A Swedish monitoring project detected over 50 different new psychoactive substances in emergency department patients, predominantly young males, with synthetic cannabinoids among the most common alongside classical drugs.
Read this if you want to understand the scale and diversity of new psychoactive substance use detected in emergency departments.
Over 50 different new psychoactive substances detected in ER patients
What the researchers found
The STRIDA project monitored new psychoactive substance (NPS) use among patients presenting to Swedish emergency departments and intensive care units. Of 189 initial samples submitted for analysis, 83% tested positive for at least one drug. Beyond classical substances (ethanol, cannabis, amphetamines), more than 50 different NPS were detected.
The NPS spectrum included synthetic cannabinoid receptor agonists ("Spice"), piperazines, substituted phenethylamines, synthetic cathinones, hallucinogenic tryptamines, piperidines, opioid-related substances, ketamine analogs, and GABA analogs. Users were predominantly young (median age 20, range 13-63) and male (79%).
About half of cases involved multiple drug intoxications, making it difficult to attribute specific clinical symptoms to individual substances.
Why it matters
This project demonstrated the scale and diversity of the NPS problem in a high-income country. The detection of over 50 different substances in emergency patients shows that the challenge extends far beyond synthetic cannabinoids to a broad spectrum of novel compounds.
The numbers in context
189 samples, 83% positive for at least one drug. Over 50 different NPS detected. Predominantly young males (median age 20, 79% male). About half were multiple drug intoxications. Age range: 13-63 years.
How the study worked
Prospective monitoring project collecting urine and blood samples from drug intoxication cases at emergency departments across Sweden. Multi-component LC-MS/MS analysis identified a wide range of NPS. Clinical severity was graded using the Poisoning Severity Score.
What this study cannot tell us
Emergency department presentations represent the most severe outcomes and do not capture the full spectrum of NPS use. Multiple drug intoxications complicated attribution of effects to individual substances. The project captured a snapshot that would have changed rapidly as new substances emerged.
How to read the evidence
Prospective monitoring project with advanced analytical chemistry, providing systematic detection data from a national sample.
When this study was published
Published in 2014. The new psychoactive substance landscape has continued to evolve rapidly.
The bigger picture
The STRIDA project model of systematic emergency department monitoring with advanced analytical chemistry provides a template for tracking NPS emergence in real time. The breadth of substances detected underscores the inadequacy of standard drug screening and the need for advanced detection methods.
Questions still open
- Has the NPS landscape changed since 2014? Are current emergency department screening protocols adequate for detecting novel substances? How many NPS users have adverse effects that do not result in emergency visits?
Common questions
How many different new drugs are being used?
Who uses new psychoactive substances?
Read the original research
Detection of new psychoactive substance use among emergency room patients: results from the Swedish STRIDA project.
Forensic science international, 243, 23-9
Citation
Helander, Anders; Bäckberg, Matilda; Hultén, Peter; Al-Saffar, Yasir; Beck, Olof. (2014). Detection of new psychoactive substance use among emergency room patients: results from the Swedish STRIDA project.. Forensic science international, 243, 23-9. https://doi.org/10.1016/j.forsciint.2014.02.022
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