The largest collection of test results from drug samples delivered from cryptomarkets are reported in this study. Most substances contained the advertised ingredient and most samples were of high purity. The representativeness of these results is unknown.

We report the presence of a new substance detected in the hidden web as an adulterant of heroin, ocfentanil. It has short acting opioid-like effects, roughly the same potency as fentanyl, and can be injected, snorted or smoked. Severe side effects have been associated with its use, including one death. No discussion about this substance could be found in the Internet, which suggests this substance has not been sold as such. Available data about purities of drugs purchased in cryptomarkets suggest that adulteration is not a severe problem and this agrees with users' perceptions. However, this study suggests that adulteration is a real threat not only at the street level, but also for users that buy substances in cryptomarkets, and suggest the need for harm reduction initiatives in this setting.

Since the emergence of these substances could prove to be the next step to the cat-and-mouse game existing between drug producers and legislation, further clinical and epidemiological research should be carried out in order to build evidence to support policy for public health issues.

New psychoactive tryptamines may be a public health risk since they intend to mimic the hallucinogenic effects of regulated psychoactive drugs. Few studies describe uses and clinical effects of unregulated new psychoactive tryptamines. This study aims (1) to explore the presence of tryptamines classified as NPS among the substances delivered for analysis to a harm-reduction organization; (2) to describe the substances found in the samples after analysis; and (3) to compare analytical results of regulated vs. non-regulated tryptamines. Samples delivered and analyzed by gas chromatography-mass spectrometry from 2006 to 2015 were included. A descriptive study of results was conducted. From 25,296 samples that were delivered, 436 were tryptamines; from these 232 (53.21%) were non-regulated. The most delivered non-regulated tryptamine was 4-AcO-DMT. A search of the PubMed database in July 2016 revealed that no studies in humans have ever been carried out with 4-AcO-DMT. Unregulated tryptamines likely contained one unadulterated substance (p ≤ 0.001). The number of samples submitted which contained tryptamines increased during the course of the study, with significant differences in client expectations vs. analysis results between the controlled and uncontrolled groups. There is a need for further research in order to prevent the potential health risks associated with their use.

IntroductionNovel psychoactive substances (NPS) use is progressively increasing year on year. A new group of phenethylamines sold as legal stimulants and hallucinogens is being reported increasingly since 2012. Within this group, 25I-NBOMe is an outstanding substance with powerful effects and high affinity with the serotonin 2a (5HT2a) receptor. Several toxicity cases have been reported so far.ObjectivesTo describe the presence of 25I-NBOMe and its characteristics in samples delivered to Energy Control from 2009 to 2015 in Spain.MethodsAmong the samples, 21,198 analyzed from august 2009 to august 2015 and only those samples containing 25I-NBOMe were studied (n = 56). Samples were analyzed by Energy Control, a Spanish harm-reduction NGO that offers users the possibility of analyzing the substances they intend to consume. Analysis was done by Gas Chromatography–Mass Spectrometry.ResultsFrom 56 samples were 25I-NBOMe was found, 24 were bought as LSD (42.8%), 12 as 25I-NBOMe (21.4%), 4 as 25C-NBOMe (7.1%), 4 as 25I-NBOH (7.1%) and 12 as other substances (21.4%), gummy bears included. All samples were received from 2012 on, having the highest peak on 2013 (19 samples).Conclusions25I-NBOMe consumption represents an emerging issue with potential harmful effects, especially when the substance used is not the expected. Further pharmacokinetic, pharmacodynamic, clinical and epidemiological researches should be conducted to deepen knowledge about 25I-NBOMe and the management of its possible toxic effects. Physicians should be aware of NPS, their increasing use and the clinical differences between them.Disclosure of interestThe authors have not supplied their declaration of competing interest.