This six-year multicentre study investigated acute intentional poisoning with substances of abuse in adolescents to identify changes and patterns in substance use. Data from 562 adolescents were collected from three paediatric poison centres in Romania between January 2017 and December 2022. This study analysed the epidemiological and sociodemographic characteristics of the adolescents, including age, gender, place of residence, history of substance abuse, psychiatric history, and history of institutionalised care. The findings revealed that cannabis and new psychoactive substances (NPSs) are the most commonly implicated substances, each with distinct profiles among adolescents. Cannabis was involved in 46.1% of cases, with a significant association with urban residency. NPSs were identified as the second most prevalent substance, accounting for 39.3% of cases. These were more prevalent in rural areas and among patients with psychiatric disorders. Cannabis and NPSs were also the most commonly implicated substances in acute intentional poisoning cases with substances of abuse. These substances have distinct profiles among adolescents, including age, gender, residency area, history of substance abuse, psychiatric history, and institutional care. These findings underscore the necessity of targeted public health interventions and integrated care approaches to address substance use and related mental health issues in adolescents.

UNASSIGNED: Cannabis is the most common recreational drug worldwide and synthetic cannabinoid receptor agonists are currently the largest group of new psychoactive substances. The aim of this study was to compare the clinical features and outcomes of lone acute cannabis toxicity with lone acute synthetic cannabinoid receptor agonist toxicity in a large series of presentations to European emergency departments between 2013-2020.
UNASSIGNED: Self-reported drug exposure, clinical, and outcome data were extracted from the European Drug Emergencies Network Plus which is a surveillance network that records data on drug-related emergency department presentations to 36 centres in 24 European countries. Cannabis exposure was considered the control in all analyses. To compare the lone cannabis and lone synthetic cannabinoid receptor agonist groups, univariate analysis using chi squared testing was used for categorical variables and non-parametric Mann-Whitney U- testing for continuous variables. Statistical significance was defined as a P value of <0.05.
UNASSIGNED: Between 2013-2020 there were 54,314 drug related presentations of which 2,657 were lone cannabis exposures and 503 lone synthetic cannabinoid receptor agonist exposures. Synthetic cannabinoid receptor agonist presentations had statistically significantly higher rates of drowsiness, coma, agitation, seizures and bradycardia at the time of presentation. Cannabis presentations were significantly more likely to have palpitations, chest pain, hypertension, tachycardia, anxiety, vomiting and headache.
UNASSIGNED: Emergency department presentations involving lone synthetic cannabinoid receptor agonist exposures were more likely to have neuropsychiatric features and be admitted to a psychiatric ward, and lone cannabis exposures were more likely to have cardiovascular features. Previous studies have shown variability in the acute toxicity of synthetic cannabinoid receptor agonists compared with cannabis but there is little comparative data available on lone exposures. There is limited direct comparison in the current literature between lone synthetic cannabinoid receptor agonist and lone cannabis exposure, with only two previous poison centre series and two clinical series. Whilst this study is limited by self-report being used to identify the drug(s) involved in the presentations, previous studies have demonstrated that self-report is reliable in emergency department presentations with acute drug toxicity.
UNASSIGNED: This study directly compares presentations with acute drug toxicity related to the lone use of cannabis or synthetic cannabinoid receptor agonists. It supports previous findings of increased neuropsychiatric toxicity from synthetic cannabinoid receptor agonists compared to cannabis and provides further data on cardiovascular toxicity in lone cannabis use.

OBJECTIVE: Smartphones have become everyday objects on which the accumulation of fingerprints is significant. In addition, a large proportion of the population regularly uses a smartphone, especially younger people. The objective of this study was to evaluate smartphones as a new matrix for toxico-epidemiology.
METHODS: This study was conducted during two separate events (techno and trance) at an electronic music nightclub in Grenoble, France. Data on reported drug use and whether drugs were snorted directly from the surface of the smartphone were collected using an anonymous questionnaire completed voluntarily by drug users. Then, a dry swab was rubbed for 20 s on all sides of the smartphone. The extract was analyzed by liquid chromatography coupled to tandem mass spectrometry on a Xevo TQ-XS system (Waters).
RESULTS: In total, 122 swabs from 122 drug users were collected. The three main drugs identified were MDMA (n=83), cocaine (n=59), and THC (n=51). Based on declarative data, sensitivity ranged from 73 to 97.2 % and specificity from 71.8 to 88.1 % for MDMA, cocaine, and THC. Other substances were identified such as cocaine adulterants, ketamine, amphetamine, LSD, methamphetamine, CBD, DMT, heroin, mescaline, and several NPS. Numerous medications were also identified, such as antidepressants, anxiolytics, hypnotics, and painkillers. Different use patterns were identified between the two events.
CONCLUSIONS: This proof-of-concept study on 122 subjects shows that smartphone swab analysis could provide a useful and complementary tool for drug testing, especially for harm-reduction programs and toxico-epidemiolgy studies, with acceptable test performance, despite declarative data.

The acute psychoactive, autonomic, and endocrine effects of the new psychoactive substance (NPS) 5,6-methylenedioxy-2-aminoindane (MDAI; 3.0 mg/kg, range 180-228 mg) were investigated in six healthy volunteers (four males, two females) in a non-blinded fashion without placebo. Subjective, cardiovascular, and endocrine responses were compared with two different doses of 3,4-methylenedioxymethamphetamine (MDMA) (75 mg and 125 mg) described in previously published placebo-controlled studies, which used identical outcome measures including Visual Analogue Scales (VAS), the Adjective Mood Rating Scale (AMRS), and the 5 Dimensions of Altered States of Consciousness (5D-ASC) scale. MDAI was well tolerated and produced subjective effects comparable with those of 125 mg MDMA. MDAI increased blood pressure similar to 125 mg MDMA but did not increase heart rate or body temperature. MDAI increased cortisol and prolactin levels and could be detected in serum about 20 min post ingestion and remained detectable at least for 4 days. In urine, MDAI was detectable over a period of at least 6 days. Further clinical investigations are warranted to assess whether MDAI could serve as drug with medicinal properties.

Mephedrone is a psychoactive drug that increases dopamine, serotonin and noradrenaline levels in the central nervous system via interaction with transporters or monoamines. The aim of the presented study was to assess the role of the GABA-ergic system in the expression of mephedrone-induced reward. For this purpose, we conducted (a) a behavioral evaluation of the impact of baclofen (a GABAB receptors agonist) and GS39783 (a positive allosteric modulator of GABAB receptors) on the expression of mephedrone-induced conditioned place preference (CPP) in rats, (b) an ex vivo chromatographic determination of the GABA level in the hippocampi of rats subchronically treated with mephedrone and (c) an in vivo evaluation of GABA hippocampal concentration in rats subchronically administered with mephedrone using magnetic resonance spectroscopy (MRS). The results show that GS39783 (but not baclofen) blocked the expression of CPP induced by (20 mg/kg of) mephedrone. The behavioral effect was consistent with chromatographic analysis, which showed that mephedrone (5 and 20 mg/kg) led to a decrease in GABA hippocampal concentration. Altogether, the presented study provides a new insight into the involvement of the GABA-ergic system in the rewarding effects of mephedrone, implying that those effects are at least partially mediated through GABAB receptors, which suggests their potential role as new targets for the pharmacological management of mephedrone use disorder.

UNASSIGNED: Synthetic cathinones are a heterogenous group of new psychoactive substances (NPS) with a surging prevalence of use. They are sold under the name of \"Bath Salts,\" \"Legal Highs\" or \"Research Chemical.\" It is a heterogeneous group of substances that have a varying binding selectivity and affinity. Due to limited availability of NPS screening tests, inadequate legislation, the exponential increases in availability of new NPS and the comorbid use of other illicit substances, scientific research remains scarce. As a result, insight in their mental and psychomotor effects is limited.
UNASSIGNED: We present a case of a 21-year-old woman with daily usage of synthetic cathinones, more specifically α-Pyrrolidinopentiophenone (α-PVP-better known as \"Flakka\"), α-Pyrrolidinohexiophenone (α-PHP) and alpha-Pyrrolidinoisohexaphenone (α-PHiP). Besides a severe paranoid psychotic state of mind, characterized by persecutory and somatic delusions, there was also a very pronounced psychomotor restlessness during the whole period of hospitalization which was diagnosed as akathisia. She reported that she was unable to sit during meals, had difficulty standing still and felt a constant urge to pay attention to the restlessness. The patient did not take any antipsychotic medication at admission.
UNASSIGNED: The patient was treated in accordance with the current guidelines concerning akathisia with a combination of Quetiapine 200 mg, Propranolol 80 mg, Diazepam 10 mg, Biperiden 4 mg, and Mirtazapine 15 mg without any sufficient alleviation of complaints. Before the start of the treatment, Barnes Akathisia Rating Scale (BARS) score was 11 out of 14 which evolved toward a score of 7 over the course of the 40 day hospitalization, implying persisting severe akathisia which only improved modestly.
UNASSIGNED: The current case suggests that besides cocaine, amphetamines and methamphetamines, synthetic cathinones can also increase the risk for development of extrapyramidal symptoms such as akathisia. Especially a-PVP-analogs as used by the current patient and Pyrovalerone-analogs such as Methylenedioxypyrovalerone (MDPV) are very powerful dopamine reuptake-inhibitors which might lead to strong locomotor activation. Up to this day it remains very difficult to establish a guideline concerning the treatment of intoxication with synthetic cathinones or dependence thereof.

BACKGROUND: Russia, like many other places, is currently experiencing a proliferation of new psychoactive substances, many of which are psychostimulants. In St. Petersburg, these appear to be mostly congeners of cathinone. We sought to obtain qualitative data to better understand the impact on the health and behaviors of people who use drugs (PWUD) by recruiting individuals who reported recent use of psychostimulants.
METHODS: In-depth qualitative data on current drug use and its effects were collected through thirty interviews (n=30) and two focus groups (n=10: five male, five female). The interviews and focus groups also provided data on the social contexts of drug use including sexual behaviors and associated medical issues. Secondary data about online drug purchases were obtained from a source that accesses and analyzes darknet purchases. Qualitative data were initially coded using a priori codes developed on the basis of the interview guide, and then data were coded again inductively based on emergent findings from the data. Thematic analysis was carried out using OpenCode 4.0 qualitative data analysis software.
RESULTS: Thematic analysis of the interviews and focus groups identified distinct differences in behavior patterns between older, more experienced PWUD and a \"new generation\" of PWUD. Routes of initiation of drug use and sexual behaviors associated with drug use differed, but both groups reported high levels of unsafe injection and sexual behaviors. In interpreting the texts and purchasing data, we have attempted to anticipate how the drug use patterns can influence HIV transmission.
CONCLUSIONS: The emergence of a new class of psychostimulant drugs presents new threats to the health of drug users and new opportunities to intervene to reduce those risks. The information obtained may assist HIV/AIDS prevention specialists and drug user support groups in their efforts to decrease unsafe drug use and sexual behaviors.

The use of drugs of abuse has grown significantly in recent decades. In forensic chemistry, methods of identifying and characterizing illicit drugs contribute to the interests of researchers, experts, and public security authorities. Among existing methods, portable Raman spectroscopy is notable for performing rapid, non-destructive, and highly selective analysis in the laboratory or on-site. When the resulting spectral data are paired with chemometric tools, methods of exploratory analysis and multivariate calibration can be developed. Thus, this work describes the application of Raman spectroscopy associated with principal component analysis (PCA) and interval principal component analysis (iPCA) to assessing trends in samples of cocaine (n = 40), crack (n = 33), and their main adulterants (n = 5) and diluents (n = 5), tablets of ecstasy (n = 14), designer drugs papers (n = 27), and alcoholic solutions adulterated with benzodiazepines (alprazolam and diazepam). In addition, competitive adaptive reweighted sampling (CARS) combined with partial least squares (PLS) regression (CARSPLS) was used to quantify adulterants (benzocaine, lidocaine, and procaine) in binary mixtures with crack (n = 21) and solutions of cachaça adulterated with bromazepam (n = 11).

In this review article, we performed an overview of extraction and chromatographic analysis methods of NPS in hair from 2007 to 2021, evaluating the limit of detection (LOD), limit of quantification (LOQ), limit of reporting (LOR), and limit of identification (LOI) values reported for each NPS. Our review aimed to highlight the limitations of modern hair analytical techniques, and the prerequisites for the proper evaluation and use of analytical results in relation to the objectives of NPS hair analysis. In the selected studies the detection of a total of 280 NPS was reported. The detected NPS belonged to seven classes: synthetic cannabinoids with 109 different substances, synthetic opioids with 58, cathinones with 50, phenethylamines with 34, other NPS with 15, tryptamines with ten, and piperazines with four substances. The NPS hair analysis of real forensic/ clinical cases reported the detection of only 80 NPS (out of the 280 targeted), in significantly higher levels than the respective LODs. The analytical protocols reviewed herein for NPS hair analysis showed continuously growing trends to identify as many NPS as possible; the extraction methods seem to have a limited potential to improve, while the various mass spectroscopic techniques and relevant instrumentation provide an enormous field for development and application. Hair is a biological indicator of the past chronic, sub-chronic, and, even, in certain cases, acute exposure to xenobiotics. Therefore, future research in the field could progress NPS hair analysis and aim the monitoring of NPS expansion and extent of use in the community.

The emerging market of new psychoactive substances (NPSs) is a global-scale phenomenon, and their identification in biological samples is challenging because of the lack of information about their metabolism and pharmacokinetic. In this study, we performed in silico metabolic pathway prediction and in vivo metabolism experiments, in order to identify the main metabolites of mephtetramine (MTTA), an NPS found in seizures since 2013. MetaSite™ software was used for in silico metabolism predictions and subsequently the presence of metabolites in the blood, urine, and hair of mice after MTTA administration was verified. The biological samples were analyzed by liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS) using a benchtop Orbitrap instrument. This confirmed the concordance between software prediction and experimental results in biological samples. The metabolites were identified by their accurate masses and fragmentation patterns. LC-HRMS analysis identified the dehydrogenated and demethylated-dehydrogenated metabolites, together with unmodified MTTA in the blood samples. Besides unmodified MTTA, 10 main metabolites were detected in urine. In hair samples, only demethyl MTTA was detected along with MTTA. The combination of Metasite™ prediction and in vivo experiment was a powerful tool for studying MTTA metabolism. This approach enabled the development of the analytical method for the detection of MTTA and its main metabolites in biological samples. The development of analytical methods for the identification of new drugs and their main metabolites is extremely useful for the detection of NPS in biological specimens. Indeed, high throughput methods are precious to uncover the actual extent of use of NPS and their toxicity.