New Psychoactive Substances: A Canadian perspective on emerging trends and challenges for the clinical laboratory.
Clinical biochemistry December 1, 2024 Jessica J Miller, Mehrdad Yazdanpanah, David A Colantonio et al.
New Psychoactive Substances (NPS) are drugs designed to mimic the effects of controlled substances while evading legal regulation, often called 'legal highs.' They include classes such as cannabimimetics, depressants, dissociatives, hallucinogens, opioids, and stimulants. Structural diversity within each class makes detection by standard clinical laboratory tests difficult and complicates result interpretation. This review describes each NPS class, its mechanism of action, common structures, metabolic pathways, and recent examples, with a focus on Canadian drug trends. It also discusses analytical limitations in clinical laboratories and how toxicosurveillance can improve detection of NPS in a rapidly changing landscape.