Novel psychoactive substances: a novel clinical challenge

Abstract

The recreational use of novel psychoactive substances in the UK has increased markedly within the last decade. The variety of new substances synthesised and sold as ‘legal’, often under the pretence of being ‘plant food’ or ‘bath salts’ is similarly increasing. This presents challenges to clinicians: they may be unaware of these substances or unable to identify them and their potential for complications and drug interactions. This case describes a patient who ingested a novel psychoactive substance and presented with severe agitation following a delay of several days. He experienced renal, hepatic and neurological complications requiring critical care input. Our case adds to the current repertoire of knowledge regarding the effects of ingestion of novel cathinones.

Novel psychoactive substances (NPS) use in severe mental illness (SMI) patients: Potential changes in the phenomenology of psychiatric diseases

“…Synthetic cathinones and benzylpiperazine are reported to cause agitation (Smith, Williams, & Shaikh, ) and repetitive movements, irritation, inability to concentrate, and incoherent thoughts (Tully, Hallahan, & McDonald, ) in patients with schizophrenia. Also, in these cases, it is unclear to what extent the reported induced symptoms repeat or not those of the preexistent clinical features of the patients.…”

‘Designer drugs’: update on the management of novel psychoactive substance misuse in the acute care setting

“…Adding to the confusion relating to terminology, the brand name (eg NRG-1) is recognised to correlate poorly with the active substance(s) and should not be relied upon to inform about the active agent. 1 Most cathinones have sympathomimetic effects. Symptoms and signs therefore include sweating, palpitations, restlessness, tachycardia, nausea, chest pain, confusion, headache and psychosis.…”

“…In addition, as previously reported with use of MDMA, mephedrone can cause hyperthermia without other serotonergic substances and is associated with rhabdomyolysis. 1,20,21 The mechanism is thought to be associated with uncoupling of oxidative phosphorylation in skeletal muscle mitochondria and activation of β-3-and α-1-adrenoreceptors, inducing vasoconstriction at cutaneous blood vessels. 22 In such cases, aggressive cooling should be instituted, benzodiazepines should be used to reduce muscle activity, and paralysis and intubation should be considered, as described above.…”

“…1 Data from the National Crime Survey for England and Wales in 2012 shows that 3.3% of adults aged 18-24 years had used mephedrone (a novel synthetic cathinone) within the previous year. 2 On an international level, data from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)'s early warning system currently receives a report relating to a newly identifi ed substance about once every week.…”

A novel psychoactive substance poses a new challenge in the management of paranoid schizophrenia

“…Two cases reporting NPS use in psychiatric patients exist to date. The first discusses a psychiatric inpatient admitted to intensive care following use of a substance named neuregulin 3 (NRG-3), which he had bought from an online company 20. A second report tells of a schizophrenic patient, with comorbid polysubstance abuse, who became addicted to ‘bath salts’ as an alternative to methamphetamine.…”