New challenges in clinical and forensic toxicology

Analytical toxicology plays a critical role in clinical biochemistry and laboratory medicine, primarily by identifying pharmacologically active substances and xenobiotics in biological and non-biological samples. Clinical toxicology uses these results to diagnose and treat patients, while forensic toxicology applies them for legal purposes, such as drug-related deaths or criminal cases. However, clinical data can sometimes have forensic implications, necessitating adherence to strict procedures to ensure the reliability of results in legal contexts. Recent advancements in analytical toxicology have posed new challenges and opportunities, especially in detecting new psychoactive substances (NPS). These substances are difficult to detect due to their varied chemical structures and complex biological matrices. Laboratories are developing new extraction methods and use advanced technologies such as high-resolution mass spectrometry to detect a broader range of substances, including NPS. In addition to detection, metabolite profiling is key for identifying biomarkers of NPS abuse, as the pharmacokinetics of these substances are poorly understood when they first appear on the market. In silico and in vitro models are used to predict NPS metabolism, aiding in finding reliable biomarkers for consumption. NPS can have serious toxic effects on the central nervous system, including agitation, euphoria, and hypertension, with few studies addressing their pharmacological impacts. Research suggests that NPS may interfere with neuronal excitability and alter ion channel activity, potentially leading to neurological damage. Overall, the continuous advancement of analytical techniques and growing understanding of NPS metabolism are crucial for addressing the public health and legal challenges posed by these substances.