Emerging Synthetic Drug Intoxications: Toxidrome Recognition, Emergency Stabilization, and Neuropsychiatric Outcomes
Mauricio Quijano, Stalin Omar Toapanta Usuay, Valentina López Corredor, Ciro Ernesto Redondo Mendoza, Esteban Fernando Torres Perez, Catalina Antonia de Jesús Opazo Hurtado, Sebastián Hoyos-Sanabria, María Alejandra Cogollo Tarazona
IECCMEXICO September 28, 2026 DOI: 10.64784/347 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Key findings | The review concludes that emerging synthetic drugs produce overlapping toxicological syndromes requiring a physiology-first, syndromic approach to emergency stabilization. It reports that synthetic cannabinoids and cathinones are prominent in psychiatric intoxication cases, nitazene poisoning requires variable and sometimes prolonged naloxone infusion, and xylazine is associated mainly with central nervous system depression, bradycardia, hypotension, and respiratory compromise, particularly in polysubstance use. |
Abstract
Emerging synthetic drugs and new psychoactive substances represent a growing challenge for emergency medicine, clinical toxicology, and psychiatry due to their rapidly changing composition, variable potency, frequent polysubstance exposure, and capacity to produce overlapping toxicological syndromes. This study analyzed the clinical presentation, emergency stabilization strategies, and neuropsychiatric complications associated with synthetic cannabinoids, synthetic cathinones, nitazenes, designer benzodiazepines, xylazine, and other emerging psychoactive compounds. A structured analytical review based on the Scientific Method was conducted using recent clinical studies, systematic reviews, toxicological reports, and emergency medicine publications. The evidence showed that these substances can produce neurological, cardiovascular, respiratory, metabolic, and psychiatric abnormalities ranging from agitation, hallucinations, paranoia, and psychosis to seizures, hyperthermia, respiratory depression, bradycardia, hypotension, altered consciousness, and multiorgan complications. Synthetic cannabinoids and synthetic cathinones were prominently represented among psychiatric intoxication cases, while nitazene poisoning demonstrated variable naloxone requirements, including the need for prolonged infusion in selected patients. Xylazine exposure was mainly associated with central nervous system depression, bradycardia, hypotension, and respiratory compromise, particularly in the context of polysubstance use. The findings support a syndromic and physiology-first approach in which airway protection, ventilatory support, cardiovascular monitoring, temperature control, seizure management, treatment of severe agitation, correction of metabolic abnormalities, and selective antidotal therapy are prioritized according to the patient’s clinical condition. Persistent neuropsychiatric manifestations require reassessment after acute stabilization to differentiate transient intoxication from prolonged substance-induced psychiatric syndromes. An integrated approach involving emergency medicine, clinical toxicology, and psychiatry is essential for the effective management of these rapidly evolving intoxications.