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Detection of new psychoactive substances (NPS) in Canary Islands emergency departments: epidemiological and analytical aspects (CaNPuS study)

Clara Gironés Bredy^1,2, Maira Almeida González^2,3, Jesús Hamid Cedrés⁴, Ignacio Guigou Tudela⁵, Cristian Almeida González⁶, Nayra Cabrera González⁷, Mercedes García Rodríguez⁸, Fernando Fernández Pérez⁸, Ángeles López Hernández⁹, Rosa María Zumbado Víctor¹⁰, Luis Domínguez Boada³, Guillermo Burillo-Putze^1,9

Affiliation of the authors

¹Departamento de Medicina Física y Farmacología, Universidad de La Laguna, Tenerife, Spain. ²Instituto de Medicina Legal, Las Palmas de Gran Canaria, Spain. ³Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Spain. ⁴Servicio de Urgencias. Hospital Vithas, Santa Cruz de Tenerife, Spain. ⁵Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Tenerife-Zona I, Tenerife, Spain. ⁶Servicio de Digestivo, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain. ⁷Servicio de Urgencias, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria. ⁸Servicio de Urgencias, Hospital Universitario Ntra. Sra. de Candelaria, Tenerife, Spain. ⁹Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain. ¹⁰Servicio de Neurocirugía, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain.

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Gironés Bredy C, Almeida González M, Hamid Cedrés J, Guigou Tudela I, Almeida González C, Cabrera González N, García Rodríguez M, Fernández Pérez F, López Hernández A, Zumbado Víctor RM, Domínguez Boada L, Burillo-Putze G. Detection of new psychoactive substances (NPS) in Canary Islands emergency departments: epidemiological and analytical aspects (CaNPuS study). Rev Esp Urg Emerg. 2025;4:218–26

Summary

INTRODUCTION. Although the use of psychoactive substances (NPS) is growing in Spain, routine analytical methods for their immediate detection at hospital level are not available, unlike for classic drugs (cannabis, cocaine, amphetamines, etc.). Our objective was to determine the demographic and clinical characteristics associated with NPS consumption leading to hospital emergency visits in the Canary Islands Archipelago (Spain), through their qualitative detection.
MATERIAL AND METHODS. We conducted a descriptive observational study in 4 hospital emergency departments (EDs) in the Canary Islands (Spain) (3 in Tenerife and 1 in Gran Canaria) over 16 months (from October 2019 through January 2021). The study included patients older than 14 years who presented to the ED with clinical suspicion of NPS intoxication. Urine samples were collected and analyzed using immunoassay tests (Randox Biochip Assay) and subsequently by liquid chromatography-mass spectrometry (LC-MS/MS). Demographic, clinical, evolutionary, and analytical data were recorded.

RESULTS. A total of 158 cases were obtained, with NPS detected in 96 (60.8%). There were no differences in age and sex related to NPS detection. A total of 32.3% of all cases tested positive for NPS and classic drugs. Ultrapotent opioids were detected in 34.2%, new benzodiazepines in 27.8%, piperazines in 22.8%, synthetic cathinones in 14%, phenethylamines in 8.4%, and synthetic cannabinoids in 7.7%. When analyzing samples by LC-MS/MS, ultrapotent opioids (16.4% of the sample), phenethylamines (13.3%), and new benzodiazepines (8.9%) stood out among the NPS groups, with no significant differences in sex. The sensitivity of RANDOX® was 100% for clonazepam and 81% for fentanyl, while the positive predictive value (PPV) was 37% for clonazepam and 100% for fentanyl. Specificity rate was > 82% in all contrasted cases, and the negative predictive value (NPV) ranged between 96% and 100%. For the rest of the substances, both sensitivity and PPV rates were 0%.
CONCLUSIONS. The high detection rate of ultrapotent opioids, previously unknown in Spain to date, should prompt us to pay more attention to this group of substances. The detection of other NPS was higher than expected according to consumption surveys. Qualitative NPS detection can have clinical applications in hospital EDs.