the NPS supply chain in China. The sample consisted of 341 major cases concerning the illicit supply of three groups of NPS (ketamine, synthetic cathinone, and fentanyl) and five categories of offense, including manufacturing, distributing, retailing, transporting, and manufacturing-retailing. Significant differences between these categories of offense in terms of offenders' profiles, behaviors, and supply patterns were observed. Our results suggest the existence of a dynamic and complex supply network both in China and in terms of smuggling routes from China.

A retrospective analysis of the "Neverending Trip" after administration of a potent full agonist of 5-HT2A receptor - 25I-NBOMe

BACKGROUND

5-HT2A receptor (e.g. 25I-NBOMe) agonists not only pose risks of acute intoxication but also long-term effects and significant adverse reactions, e.g. hallucinogen persisting perception disorder (HPPD), derealization, and depersonalization.

AIMS

We evaluated the risk associated with single and repeated use of 25I-NBOMe. We aimed to identify factors that may increase the risk of HPPD, increase its severity and determine the time when the first symptoms appear. Herein, we report the first extensive evaluation of 25I-NBOMe-induced HPPD.

METHOD

We assessed all reports (58) collected by The Pomeranian Pharmacovigilance Centre (PPC) from 2013 to 2020.

RESULTS

The study included a total of 58 reports of adverse reactions caused by 25I-NBOMe. In the case of 15 reports (in patients aged 19-26 years), symptoms persisted many months after the discontinuation of 25I-NBOMe. The most common were: pseudohallucinations, bizarre delusions, derealizations and in some cases development or worsening of depression has been diagnosed. HPPD-like symptoms were most common in patients who took the drug regularly (i.e., several times a month). The risk of HPPD-like symptoms is higher in patients who have severe visual pseudohallucinations, severe bizarre delusions, derealization and/or depersonalization onset immediately after taking the drug. Recurrence of HPPD symptoms may be provoked by many factors, however, there is some cases there is no apparent reason. HPPD after 25I-NBOMe use can last from 2 months up to 2 years. In some patients, pharmacological treatment was necessary due to 25I-NBOMe-induced HPPD and depression.

CONCLUSIONS

The study showed long-lasting effects after 25I-NBOMe administration and allowed for the determination of HPPD risk factors.

No Good Time Without Drugs: Qualitative Study Among Nightlife Attendees in Tbilisi, Georgia

INTRODUCTION

Individuals who visit nightclubs and electronic dance music (EDM) festivals tend to use psychoactive substances, often multiple substances, in this setting and are at risk of serious negative health effects. This paper aims to explore respondents' experiences and perceptions in order to have a better understanding of patterns and motives related to psychoactive substance use and high-risk behaviours in EDM event attendees.

METHODS

In-depth and focus group interviews with 30 EDM event attendees who reported psychoactive substance use at nightlife events. The data was analysed using the Nvivo-v.10 software.

RESULTS

Mixing multiple substances to get the desired effects was common. Ecstasy was often combined with Jager (alcohol). Drug use in nightlife settings occurred in a group of friends and was perceived as an essential part of having a good time. Most participants reported that they did not use drugs outside nightlife settings. The dangerous synthetic hallucinogen NBOMe was still on the scene. The respondents had a very low level of knowledge about, and perception of, the risks associated with drug consumption. Knowledge about risk minimisation strategies was very low or non-existent.

CONCLUSIONS

Polydrug use and a lack of perceived harmful effects put drug-using nightlife attendees at increased risk of negative health consequences. Future research should focus on identifying strategies to raise the awareness of people who use drugs in nightlife settings and encourage them to employ health protection strategies. Using the social network infrastructure can be thought of as one potentially beneficial approach.

Analysis of drug residue in needle-exchange syringes in Washington, D.C

For the first time in Washington, D.C., an analysis of drug residue from used needle-exchange syringes has been performed. This analysis is part of a larger initiative to understand the District of Columbia's illicit drug supply and its intravenous (IV) user's consumption trends as our nation faces the opioid epidemic. The goal of this study is to develop a more comprehensive monitoring program that provides real-time analysis necessary for public health organizations, in addition to providing initial observations of drugs detected. A total of 1187 syringes were analyzed over a period of nine months. Of these, 732 syringes (61.7%) were confirmed to contain a controlled dangerous substance (CDS). Fentanyl was detected in 490 syringes, the most observed CDS in all syringes analyzed. Heroin was the second most detected CDS, observed in 192 syringes. The third most detected CDS was cocaine, which was observed in 132 syringes, followed by the fourth most detected CDS, methamphetamine, observed in 82 syringes. Novel findings of this study include the first reported detections of methamphetamine, synthetic cathinones, and synthetic cannabinoids in used syringes in D.C. Ninety-seven syringes that contained no CDS contained a non-controlled substance of interest, such as diphenhydramine, xylazine, and etizolam. One limitation of this study is that this method cannot determine whether mixtures present in syringes stem from mixtures present prior to injection, back-to-back usage, or sharing of needles. This preliminary study illustrates the strength of surveillance to monitor drug trends and can be used to detect emerging novel dangerous substances in the future.

New insights into methoxetamine mechanisms of action: Focus on serotonergic 5-HT2 receptors in pharmacological and behavioral effects in the rat

Methoxetamine (MXE) is a dissociative substance of the arylcyclohexylamine class that has been present on the designer drug market as a ketamine-substitute since 2010. We have previously shown that MXE (i) possesses ketamine-like discriminative and positive rewarding effects in rats, (ii) affects brain processing involved in cognition and emotional responses, (iii) causes long-lasting behavioral abnormalities and neurotoxicity in rats and (iv) induces neurological, sensorimotor and cardiorespiratory alterations in mice. To shed light on the mechanisms through which MXE exerts its effects, we conducted a multidisciplinary study to evaluate the various neurotransmitter systems presumably involved in its actions on the brain. In vivo microdialysis study first showed that a single administration of MXE (0.25 and 0.5 mg/kg, i.v.) is able to significantly alter serotonin levels in the rat medial prefrontal cortex (mPFC) and nucleus accumbens. Then, we observed that blockade of the serotonin 5-HT₂ receptors through two selective antagonists, ketanserin (0.1 mg/kg, i.p.) and MDL 100907 (0.03 mg/kg, i.p.), at doses not affecting animals behavior per se, attenuated the facilitatory motor effect and the inhibition on visual sensory responses induced by MXE (3 mg/kg, i.p.) and ketamine (3 mg/kg, i.p.), and prevented MXE-induced reduction of the prepulse inhibition in rats, pointing to the 5-HT₂ receptors as a key target for the recently described MXE-induced sensorimotor effects. Finally, in-vitro electrophysiological studies revealed that the GABAergic and glutamatergic systems are also likely involved in the mechanisms through which MXE exerts its central effects since MXE inhibits, in a concentration-dependent manner, NMDA-mediated field postsynaptic potentials and GABA-mediated spontaneous currents. Conversely, MXE failed to alter both the AMPA component of field potentials and presynaptic glutamate release, and seems not to interfere with the endocannabinoid-mediated effects on mPFC GABAergic synapses. Altogether, our results support the notion of MXE as a NMDA receptor antagonist and shed further lights into the central mechanisms of action of this ketamine-substitute by pointing to serotonin 5-HT₂ receptors as crucial players in the expression of its sensorimotor altering effects and to the NMDA and GABA receptors as potential further important targets of action.

Analysis of Google Trends to monitor new psychoactive substance. Is there an added value?

The past decade has seen an increase in the development and availability of a broad category of drugs, known as new psychoactive substances (NPS). NPS are challenging for public health authorities, therefore the two major drug monitoring bodies - the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the United Nations Office on Drugs and Crime (UNODC) - have implemented the EU Early Warning System (EWS) and Early Warning Advisory (EWA), respectively. While these monitoring systems are informative, it is difficult to keep up with the constant and rapid developmental rate of NPS. The EMCDDA has recognised the need for an alternative and technologically derived early warning system. The aim of this research is to determine whether Google Trends and drug discussion forum data can be used to complement early warning systems for NPS. Forty-eight substances were used in this study and classed into groups based on their chemical structure, following the UNODC classification system. Google Trends data (time range: 2004-2019) and drug forum data (time range: 2003-2018) were extracted for each substance and visual trend profiles were created for class groups as well as individual substances. Analysis was conducted to determine when a substance first appeared on Google Trends and a drug discussion forum as well as their trends over time. This date of first appearance was then compared to the date the substance was first reported to UNODC. Of the three data sources utilised, substances were most likely to appear on Google Trends first. Amongst the different classes of NPS, discernible trends ('block', 'successive', and 'generational' trends) were observed. These trends reflect the evolution of the manufacture of substances or generations of substances that has been observed in the literature. For example, in the synthetic cannabinoids' category, a generational trend is observed that corresponds to the different generations of synthetic cannabinoids. When comparing Google Trends and Drugs-Forum directly, the order of appearance and duration of presence for substances aligns accurately for most classes. Google Trends showed the emergence, persistence, or transient nature of substances, which could direct the focus of law enforcement, health organisation and laboratory resources towards a limited number of substances. When one considers the reliance of individual information seeking on the Web as well as the prominence of NPS on the Web, it becomes clear that Google Trends and drug discussion forums could be used as a complement to current early warning systems.

Determination of AB-FUBINACA and 5F-NPB-22 in rats exposed to "Bonsai" via inhalation and analysis of seized product

Synthetic cannabinoids (SCs) are the most rapidly growing class of recreational designer drugs. Illicit drug manufacturers began to produce herbal smoking materials under a variety of brands names, e.g. "Spice, K2, Bonsai, Yucatan Fire". They were appeared on the European market in 2008. In this study, types of SCs in the herbal product sold as "Bonsai" in Turkey were determined and the identification of these substances in biological samples collected from rats depending on the inhalation of different amounts of plant material were aimed. To determine the SC species in the content of the plant product, analysis was performed via gas chromatography-mass spectrometry. Liquid-liquid extraction methods were utilized for blood and organ samples, while solid-phase extraction with β-glucuronidase enzyme treatment was applied for urine sample preparation. The relationship between the amount of burned plant and the amount of SCs accumulated in the blood, urine and organ samples of rats exposed to the plant product by inhalation was examined by liquid chromatography-tandem mass spectrometry. AB-FUBINACA and 5F-NPB-22 were detected in the herbal product. A significant correlation was found between the amount of herbal product inhaled and the prevalence of SCs, especially in lung tissues while no SCs were detected in the blood and urine samples of rats. There is currently no study on biological samples of individuals exposed to herbal products containing SCs by inhalation. Regarding the findings obtained in this study, the overall increase in the amounts of herbal product inhaled was demonstrated to pose a potential risk to humans.

Structure Assignment of Seized Products Containing Cathinone Derivatives Using High Resolution Analytical Techniques

The innovation of the new psychoactive substances (NPS) market requires the rapid identification of new substances that can be a risk to public health, in order to reduce the damage from their use. Twelve seized products suspected to contain illicit substances were analyzed by attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), gas chromatography coupled to mass spectrometry (GC-MS), and nuclear magnetic resonance spectroscopy (NMR). Synthetic cathinones (SCat) were found in all products, either as a single component or in mixtures. Infrared spectra of all products were consistent with the molecular structure of SCat, showing an intense absorption band at 1700–1674 cm⁻¹, corresponding to the carbonyl stretching, a medium/strong peak at 1605–1580 cm⁻¹, indicating stretching vibrations in the aromatic ring (C=C) and bands with relative low intensity at frequencies near 2700–2400 cm⁻¹, corresponding to an amine salt. It was possible to identify a total of eight cathinone derivatives by GC-MS and NMR analysis: 4′-methyl-α-pyrrolidinohexanophenone (MPHP), α-pyrrolidinohexanophenone (α-PHP), 3-fluoromethcathinone (3-FMC), methedrone, methylone, buphedrone, N-ethylcathinone, and pentedrone. Among the adulterants found in these samples, caffeine was the most frequently detected substance, followed by ethylphenidate. These results highlight the prevalence of SCat in seized materials of the Portuguese market. Reference standards are usually required for confirmation, but when reference materials are not available, the combination of complementary techniques is fundamental for a rapid and an unequivocal identification of such substances.

An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: Preliminary results from a community drug checking program using point-of-care and confirmatory methods

BACKGROUND

From mid-2018, an increase in novel psychoactive substance (NPS) benzodiazepines was noted on surveillance of the unregulated drug market around Vancouver, British Columbia, Canada. The rise was concordant with an outbreak of atypical overdoses suspicious for benzodiazepine adulteration of unregulated opioids. This study sought to describe the number and type of NPS benzodiazepines in a sample drawn from a community drug checking program during this period, and to explore accuracy of point-of-care drug checking technologies when compared to confirmatory methods in this sample.

METHODS

Point-of-care drug checking data using fentanyl and benzodiazepine test strips as well as Fourier transform infrared spectroscopy were gathered at harm reduction sites in the Vancouver area from October 2018 to January 2020. A convenience subsample underwent confirmatory testing with gas chromatography-mass spectrometry, liquid chromatography-mass spectrometry, or quantitative nuclear magnetic resonance spectroscopy.

RESULTS

Of 159 samples with both point-of-care and confirmatory results, 24 (15.1%) contained at least one NPS benzodiazepine, including etizolam (n = 18), flubromazolam (n = 3), flualprazolam (4), and flubromazepam (n = 1). Of 114 confirmatory samples expected by participants on self-report to contain opioids, 18 (15.8%) contained some NPS benzodiazepine, with 16 (14.0%) containing both an NPS benzodiazepine and an opioid, always fentanyl. False positive and negative rates were 15.5% and 37.5% for test strips, and 3.9% and 91.7% for FTIR, respectively. Combined together, false positive and negative rates of point-of-care methods were 17.8% and 29.2%.

CONCLUSIONS

NPS benzodiazepine adulteration in an unregulated drug supply sample reveals new risks compounding ongoing harms associated with the synthetic opioid epidemic. Given substantial false positive and false negative rates noted in our sample for point-of-care detection methods, cautious use of combined point-of-care methods, routinely paired with confirmatory drug checking may aid in early detection and monitoring of unregulated drug markets and inform targeted harm reduction strategies and health policy approaches.

Should You Recommend Cannabinoids for This Patient With Painful Neuropathy? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Cannabis includes 140 active cannabinoid compounds, the most important of which are tetrahydrocannabinol and cannabidiol (CBD). Tetrahydrocannabinol is primarily responsible for the intoxicating effects of cannabis; CBD has potential therapeutic effects, including reduction in chronic pain. Recent legislative changes have resulted in the legal availability of cannabinoids in all 50 states, as well as a marked increase in patients' interest in their use. Despite an abundance of data, albeit of varied quality, clinicians may feel poorly prepared to counsel patients seeking advice on the suitability of CBD products for various indications, particularly chronic neuropathic pain. In 2018, on the basis of a systematic review of the literature, a Canadian Evidence Review Group published a guideline with recommendations for clinicians on prescribing cannabinoids in primary care practice. The overall quality of evidence was low to very low. In a meta-analysis of 15 randomized trials of medical cannabis for treating chronic pain, 39% of patients achieved at least a 30% reduction in pain. The corresponding value for placebo-treated patients was 30%; the number needed to treat was 11. More evidence exists for neuropathic pain than for other types of noncancer pain. Here, a general internist with a focus on addiction medicine and an addiction psychiatrist discuss how they would apply the literature to make recommendations for a patient with painful diabetic neuropathy, including counseling on both potential benefits and harms.

Care of the Patient Using Cannabis

The past 2 decades have seen a revolution in legal access to cannabis, driven largely by activists and business interests. As a result, the population of cannabis users nationwide-especially daily users-has grown significantly. An estimated 4.5-7 million persons in the United States now meet criteria for cannabis use disorder annually. This article focuses on the effects of cannabis use, intoxication, and withdrawal while also reviewing the developmental pathways of cannabis use disorder as well as evidence-based pharmacologic and psychosocial treatments.

Accidental Ingestion of a Novel Psychoactive Substance: A Case Report

Novel psychoactive substances (NPSs) are a new generation of designer drugs that are quickly replacing the traditionally abused street drugs. Since their development, the number of molecules in NPSs and their variants have expanded exponentially. Little is known locally about the toxic effects of the exposure of these NPSs. We report two cases of accidental ingestion of methyl (2S)-2-{[1-(5-fluoropentyl)-1H-indole-3-arbonyl]amino}-3,3-dimethylbutanoate (5-fluoro-MDMB-PICA), a recent NPS. They were drinking the liquid in a winter melon tea bottle, and one patient had a seizure episode directly after ingestion. Both patients were managed supportively and discharged after a brief hospitalization period. Presentation to the emergency departments (EDs) following exposure to NPSs may become more common. Knowledge about the impact of NPS exposure and their clinical effects is lacking amongst emergency physicians in Singapore, and this case report serves as a potential resource for physicians.

Long-Term Substance Use Can Cause Irreversible Photopic Vision Changes in Substance Use Disorder in Remission

OBJECTIVE

Substance use has such effects on pupil diameter. Although there is knowledge about the acute effects of substances on pupils, studies showing their chronic effects are limited. The aim of the present study was to evaluate the effect of long-term substance use on scotopic, mesopic, and photopic vision.

METHODS

The present study with cross-sectional desgn was conducted at the Adiyaman Training and Research Hospital for Psychiatry in Adiyaman. This study involved 110 substance use disorder (SUD) patients and 46 healthy volunteers as the control. The parameters were measured and recorded automatically by a device.

RESULTS

The mean age was 23.44±5.53 years in the SUD group and 24.26±5.38 years in healthy controls (p=0.420). The mean age of onset of the substance was 17.74±3.89 years and the mean duration of substance use was 3.54±2.9 years. It was determined that the patients had not used any substance for a mean of 121.73±117.49 days. There was no significant difference between patient and control groups in terms of scotopic and mesopic measurements of both eyes (p>0.05). Photopic measurements were significantly higher in the patient group than in the control group (p<0.05). Photopic measurements were significantly higher in the opioid, cannabis, ecstasy, and multiple substance use groups than in the control group (p<0.05).

CONCLUSION

The most important topic of this study is that photopic vision is permanently impaired in patients with a history of chronic substance use. This was attributed to disrupted sympathetic-parasympathetic hierarchy.

Exploring the chemical profile of designer drugs by ESI(+) and PSI(+) mass spectrometry-An approach on the fragmentation mechanisms and chemometric analysis

The consumption of design drugs, frequently known as new psychoactive substances (NPS), has increased considerably worldwide, becoming a severe issue for the responsible governmental agencies. These illicit substances can be defined as synthetic compounds produced in clandestine laboratories in order to act as analogs of schedule drugs mimetizing its chemical structure and improving its pharmacological effects while hampering the control and making regulation more complicated. In this way, the development of new methodologies for chemical analysis of NPS drugs is indispensable to determine a novel class of drugs arising from the underground market. Therefore, this work shows the use of high-resolution mass spectrometry Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) applying different ionization sources such as paper spray ionization (PSI) and electrospray ionization (ESI) in the evaluation of miscellaneous of seized drugs samples as blotter paper (n = 79) and tablet (n = 100). Also, an elucidative analysis was performed by ESI(+)MS/MS experiments, and fragmentation mechanisms were proposed to confirm the chemical structure of compounds identified. Besides, the results of ESI(+) and PSI(+)-FT-ICR MS were compared with those of GC-MS, revealing that ESI(+)MS showed greater detection efficiency among the methodologies employed in this study. Moreover, this study stands out as a guide for the chemical analysis of NPS drugs, highlighting the differences between the techniques of ESI(+)-FT-ICR MS, PSI(+)-FT-ICR MS, and GC-MS.

Determining changes in new psychoactive substance use in Australia by wastewater analysis

Measuring community consumption of new psychoactive substances (NPS) is notoriously difficult to assess by traditional means such as surveys and seizure data. Previously, we used the approach to demonstrate the prevalence of NPS on a national scale. In the current study we explored the temporal resolution for the analysis of NPS in wastewater from Australia. Samples covering all States and Territories in Australia and both metropolitan and regional areas and were collected bimonthly from October 2017-June 2018 and October 2019-February 2020. A qualitative screening method was applied, screening for 201 NPS. In total, 15 substances were found from a variety of classes of NPS. The most prevalent class was synthetic cathinones, with pentylone, N-ethylpentylone and ethylone found in all periods in at least one site in the earlier sampling period, as well as the amphetamine-like paramethoxyamphetamine (PMA). In the latter period, synthetic cathinones were also the most prevalent, including eutylone, marking the first time that this compound has been detected in wastewater. This study shows the application of wastewater analysis to detect outbreaks of NPS use and temporal differences among sites.

Method Consolidation to Improve Scope and Efficiency in Postmortem Toxicology

Systematic toxicological approaches that employ both ideology changes and improvements in instrumentation and sample extraction allow for improved toxicology testing efficiency through lower sensitivities, higher specificity and minimized resource use. Historically, the San Francisco Office of the Chief Medical Examiner relied heavily on a gas chromatography mass spectrometry (GC-MS) testing regime, comprised of individual drug-class confirmation and quantitation assays. Traditional methods utilizing GC-MS typically require iterations of testing, exhausting sample volume, and hindering productivity and turnaround times, particularly for polypharmacy cases frequently seen in modern postmortem toxicology. The method described here consolidated the scope of seven legacy methods into a single liquid chromatography tandem mass spectrometry (LC-MS/MS) method for better sensitivity, higher throughput, minimal sample consumption for the quantitation of drugs of abuse and improved quality assurance with the incorporation of smart, automated processing. About 100 μL of blood or urine were rapidly extracted using a simple acetonitrile protein crash and subsequent in-vial filtration and injected on to an LC-MS-MS system. The developed method was fully validated to SWGTOX and international guidelines and incorporated 55 analytes along with a customized query that facilitates rapid and consistent application of acceptability criteria for data processing and review. Applicability was demonstrated with the analysis of 1,389 samples (858 blood and 531 urine) where at least 41% of positive results may have been missed due to their decreased sensitivity and 11% of results were not within the scope of the previous analytical methods estimated. On average, cases in this study would have previously required three distinct GC-MS assays, 3 mL of blood, and upwards of 30 h of active staff time. The described LC-MS-MS analytical approach has mitigated the need to perform multiple assays, utilized only 0.1 mL of sample, significantly reduced analyst work time, incorporated 10 additional analytes and allowed for a more comprehensive testing regime to better inform cause of death determinations.

In vitro and in vivo pharmacological characterization of the synthetic opioid MT-45

MT-45 is a synthetic opioid that was developed in the 1970s as an analgesic compound. However, in recent years MT-45 has been associated with multiple deaths in Europe and has been included in the class of novel psychoactive substances known as novel synthetic opioids (NSOs). Little is known about the pharmaco-toxicological effects of MT-45. Therefore, we used a dynamic mass redistribution (DMR) assay to investigate the pharmacodynamic profile of this NSO in vitro compared with morphine. We then used in vivo studies to investigate the effect of the acute systemic administration of MT-45 (0.01-15 mg/kg i.p.) on motor and sensorimotor (visual, acoustic and tactile) responses, mechanical and thermal analgesia, muscle strength and body temperature in CD-1 male mice. Higher doses of MT-45 (6-30 mg/kg i.p.) were used to investigate cardiorespiratory changes (heart rate, respiratory rate, SpO₂ saturation and pulse distention). All effects of MT-45 were compared with those of morphine. In vitro DMR assay results demonstrated that at human recombinant opioid receptors MT-45 behaves as a potent selective mu agonist with a slightly higher efficacy than morphine. In vivo results showed that MT-45 progressively induces tail elevation at the lowest dose tested (0.01 mg/kg), increased mechanical and thermal antinociception (starting from 1 to 6 mg/kg), decreased visual sensorimotor responses (starting from 3 to 6 mg/kg) and reduced tactile responses, modulated motor performance and induced muscle rigidity at higher doses (15 mg/kg). In addition, at higher doses (15-30 mg/kg) MT-45 impaired the cardiorespiratory functions. All effects were prevented by the administration of the opioid receptor antagonist naloxone. These findings reveal the risks associated with the ingestion of opioids and the importance of studying these drugs and undertaking more clinical studies of the current molecules to better understand possible therapeutic interventions in the case of toxicity.

A qualitative descriptive analysis of effects of psychedelic phenethylamines and tryptamines

OBJECTIVE

The number of novel psychedelic phenethylamines and tryptamines has continued to increase, but little academic research has focused on the effects of these substances. We sought to determine and compare the subjective effects of various substances.

METHODS

We conducted in-depth interviews with 39 adults (75.4% male and 87.2% White) who reported experience using psychedelic phenethylamines and/or tryptamines. Participants described the effects of compounds they have used. We examined the subjective drug effects in a qualitative descriptive manner.

RESULTS

Participants reported on the use of 36 compounds. The majority (64.1%) reported the use of 2C series drugs, with 2C-B use being most prevalent; 38.5% reported the use of NBOMe, and 25.6% reported the use of DOx. With regard to tryptamines, 46.2% reported use, and 4-AcO-DMT was the most prevalent drug used in this class. 2C-B was often described as being more favorable than other 2C series compounds with the effects described as being comparable with MDMA and LSD. NBOMe effects were generally described in an unfavorable manner, and the effects of DOx were often described as lasting too long (12-36 hr). The effects of 4-AcO-DMT were often described as mimicking psilocybin.

CONCLUSION

Knowing the effects of various compounds can inform education, prevention, and harm reduction efforts regarding the use of these drugs.

New psychoactive substances: a review and updates

New psychoactive substances (NPS) are a heterogeneous group of substances. They are associated with a number of health and social harms on an individual and societal level. NPS toxicity and dependence syndromes are recognised in primary care, emergency departments, psychiatric inpatient and community care settings. One pragmatic classification system is to divide NPS into one of four groups: synthetic stimulants, synthetic cannabinoids, synthetic hallucinogens and synthetic depressants (which include synthetic opioids and benzodiazepines). We review these four classes of NPS, including their chemical structures, mechanism of action, modes of use, intended intoxicant effects, and their associated physical and mental health harms. The current challenges faced by laboratory testing for NPS are also explored, in the context of the diverse range of NPS currently available, rate of production and emergence of new substances, the different formulations, and methods of acquisition and distribution.

Differential Risk for Drug Use by Sexual Minority Status among Electronic Dance Music Party Attendees in New York City

Background: Drug use among electronic dance music (EDM) party attendees is common; however, studies are needed to examine associations between drug use and sexual orientation as this can inform prevention and harm reduction efforts in the lesbian, gay, and bisexual (LGB) community. Methods: Data were examined from a repeated cross-sectional study of 3066 young adult EDM party attendees surveyed entering nightclubs and dance festivals in New York City between 2016 and 2018. Of these participants, 277 identified as gay/lesbian, 293 identified as bisexual, and 83 identified as other sexuality. We examined how sexual orientation relates to past-year use of various 'traditional' drugs (e.g., ecstasy/MDMA/Molly) and new psychoactive substances (NPS; e.g., "bath salts") in a bivariable and multivariable manner, stratified by sex. Results: Compared to heterosexual males, gay males were at higher odds for use of ecstasy, GHB, and methamphetamine; bisexual males were at higher odds for use of LSD and unknown powders, and males identifying as "other" sexuality were at higher odds for use of mushrooms and 2C drugs. Compared to heterosexual females, lesbians were at higher odds for use of mushrooms and GHB; bisexual females were at higher odds for use of cocaine, LSD, mushrooms, and tryptamines, and females identifying as "other" sexuality were at higher odds for use of cocaine and tryptamines. Conclusions: We determined differential risk of use of different drugs among those who attend EDM parties according to sexual orientation. Findings can be used to tailor prevention messaging to specific groups within the LGB community.

DARK Classics in Chemical Neuroscience: Synthetic Cannabinoids (Spice/K2)

This Review covers the background, pharmacology, adverse effects, synthesis, pharmacokinetics, metabolism, and history of synthetic cannabinoid compounds. Synthetic cannabinoids are a class of novel psychoactive substances that act as agonists at cannabinoid receptors. This class of compounds is structurally diverse and rapidly changing, with multiple generations of molecules having been developed in the past decade. The structural diversity of synthetic cannabinoids is supported by the breadth of chemical space available for exploitation by clandestine chemists and incentivized by attempts to remain ahead of legal pressures. As a class, synthetic cannabinoid products have a more serious adverse effect profile than that of traditional phytocannabinoids, including notable risks of lethality, as well as a history of dangerous adulteration. Most synthetic cannabinoids are rapidly metabolized to active species with prolonged residence times and peripheral tissue distribution, and analytical confirmation of use of these compounds remains challenging. Overall, the emergence of synthetic cannabinoids serves as a noteworthy example of the pressing public health challenges associated with the increasing development of easily synthesized, structurally flexible, highly potent, psychoactive drugs.

Successful use of a novel lux® i-Amylose-1 chiral column for enantioseparation of "legal highs" by HPLC

Bath salts, fumigations, cleaners and air fresheners, behind these terms substances are hidden, which count as "Legal Highs". These fancy names are used to pretend Legal Highs as harmless compounds, to circumvent legal regulations for marketing as well as to increase the sales. Besides classic illicit drugs of synthetic origin such as amphetamines, cocaine and MDMA, the trade of these compounds, also known as new psychoactive substances (NPS), is not uncommon today. In many countries, NPS are still not subject to drug control. Among them, there are stimulants such as new amphetamine derivatives or cathinones, which possess a chiral centre. Little is known about the fact that the two possible enantiomers may differ in their pharmacological effect. The aim of this study was to test a novel HPLC column for the enantioseparation of a set of 112 NPS coming from different chemical groups and collected by internet purchases during the years 2010-2018. The CSP, namely Lux® 5 μm i-Amylose-1, LC Column 250 x 4.6 mm, was run in normal phase mode under isocratic conditions, UV detection was performed at 245 nm and 230 nm, injection volume was 10 μl and flow rate was 1 ml/min. With a mobile phase consisting of n-hexane/isopropanol/diethylamine (90:10:0.1), herein, 79 NPS were resolved into their enantiomers successfully, for 37 of them baseline resolution was achieved. After increase of lipophily of the mobile phase to 99:1:0.1, another 27 compounds were baseline separated. It was found that all separated NPS are traded as racemic compounds.

New psychoactive substances (NPS) prevalence over LSD in blotter seized in State of Santa Catarina, Brazil: A six-year retrospective study

Designer drugs or new psychoactive substances (NPS) are a heterogeneous group of substances obtained through the modification of chemical structure of some natural products or drugs. NPS illegally commercialized in blotter papers mimicking the most common form of LSD consumption, with a great variability of colours and symbols, have largely increased worldwide, including in Brazil, becoming an important emerging public health issue. In this study, we have evaluated the presence and profile of NPS in blotters seized in the State of Santa Catarina, Brazil, over the period of 2011 to 2017. The state government criminal forensics staff has performed gas chromatography-mass spectrometer (GC-MS) analyses in order to determine the chemical composition of the blotters. During the evaluated period, there was a considerable increase in the seizing of blotters events, from 87 in 2011, to 301 in 2016 and reaching 277 in 2017. There was also an increase in the number of blotters seized per event. Interestingly, while in 2011, 100% of blotters contained LSD, this number decreased to 0,1% in 2014, and achieved 17,6% in 2017, when up to 25 different substances were detected in blotters seized. Drugs such as DOx, NBOMe, fentanyl, mescaline derivatives, triptamines, cathinones, and synthetic cannabinoids were detected and became the major substances found in blotters. In some cases, more than one substance was found in the same blotter, characterizing a new mixture scenario. The presence of several new psychoactive substances in blotters is a reality in forensic toxicology. In Brazil, it might be related to the fact that most of these substances were not considered illegal by Brazilian legislation by the time they emerged.