Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
Department of Laboratory Medicine, Unity Health Toronto (St. Michael's Hospital), Toronto, ON, Canada.
Clin Biochem. 2024 Dec;133-134:110810. doi: 10.1016/j.clinbiochem.2024.110810. Epub 2024 Aug 23.
The production and use of New Psychoactive Substances (NPS) has skyrocketed over the last decade, causing major challenges for government authorities, public health agencies, and laboratories across the world. NPS are designed to mimic the psychoactive effects of unregulated or controlled drugs, while constantly being modified to evade drug control regulation. Hence, they are referred to as "legal highs", as they are technically legal to sell, possess, and use. NPS can be classified by their pharmacological mechanism of action and include cannabimimetic, depressants, dissociatives, hallucinogens, opioids, and stimulants. There is significant structural diversity within each NPS class, leading to variable detection using traditional clinical laboratory testing and complicating the interpretation of results. In this article, we review each of the NPS classes and summarize their associated mechanism of action, common structures, and metabolic pathways, and provide examples of recent drugs and emerging threats with a focus on Canadian drug trends. We also explore the current analytical advantages and limitations commonly faced by the clinical laboratory and provide insight on how toxicosurveillance can improve detection of NPS in the ever-changing NPS landscape.
在过去十年中，新精神活性物质（NPS）的生产和使用呈爆炸式增长，给世界各国政府当局、公共卫生机构和实验室带来了重大挑战。NPS 的设计目的是模拟未经管制或受管制药物的致幻效果，同时不断进行修改以逃避药物管制法规。因此，它们被称为“合法兴奋剂”，因为从技术上讲，它们可以合法销售、拥有和使用。NPS 可以根据其药理作用机制进行分类，包括拟大麻素、抑制剂、解离剂、致幻剂、阿片类药物和兴奋剂。每种 NPS 类别都有很大的结构多样性，这导致使用传统的临床实验室检测方法进行检测时存在差异，并使结果的解释变得复杂。在本文中，我们回顾了每种 NPS 类别，并总结了它们的作用机制、常见结构和代谢途径，并提供了最近的药物和新出现的威胁的例子，重点介绍了加拿大的毒品趋势。我们还探讨了临床实验室通常面临的当前分析优势和局限性，并就毒理学监测如何在不断变化的 NPS 环境中提高 NPS 的检测提供了见解。
