title: Understanding the risks associated with the use of new psychoactive substances (NPS): high variability of active ingredients concentration, mislabelled preparations, multiple psychoactive substances in single products.
abstract: New psychoactive substances (NPS), are now a large group of substances of abuse not yet completely controlled by international drug conventions, which may pose a public health threat. Anxiety, paranoia, hallucinations, seizures, hyperthermia and cardiotoxicity are some of the common adverse effects associated with these compounds. In this paper, three case reports taken from the archive of processed cases of the authors' laboratory are presented and discussed to stress the risks of possible adverse consequences for NPS users: in particular, (i) the risk deriving from the difficulty of predicting the actual consumed dose, due to variability of active ingredients concentration in consumed products, (ii) the risk deriving from the difficulty of predicting the actual active ingredients present in consumed products, as opposed to those claimed by the manufacturer, and (iii) the risk deriving from the difficulty of predicting the actual pharmacological and toxicological effects related to the simultaneous consumption of different psychoactive ingredients contained in single products, whose interactions are mostly unknown. Each of them individually provide a source of concern for possible serious health related consequences. However, they should be considered in conjunction with each others, with the worldwide availability of NPS through the web and also with the incessantly growing business derived from the manipulation and synthesis of new substances. The resulting scenario is that of a cultural challenge which demands a global approach from different fields of knowledge.
authors.affiliation: Laboratory of Environmental Hygiene and Forensic Toxicology (LIATF), Department of Prevention, Azienda ULSS 12 Veneziana, Mestre, Venezia, Italy. Electronic address: luca.zamengo@ulss12.ve.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Zamengo
authors.affiliation: Laboratory of Environmental Hygiene and Forensic Toxicology (LIATF), Department of Prevention, Azienda ULSS 12 Veneziana, Mestre, Venezia, Italy.
authors.forename: Giampietro
authors.initials: G
authors.lastname: Frison
authors.affiliation: Laboratory of Environmental Hygiene and Forensic Toxicology (LIATF), Department of Prevention, Azienda ULSS 12 Veneziana, Mestre, Venezia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bettin
authors.affiliation: Laboratory of Environmental Hygiene and Forensic Toxicology (LIATF), Department of Prevention, Azienda ULSS 12 Veneziana, Mestre, Venezia, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Sciarrone
mesh_terms: D000293:Adolescent; D002851:Chromatography, High Pressure Liquid; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004340:Drug Contamination; D004348:Drug Labeling; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D013287:Illicit Drugs / Q000737:chemistry* / Q000633:toxicity*; D008297:Male; D008694:Methamphetamine / Q000031:analogs & derivatives / Q000737:chemistry / Q000633:toxicity; D010879:Piperazines / Q000633:toxicity; D028321:Plant Preparations / Q000737:chemistry; D011619:Psychotropic Drugs / Q000737:chemistry* / Q000633:toxicity*; D012306:Risk; D012640:Seizures / Q000139:chemically induced; D019966:Substance-Related Disorders
chemical_list: D004338:Drug Combinations; D013287:Illicit Drugs; D010879:Piperazines; D028321:Plant Preparations; D011619:Psychotropic Drugs; D008694:Methamphetamine; C548233:mephedrone
keywords: Health risks; NPS; New psycoactive substances