The hidden severity of new psychoactive substances: clinical evidence from emergency and intensive care admissions in Taiwan - 28/09/26

Doi : 10.1016/j.aicoj.2026.100163

Po-Hsiang Liao ^a,^b,^c, Chih-Chuan Lin ^d,^e, Chia-Ming Chang ^a,^b, Sung-Wei Liu ^f,^g, Te-I Weng ^h,^i,^j, Hsien-Yi Chen ^d,^e, Cheng-Chung Fang ^h,ⁱ, Jiun-Hao Yu ^k, Yu-Jang Su ^l,^m,^n,^o,^p, Yen-Chia Chen ^a,^b,^q,⁎

^a Department of Emergency Medicine, Taipei Veterans General Hospital, Taiwan

^b School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

^c Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan

^d College of Medicine, Chang Gung University, Taoyuan, Taiwan

^e Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan

^f Department of Emergency, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan

^g Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan

^h Department of Emergency Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan

ⁱ Forensic and Clinical Toxicology Center, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

^j Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

^k Department of Emergency Medicine, China Medical University Hsinchu Hospital, China Medical University, Hsinchu 30272, Taiwan

^l Emergency Department, Mackay Memorial Hospital, Taipei, 10449, Taiwan

^m Toxicology Division and Poison Center, MacKay Memorial Hospital, Taipei, 10449, Taiwan

ⁿ Department of Medicine, MacKay Medical College, New Taipei City, Taiwan

^o MacKay Junior College of Medicine, Nursing, and Management, Taipei City, 11260, Taiwan

^p Yuanpei University of Medical Technology, Hsinchu, Taiwan

^q Department of Emergency Medicine, School of Medicine, National Defense Medical Center, Taipei, 11490, Taiwan

^⁎ Corresponding author.

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Abstract

Background

New psychoactive substances (NPS) have emerged as a growing threat in Taiwan, yet their clinical severity compared with traditional illicit drugs (TID) remains uncertain. This study aimed to compare the clinical characteristics and critical outcomes between patients with NPS and TID poisoning confirmed by liquid chromatography–tandem mass spectrometry (LC–MS/MS).

Methods and Results

We conducted a multicenter retrospective cohort study of patients presenting to the emergency departments of six medical centers and three regional hospitals across Taiwan. Between March 2019 and January 2020, 1,378 patients with suspected drug intoxication underwent urine LC–MS/MS analysis at certified toxicology laboratories. A total of 362 patients (26.3%) tested positive, including 147 (40.6%) with NPSs, 130 (35.9%) with TIDs, and 85 (23.5%) with mixed substances.

Demographic, clinical, and laboratory data were collected through a chart review. Synthetic cathinones and ketamine analogs were the most frequently detected NPSs, whereas methamphetamine/amphetamine and morphine were predominant among TID cases. Critical outcomes were defined as intensive care unit admission or death in the emergency department. The overall rate of critical outcomes was 18.3% (252/1,378). The odds of critical illness did not significantly differ between NPS and TID users (adjusted odds ratio, 0.94; 95% confidence interval [CI], 0.51–1.74). Kaplan–Meier survival analysis revealed no significant difference in 3-month survival among the NPS, TID, and mixed-drug groups (log-rank p = 0.665).

Conclusions

No statistically significant difference in clinical severity or mortality risk was observed between NPS and TID poisoning. These findings highlight that NPS exposure has a similar potential for critical illness and should be managed with the same clinical vigilance as conventional drug poisoning.

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Key words : New psychoactive substances, Illicit drugs, Emergency department, Intensive care unit, Toxicology

Abbreviations : APACHE, BUN, CI, CK, COPD, CPR, DBP, ECG, ED, ESRD, GCS, GHB, HR, ICU, IQR, IRB, LC–MS/MS, LFT, MDMA, NPS, NPSs, OR, PR, QRS, QTc, qSOFA, RR, SBP, SpO₂, TID, TIDs, WBC