Elsevier

Toxicology Letters

Volume 229, Issue 1, 17 August 2014, Pages 220-228
Toxicology Letters

Understanding the risks associated with the use of new psychoactive substances (NPS): High variability of active ingredients concentration, mislabelled preparations, multiple psychoactive substances in single products

https://doi.org/10.1016/j.toxlet.2014.06.012Get rights and content

Abstract

New psychoactive substances (NPS), are now a large group of substances of abuse not yet completely controlled by international drug conventions, which may pose a public health threat. Anxiety, paranoia, hallucinations, seizures, hyperthermia and cardiotoxicity are some of the common adverse effects associated with these compounds. In this paper, three case reports taken from the archive of processed cases of the authors' laboratory are presented and discussed to stress the risks of possible adverse consequences for NPS users: in particular, (i) the risk deriving from the difficulty of predicting the actual consumed dose, due to variability of active ingredients concentration in consumed products, (ii) the risk deriving from the difficulty of predicting the actual active ingredients present in consumed products, as opposed to those claimed by the manufacturer, and (iii) the risk deriving from the difficulty of predicting the actual pharmacological and toxicological effects related to the simultaneous consumption of different psychoactive ingredients contained in single products, whose interactions are mostly unknown. Each of them individually provide a source of concern for possible serious health related consequences. However, they should be considered in conjunction with each others, with the worldwide availability of NPS through the web and also with the incessantly growing business derived from the manipulation and synthesis of new substances. The resulting scenario is that of a cultural challenge which demands a global approach from different fields of knowledge.

Graphical abstract

The risk derived from the intra- and inter-product concentration variability, which may expose users to unexpected dosages, the risk derived from the lack of quality in the manufacture process and mislabelled preparations, which doesn't provide users the basic information about what they consume, and the risk derived from the simultaneous consumption of different psychoactive substances, whose pharmacodynamics and adverse effects are almost unknown, are a source of concern for possible serious health related consequences.

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Section snippets

Background

New psychoactive substances (NPS), are now a large group of substances of abuse not yet completely controlled by international drug conventions, which may pose a public health threat UNODC, 2013a. Many of these substances were synthesized and patented in the early 1970s or even earlier, but only recently their chemistry have been modified to produce new substances with similar subjective effects to established recreational drugs UNODC, 2013a. ‘Legal highs’, ‘herbal highs’, ‘research chemicals’

Case #1 – how much of it?

The first event, from which Case #1 started, was a medical report about a young boy (age 18) who presented a critical clinical status caused by the consumption of an unknown white powder. When the boy was admitted to the hospital he presented hallucinations, agitation, confusion, memory loss and clonus and amphetamine overdose was initially suspected. At screening tests performed at the emergency department he was also found positive to cannabinoids and was hospitalized under sedation. After a

Case #2 – what is it… actually?

Case #2 concerns a seizure consisting of 16 coloured, industrial made packages, each containing 3 white capsules filled with about 500 mg each of yellowish fine powder, which was submitted to the LIATF for analysis. All the packages were bar-coded and reported clearly, printed or attached on the rear, lists of the ingredients contained in the capsules. According to the package labelling, the capsules were of two kinds: type-A, containing amino acid blend, gelatine (capsule shell),

Case #3 – how many are they?

The third case report regards the risk related to poly-substance consumption. In this Case, 50 industrial made packages containing about 2 g each of herbal materials being sold in a so-called ‘smart-shop’ were seized under suspicion of containing illicit active ingredients and submitted to the LIATF for analysis. According to the packaging, these were divided into three groups: A (30 packages), B (18 packages) and C (2 packages). Along with these, another bigger wrapping with no label or

Discussion

The risk derived from the intra- and inter-product concentration variability which may expose users to unexpected dosages has been represented in Case #1. Although herbal materials containing NPS are prepared to evoke traditional cannabis, it should be noted that synthetic cannabinoids appear to be more potent and to have more pronounced and severe cardiovascular adverse effects than traditional cannabis Lapoint et al., 2011, Tomiyama and Funada., 2014, Fantegrossi et al., 2014, Young et al.,

Conclusions

The aim of this paper was to stress the importance of possible risks of toxicological effects after the consumption of NPS-containing home made and industrial products. In particular, (1) the risk derived from the intra- and inter-product concentration variability (Case #1), which may expose users to unexpected dosages, (2) the risk derived from the lack of quality in the manufacture process (Case #2), which doesn’t provide users the basic information about what they consume, and (3) the risk

Conflict of interest

The authors declare no conflict of interest.

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