title: Non-targeted screening for novel psychoactive substances among agitated emergency department patients.
abstract: BACKGROUND
  Novel psychoactive substances (NPS) are being created and introduced at an unprecedented rate, causing frequent, large-scale epidemics. Current identification of NPS in clinical settings in the USA is limited to the retrospective case or small cluster analysis.
  
  
  OBJECTIVE
  The purpose of this study was to assess the utility of non-targeted comprehensive drug screening in the agitated patients in an emergency department (ED) setting.
  
  
  METHODS
  This is a prospective, observational case series that was conducted in the ED of an urban Level I Trauma Center with an annual census of approximately 65,000 patients per year. Since it is common clinical practice at this facility for haloperidol to be used as a second-line chemical restraint when initial dose(s) of benzodiazepines are deemed insufficient, we surmised that the subset of ED patients with psychomotor agitation severe enough to receive both these pharmaceuticals would be likely users of NPS. For 1 month, biweekly pharmacy medication audits identified 49 of these patients. There were sufficient, remaining blood samples from 23 of these patients for analysis. Serum from stored blood samples was analyzed using liquid chromatography-time-of-flight mass spectrometry (LC-TOF/MS; LC 1260, TOF/MS 6230, Agilent). Retrospective chart review was done to identify patient clinical information.
  
  
  RESULTS
  Six patient samples yielded seven different NPS: JWH-073, JWH-081, JWH-200, methylenedioxybenzylpiperazine, mephedrone, methoxetamine, and herkinorin.
  
  
  CONCLUSIONS
  This study demonstrates that prospective, non-targeted NPS screening in a selected ED patient population is feasible and effective in identifying NPS.
authors: a Division of Clinical Pharmacology, Department of Medicine , University of California , San Francisco , CA , USA ;
authors: Derrick
authors: D
authors: Lung
authors: b Department of Emergency Medicine , University of California , San Francisco , CA , USA ;
authors: Nathan
authors: N
authors: Wilson
authors: c Faculte De Pharmacie , Universite D'Auvergne , Auvergne , France ;
authors: Francois-Thibaut
authors: FT
authors: Chatenet
authors: c Faculte De Pharmacie , Universite D'Auvergne , Auvergne , France ;
authors: Clemence
authors: C
authors: LaCroix
authors: d Department of Laboratory Medicine, University of California , San Francisco , CA , USA.
authors: Roy
authors: R
authors: Gerona
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000470:Alkaloids / Q000097:blood; D000701:Analgesics, Opioid / Q000097:blood; D002186:Cannabinoids / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000097:blood; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000097:blood*; D011619:Psychotropic Drugs / Q000097:blood*
chemical_list: D000470:Alkaloids; D000701:Analgesics, Opioid; D002186:Cannabinoids; D010879:Piperazines; D011619:Psychotropic Drugs; C023665:cathinone
keywords: Drug surveillance; emergency medicine; novel psychoactive substances; substance abuse; toxicology