Epidemiology of New Psychoactive Substances in Relation to Traditional Drugs of Abuse in Clinical Oral Fluid Samples.
Magnus A B Axelsson, Hanna Lövgren, Robert Kronstrand, Henrik Gréen, Moa Andresen Bergström
Basic & clinical pharmacology & toxicology February 1, 2025 DOI: 10.1111/bcpt.14117 via PubMed
Summary
AI-generated from the abstractNew psychoactive substances (NPS) are a health hazard due to unpredictable toxicity and unknown prevalence. Analyzing 34,183 oral fluid samples from 9,468 psychiatric and addiction care patients in a Swedish region during 2019–2020, 58 different NPS were detected in 481 samples from 201 patients, totaling 618 findings. NPS use was more common in males and patients aged 25 or older. Ketamine use was associated with most NPS classes except cannabinoids; fentanyl, methadone, tapentadol, and clonazepam also correlated with multiple NPS classes. More traditional drugs of abuse correlated with sedative/hypnotic NPS, suggesting broader use. Mitragynine correlated negatively with other NPS but positively with opioid abstinence remedies buprenorphine, loperamide, and tapentadol, indicating its use for opioid withdrawal.
Study at a glance
| Characteristics | Retrospective observational study Peer reviewed |
|---|---|
| Sample size | 9,468 |
| Population | Psychiatric and addiction care patients in one Swedish health care region |
| Duration | 2019-2020 |
| Keywords | Drugs of abuse New psychoactive substances Oral fluid Pharmacoepidemiology Designer drugs |
| Citations | 6 |
| Key finding | NPS use was infrequent but occurred across ages, with ketamine and certain traditional drugs of abuse serving as potential signals for NPS use, and mitragynine showing an atypical pattern consistent with use as an opioid abstinence remedy. |
Abstract
New psychoactive substances (NPS) are health-hazardous through unpredictable toxicity and effects and largely unknown epidemiology, motivating studies of the latter. Up to 138 NPS were retrospectively identified using liquid chromatography-high resolution mass spectrometry data from all 34 183 oral fluid drug samples collected in one Swedish health care region 2019-2020 representing 9468 psychiatric and addiction care patients. In total, 618 findings representing 58 NPS were detected in 481 samples from 201 patients. Male gender and age ≥25 years correlated positively with NPS use. Ketamine correlated positively with all NPS classes except cannabinoids; additionally, fentanyl, methadone, tapentadol and clonazepam correlated with multiple NPS classes. More numerous traditional drugs of abuse (DoA) correlated positively with sedative/hypnotic NPS, indicating that these are used in broader patient groups than other NPS. Mitragynine correlated negatively with other NPS in general and with several traditional DoA, but positively with the potential opioid abstinence remedies buprenorphine, loperamide and tapentadol aside from ketamine. In conclusion, NPS use is infrequent but occur also at higher ages, certain traditional DoA and particularly ketamine could have clinical value as NPS use signals, and mitragynine exhibited an atypical NPS consumption pattern indicating significant use as an opioid abstinence remedy.