Toxicology and management of novel psychoactive drugs

J Pharm Pract. 2015 Feb;28(1):50-65. doi: 10.1177/0897190014544814. Epub 2014 Sep 26.


Health care providers are seeing an increased number of patients under the influence of several new psychoactive drug classes. Synthetic cannabinoids, cathinones, and piperazines are sought by users for their psychoactive effects, perceived safety profile, minimal legal regulations, and lack of detection on routine urine drug screening. However, these drugs are beginning to be recognized by the medical community for their toxic effects. The neuropsychiatric and cardiovascular toxicities are among the most common reasons for emergency medical treatment, which in some cases, can be severe and even life-threatening. Management strategies are often limited to supportive and symptomatic care due to the limited published data on alternative treatment approaches. The purpose of this article is to offer health care providers, emergency medical personnel in particular, an awareness and understanding of the dangers related to some of the new psychoactive drugs of abuse. The background, pharmacology, toxicity, management, detection, and legal status of each class will be discussed.

Keywords: cathinone; drug abuse; piperazine; synthetic cannabinoid; toxicity.

Publication types

  • Review

MeSH terms

  • Alkaloids / chemistry
  • Alkaloids / toxicity
  • Cannabinoids / chemistry
  • Cannabinoids / toxicity
  • Designer Drugs / pharmacology
  • Designer Drugs / toxicity*
  • Humans
  • Illicit Drugs / pharmacology
  • Illicit Drugs / toxicity*
  • Piperazine
  • Piperazines / chemistry
  • Piperazines / toxicity
  • Psychotropic Drugs / pharmacology
  • Psychotropic Drugs / toxicity*
  • Substance Abuse Detection
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / therapy*


  • Alkaloids
  • Cannabinoids
  • Designer Drugs
  • Illicit Drugs
  • Piperazines
  • Psychotropic Drugs
  • Piperazine
  • cathinone