A critical review of published case reports from January 2017 through December 2020 identified 1,319 cases of adverse events associated with novel psychoactive substances (NPS), including 378 overdose fatalities, 771 cases requiring clinical treatment or hospitalization, and 170 cases of driving under the influence. The review covers chemistry, pharmacology, user profiles, and clinical symptoms for over 60 NPS, with 50 substances reported for the first time compared to the previous four years. Cases span synthetic cannabinoids, NPS stimulants, hallucinogens, benzodiazepines, and opioids. The findings aim to improve awareness and characterization of emerging international drug threats.
N,N-dimethylpentylone (DMP), a synthetic cathinone found in counterfeit 'Ecstasy' and 'Molly' tablets, is a psychomotor stimulant that can cause adverse clinical outcomes including death. A new assay using liquid chromatography-tandem mass spectrometry measured DMP and five related compounds in 125 forensic cases. In postmortem blood, DMP concentrations ranged from 3.3 to 4600 ng/mL (mean 320 ng/mL, median 150 ng/mL). Its primary metabolite, pentylone, was present in 98% of cases. DMP potently inhibited the dopamine transporter (IC50 of 49 nM) but was 100-fold weaker at the serotonin transporter. In mice, DMP was a locomotor stimulant (ED50 of 3.5 mg/kg). After DMP's scheduling in 2024, an unregulated replacement may emerge.