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Peer-reviewedCC BYAnnals of intensive care

The hidden severity of new psychoactive substances: clinical evidence from emergency and intensive care admissions in Taiwan.

  • Po-Hsiang Liao1,2,3
  • Chih-Chuan Lin4,5
  • Chia-Ming Chang1,2
  • Sung-Wei Liu6,7
  • Te-I Weng8,9,10
  • Hsien-Yi Chen4,5
  • Cheng-Chung Fang8,9
  • Jiun-Hao Yu11,12
  • Yu-Jang Su13,14,15,16,12
  • Yen-Chia Chen1,2,17
17 affiliations
  1. 1Department of Emergency Medicine, Taipei Veterans General Hospital, Taiwan.
  2. 2School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
  3. 3Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
  4. 4College of Medicine, Chang Gung University, Taoyuan, Taiwan.
  5. 5Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.
  6. 6Department of Medical Education and Emergency Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
  7. 7School of Medicine, Tzu Chi University, Hualien, Taiwan.
  8. 8Department of Emergency Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
  9. 9Forensic and Clinical Toxicology Center, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
  10. 10Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
  11. 11Department of Emergency Medicine, China Medical University Hsinchu Hospital, China Medical University, Hsinchu 30272, Taiwan.
  12. 12Yuanpei University of Medical Technology, Hsinchu, Taiwan.
  13. 13Emergency Department, Mackay Memorial Hospital, Taipei, 10449, Taiwan.
  14. 14Toxicology Division Emergency Department, MacKay Memorial Hospital, Taipei, 10449, Taiwan.
  15. 15School of Medicine, College of Medicine, MacKay Medical University, New Taipei City, Taiwan.
  16. 16MacKay Junior College of Medicine, Nursing, and Management, Taipei City, 11260, Taiwan.
  17. 17Department of Emergency Medicine, School of Medicine, National Defense Medical University, Taipei, 11490, Taiwan.
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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 across 10 hospitals within six medical systems in 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 short-term 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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Cite

BibTeXRIS
BibTeX
@article{liao2026hidden,
  title = {{The hidden severity of new psychoactive substances: clinical evidence from emergency and intensive care admissions in Taiwan.}},
  author = {Po-Hsiang Liao and Chih-Chuan Lin and Chia-Ming Chang and Sung-Wei Liu and Te-I Weng and Hsien-Yi Chen and Cheng-Chung Fang and Jiun-Hao Yu and Yu-Jang Su and Yen-Chia Chen},
  journal = {Annals of intensive care},
  year = {2026},
  month = sep,
  doi = {10.1016/j.aicoj.2026.100163},
  url = {https://europepmc.org/article/MED/42898047},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - The hidden severity of new psychoactive substances: clinical evidence from emergency and intensive care admissions in Taiwan.
AU  - Po-Hsiang Liao
AU  - Chih-Chuan Lin
AU  - Chia-Ming Chang
AU  - Sung-Wei Liu
AU  - Te-I Weng
AU  - Hsien-Yi Chen
AU  - Cheng-Chung Fang
AU  - Jiun-Hao Yu
AU  - Yu-Jang Su
AU  - Yen-Chia Chen
PY  - 2026
DA  - 2026/09/28
JO  - Annals of intensive care
DO  - 10.1016/j.aicoj.2026.100163
UR  - https://europepmc.org/article/MED/42898047
AB  - 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 across 10 hospitals within six medical systems in 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 short-term 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.
SN  - 2110-5820
ER  -