The value of toxicological and forensic analyses in the global challenge to health risks caused by new psychoactive substances

In 2018, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reported the appearance of new psychoactive substances (NPS) on European Union (EU) at a rate of about one per week for a total of 55 new drugs detected in 2018. On one hand, this figure is similar to that communicated in 2017 (N=51) and both of them are significantly lower if compared to those, above one hundred, appeared in 2014 and 2015. On the other hand, it has to be underlined that there has been a change in the type of substances coming into illegal market, since the most recent new psychoactive substances are increasingly more targeted in the long-term and to drug users with more addictive behavior. Specifically, new synthetic opioids and benzodiazepines are now the most reported substances by the EU Early Warning System, together with a distinct range of other recreational substances. The epidemics of both classes of substances come from United States and Canada, where both caused severe intoxications and fatalities purposely related to the use of synthetic opioids, particularly fentanyl derivatives. Although these two phenomena have not been so diffused in Europe, concerns do exist also in this area. About 50 new synthetic opioids, mainly fentanyl illicit analogs, have been reported up to now to the EU Early Warning System and the seizures of carfentanil, one of the most hazardous and potent opioids, have been particularly alarming. In this latter case and in that of many other fentanyl derivatives, due to the extreme potency of these compounds, they can be trafficked in very small quantities, which are difficult to detect. In addition, the synthetic opioids and new illegal benzodiazepine share the occurrence that they have been sold as fake kinds of commonly prescribed pain-relievers and antianxiety drugs. Regarding synthetic opioids, the fake OxyContin tablets containing metoxyacetylfentanyl, or fentanyl itself, have been reported by EU early warning system in the last two years. In case of new benzodiazepines, some of these are trafficked as fake types of Xanax, containing alprazolam or other compounds of the same class but illegally produced and sold, or even containing fentanyl and analogs. In this concern, the values of accurate and immediately available toxicological and forensic data are crucial.