INCIDENCE AND CLINICAL MANIFESTATIONS OF NEW PSYCHOACTIVE SUBSTANCES (NPS) INTOXICATION: A CLINICAL TOXICOLOGY DEPARTMENT ANALYSIS
ILINCA-MIHAELA MARANDIUC 1,2,3, CORINA-ȘTEFANIA MATEI 2,3*, MARINA-IONELA NEDEA 1, EDUARD COSTIN MILEA 4, ANDREEA CAMELIA HÎRJĂU 2,3, OANA RUXANDRA AVRAM 3,5, ANDREEA-LETIȚIA ARSENE 1
1 Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 “Cantacuzino” National Institute for Medical-Military Research and Development, Bucharest, Romania
3 Bucharest Emergency Clinical Hospital, Bucharest, Romania
4 National Institute of R&D for Biological Sciences, Bucharest, Romania
5 Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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New psychoactive substances (NPS) pose a significant public health threat due to their rapid evolution, lack of international regulation, and imitation of illicit drugs. Their diverse chemical structures and unpredictable pharmacology lead to substantial variability in clinical presentations. This study focused on characterizing the detailed profile of individuals presenting to the emergency department with NPS-related complications, given this inherent clinical heterogeneity. This study characterized acute NPS intoxications (2020 - 2024), detailing patient demographics, clinical manifestations, and polydrug use patterns. Diagnosis relied on medical history, physical examination, routine labs, and gas chromatography coupled with mass-spectrometry (GC-MS/MS) urine analysis. Our findings reveal consistent polysubstance use with NPS, typically involving one additional drug (74%), mainly CNS depressants and alcohol, with growing stimulant co-ingestion. Patients presented with a wide range of Richmond Agitation-Sedation Scale (RASS) scores, from deep sedation (3.2%) to severe agitation (1.1%). Respiratory compromise affected 58% of patients, with nearly one-third requiring invasive support. While no significant correlations were found with blood pressure or biochemical changes, psychiatric comorbidities were prevalent, especially mixed-personality disorder (30.3%) and mixed-personality disorder with a history of suicide attempt (12.3%) Characterizing these intoxications from demographic and clinical perspectives advances our understanding of acute NPS emergencies and informs national public health strategies.
