Introduction: The continual appearance of new psychoactive substances (NPS) on the global market, their ever-growing number, frequent changes in their chemical composition, as well as its chemical diversity, great difficulties that come with their analysis and a steadily rising number of patients that are treated for the toxic effects of NPS in the National Poison Control Center (NPCC), indicate the need for establishing a national early warning system (EWS) in Serbia. Results: From January 2013 to September 2016, 57 patients were treated in the NPCC with the effects of NPS: 5 in 2013, 14 in 2014, 36 in 2015, 2 in 2016, and all of them had used synthetic cannabinoides. In 2016 for the first time two patients with GHB, one with ayahuasca (DMT), and one with ibogaine effects were treated in the NPCC. Products “Rainbow Special”, “Herbal insense” “Bad-Mad”, “Sharp Blueberry”, “Sharp-Aroma”, “Galaxy”, “Black grass”, “Luminated” were obtained in tabacco shops or through internet as natural herbal products and air fresheners, and consumed by smoking or inhalation of smoke. Liquid chromatography-electrospray ionization-mass spectrometry with Xterra column, liquid chromatography with PDA detector and GC-MS (ion trap detector) were used. Clinical findings were: tachycardia in 53 (92.9), mydriasis in 31 (54.4%), somnolence, nausea, vomiting in 16 (28.1%), agitation in 15 (26.3), vertigo in 10 (17.5%), disorientation in 8 (14.0%), chest pain, dispnea in 5 (8.7%). All patients had fully recovered within up to 8 hours in the emergency ward and were discharged shortly afterwards. AB-PINACA AB-FUBINACA, JWH 18, JWH-122, JWH-210, 5F-AKB48, MDMB-CHMICA (in a cigarette) and AB-CHMINACA were detected in urine samples and/or herbal products. A change of composition in the products of the same name, as well as multiple new synthetic cannabinoides were confirmed. Conclusion: The efficient and systematic collection of the relevant data on NPS poisoning, adverse effects, changes of purity and composition of controlled PS and NPS-based products, along with raising the public awareness will pave the way to the national EWS. The prerequisites for fighting this global problem are the development and fine-tuning of detection methods, sharing the information and experiences with other laboratories both nationwide and internationally, and a system of inter-connected institutions and sectors, working together to continuously monitor the NPS and promptly issue the legislative measures.

Clinical and analytical confirmation of new psychoactive substances

253rd National Meeting (2017)

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