Logan Barry K, Mohr Amanda L A, Friscia Melissa, Krotulski Alex J, Papsun Donna M, Kacinko Sherri L, Ropero-Miller Jeri D, Huestis Marilyn A
Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation, 2300 Stratford Ave, Willow Grove, PA 19090, USA.
NMS Labs, 3701 Welsh Rd, Willow Grove, PA 19090, USA.
J Anal Toxicol. 2017 Sep 1;41(7):573-610. doi: 10.1093/jat/bkx031.
Novel psychoactive substances (NPS) represent significant analytical and interpretive challenges to forensic and clinical toxicologists. Timely access to case reports and reports of adverse incidents of impairment or toxicity is imperative to clinical diagnosis and treatment, as well as to interpretation of forensic results. Delays in identifying the presence of a novel intoxicating agent have significant consequences for public health and public safety. Adverse effects of intoxications with novel cannabinoids, stimulants, hallucinogens, benzodiazepines and opioids spanning January 2013 through December 2016 as reported in emergency departments, death investigations, impaired driving cases and other forensic contexts are the subject of this review. Discussion of the chemistry, pharmacology and adverse events associated with novel drug classes is summarized and described within. Adverse effects or symptoms associated with ingestion of more than 45 NPS have been abstracted and summarized in tables, including demographics, case history, clinical or behavioral symptoms, autopsy findings and drug confirmations with quantitative results when provided. Based on these findings and gaps in the available data, we provide recommendations for future toxicological testing of these evolving substances. These include development and management of a national monitoring program to provide real-time clinical and toxicological data, confirmed analytically, on emerging drugs and their known toxidromes and side effect profiles. Increased efforts should be made to analytically confirm the agents responsible for clinical intoxications involving adverse events in emergency department admissions or hospitalizations. Evidence-based community preparedness among analytical laboratories gained through active communication and sharing of toxicological findings and trends in NPS is imperative to assist in enabling early detection of new drugs in forensic and clinical populations.
新型精神活性物质（NPS）给法医毒理学家和临床毒理学家带来了重大的分析和解释难题。及时获取病例报告以及有关损伤或毒性不良事件的报告对于临床诊断和治疗以及法医结果的解释至关重要。新型致醉剂识别的延迟对公众健康和公共安全会产生重大影响。本文综述了2013年1月至2016年12月期间在急诊科、死亡调查、酒驾案件及其他法医背景下报告的新型大麻素、兴奋剂、致幻剂、苯二氮䓬类药物和阿片类药物中毒的不良反应。文中总结并描述了与新型药物类别相关的化学、药理学及不良事件的讨论内容。已将与摄入45种以上新型精神活性物质相关的不良反应或症状进行了摘要并汇总成表格，包括人口统计学信息、病史、临床或行为症状、尸检结果以及有定量结果时的药物确认情况。基于这些发现以及现有数据中的差距，我们针对这些不断演变的物质的未来毒理学检测提出了建议。这些建议包括制定和管理一项国家监测计划，以提供经分析确认的关于新兴药物及其已知中毒症状和副作用特征的实时临床和毒理学数据。应加大力度分析确认导致急诊科收治或住院患者出现不良事件的临床中毒的致病药物。通过积极交流和分享新型精神活性物质的毒理学发现及趋势，在分析实验室中开展基于证据的社区准备工作对于协助在法医和临床人群中早期发现新药至关重要。
