New Psychoactive Substances Intoxications and Fatalities during the COVID-19 Epidemic

SIMPLE SUMMARY: We presented a comprehensive, systematic literature review of all published New Psychoactive Substances (NPS)-related intoxications and fatalities during the COVID-19 pandemic (from January 2020 to March 2022). Public implications, such as isolation and social distancing, may have reduced consumption of some drugs. These stressful conditions brought an increase in the use of other drugs, with the illicit market and related misuse of drugs moving to different drugs of abuse, such as NPS. More than 200 cases were reported in Europe, UK, USA and Japan during the pandemic period, with synthetic opioid, synthetic cannabinoids and synthetic cathinones the most representative NPS classes. Importantly, the combined consumption of several NPS classes comprised 30% of all cases. Considering that the pandemic may have reduced the capabilities of forensic toxicology laboratories to report comprehensive information, the data could have led to an underestimation. ABSTRACT: In January 2020, the World Health Organization (WHO) issued a Public Health Emergency of International Concern, declaring the COVID-19 outbreak a pandemic in March 2020. Stringent measures decreased consumption of some drugs, moving the illicit market to alternative substances, such as New Psychoactive Substances (NPS). A systematic literature search was performed, using scientific databases such as PubMed, Scopus, Web of Science and institutional and government websites, to identify reported intoxications and fatalities from NPS during the COVID-19 pandemic. The search terms were: COVID-19, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019, intox*, fatal*, new psychoactive substance, novel psychoactive substance, smart drugs, new psychoactive substance, novel synthetic opioid, synthetic opioid, synthetic cathinone, bath salts, legal highs, nitazene, bath salt, legal high, synthetic cannabinoid, phenethylamine, phencyclidine, piperazine, novel benzodiazepine, benzodiazepine analogue, designer benzodiazepines, tryptamine and psychostimulant. From January 2020 to March 2022, 215 NPS exposures were reported in Europe, UK, Japan and USA. Single NPS class intoxications accounted for 25, while mixed NPS class intoxications represented only 3 cases. A total of 130 NPS single class fatalities and 56 fatalities involving mixed NPS classes were published during the pandemic. Synthetic opioids were the NPS class most abused, followed by synthetic cathinones and synthetic cannabinoids. Notably, designer benzodiazepines were frequently found in combination with fentalogues. Considering the stress to communities and healthcare systems generated by the pandemic, NPS-related information may be underestimated. However, we could not define the exact impacts of COVID-19 on processing of toxicological data, autopsy and death investigations.