There has been an explosive increase in the non-medical use of so-called ‘designer drugs’ or ‘new psychoactive substances’ (NPS), which are synthetic alternatives to illicit drugs of abuse (Baumann et al, 2014). NPS are easy to obtain, inexpensive, and not detected by standard toxicology screens. Products containing NPS are often given deceptive names and labeled ‘not for human consumption’ to circumvent laws prohibiting the sale and use of psychoactive drugs. There are well known examples of NPS that mimic most types of abused drugs—stimulants (‘bath salts’), cannabinoids (‘spice’), hallucinogens (‘N-bombs’), and opioids (‘MT-45’)—but the pharmacology and toxicology of these substances have not been well characterized. Although NPS can elicit subjective effects that resemble their progenitors, potential off-target sites of action are unknown and adverse medical consequences are common. Life-threatening toxidromes have been described for each type of NPS, with symptoms including agitation, hallucinations, psychosis, violent behaviors, and coma. In the United States, an alarming spike in toxic exposures and fatalities associated with abuse of synthetic cannabinoids has occurred during the past year (Trecki et al, 2015). Patients intoxicated with NPS present a significant burden to healthcare professionals, especially those involved with emergency medical care, and the long-term neuropsychiatric consequences of NPS exposure are not known.

Information available on the Internet has played a major role in facilitating the current NPS problem (Brandt et al, 2014). Neuroscience research has identified the biological substrates for most drugs of abuse, whereas the medicinal chemistry and patent literatures contain synthetic schemes for the synthesis of compounds selectively targeting the transporters and receptors mediating their psychoactive effects. Such information can be diverted by skilled and unscrupulous individuals, or businesses, to produce NPS that are marketed and sold to consumers via the worldwide web or in brick-and-mortar shops. The vast majority of NPS are manufactured by overseas companies, and the sheer number of compounds is staggering. A recent United Nations report noted that 540 different NPS have been identified worldwide by the Office of Drugs and Crime as of 2014, and this number is expected to rise (United Nations Office of Drugs and Crime, 2015).

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