Grafinger Katharina Elisabeth, Liechti Matthias E, Liakoni Evangelia
Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Pharmacology, University of Bern, Bern, Switzerland.
Br J Clin Pharmacol. 2020 Mar;86(3):429-436. doi: 10.1111/bcp.14115. Epub 2019 Dec 17.
New psychoactive substances (NPS) have emerged worldwide in recent years, posing a threat to public health and a challenge to drug policy. NPS are usually derivatives or analogues of classical recreational drugs designed to imitate their effects while circumventing regulations. This article provides an overview of benefits and limitations of analytical screening in managing patients presenting with acute NPS toxicity. NPS typically cannot be analytically identified with the usual immunoassay tests. To detect NPS using an immunoassay, antibodies specifically binding to the new structures would have to be developed, which is complicated by the rapid change of the NPS market. Activity-based assays could circumvent this problem since no prior knowledge on the substance structure is necessary. However, classical recreational drugs activating the same receptors could lead to false positive results. Liquid or gas chromatography coupled with mass spectrometry is a valuable NPS analysis tool, but its costs (e.g. equipment), run time (results usually within hours vs minutes in case of immunoasssays) and the need for specialized personnel hinder its use in clinical setting, while factors such as lack of reference standards can pose further limitations. Although supportive measures are sufficient in most cases for adequate patient management, the detection and identification of NPS can contribute significantly to public health and safety in cases of e.g. cluster intoxications and outbreaks, and to the investigation of these novel compounds' properties. However, this requires not only availability of the necessary equipment and personnel, but also collaboration between clinicians, authorities and laboratories.
近年来，新型精神活性物质（NPS）在全球范围内出现，对公众健康构成威胁，并给毒品政策带来挑战。NPS通常是经典消遣性药物的衍生物或类似物，旨在模仿其效果同时规避监管。本文概述了分析筛查在处理急性NPS中毒患者时的益处和局限性。NPS通常无法通过常规免疫分析检测来进行分析鉴定。要使用免疫分析检测NPS，就必须开发能特异性结合新结构的抗体，而NPS市场的快速变化使这一过程变得复杂。基于活性的分析方法可以规避这个问题，因为无需事先了解物质结构。然而，激活相同受体的经典消遣性药物可能会导致假阳性结果。液相或气相色谱与质谱联用是一种有价值的NPS分析工具，但其成本（如设备）、运行时间（结果通常需要数小时，而免疫分析只需几分钟）以及对专业人员的需求阻碍了其在临床环境中的使用，同时缺乏参考标准等因素可能会带来进一步的限制。尽管在大多数情况下，支持性措施足以对患者进行充分管理，但在例如群体性中毒和疫情爆发的情况下，NPS的检测和鉴定对公众健康和安全有重大贡献，也有助于对这些新型化合物特性的研究。然而，这不仅需要有必要的设备和人员，还需要临床医生、当局和实验室之间的合作。
