Novel psychoactive substances: the pharmacology of stimulants and hallucinogens

ABSTRACT

There are increasing levels of concern relating to the rapidly evolving novel psychoactive substances/NPS and web markets’ scenarios. The paper aims at providing an overview of the clinical pharmacological issues related to some of the most popular NPS categories, e.g. stimulants and hallucinogens. NPS intake is typically associated with the imbalance of a complex range of neurotransmitter pathways/receptors, namely: dopamine; cannabinoid/CB1; and 5-HT_2A. The intake is almost invariably undetectable with standard screening tests. Hence, it may frequently occur that the acute management of NPS misusers will need to focus on decreasing levels of both self/outward-directed aggression and agitation. Benzodiazepines may be considered as first line treatment. Alternatively, propofol and/or antipsychotics can be administered. Focus will be as well on treatment of possible rhabdomyolysis and hyperthermia. Indeed, future studies should inform better tailored management/treatment strategies.

KEYWORDS:

• Novel psychoactive substances
• synthetic cannabimimetics
• synthetic cathinones
• hallucinogenic drugs
• phenethylamines
• psychiatric disturbances
• drug misuse

Financial & competing interests disclosure

This paper was supported in part by grants of the European Commission (Drug Prevention and Information Programme 2014-16, contract no. JUST/2013/DPIP/AG/4823, EU-MADNESS project). Further financial support was provided by the EU Commission-targeted call on cross border law enforcement cooperation in the field of drug trafficking - DG Justice/DG Migrations and Home Affairs (JUST/2013/ISEC/DRUGS/AG/6429) Project EPS/NPS (Enhancing Police Skills concerning Novel Psychoactive Substances; NPS). F Schifano is a ACMD member, UK; EMA Advisory Board Member. JM Corkery is a ACMD UK NPS group advisor. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.