Postmortem findings of organ damage in novel psychoactive substances users: a comprehensive review

INTRODUCTION: Despite the rising number of NPS-related deaths, comprehensive data on their prevalence, identification, and associated organ damage remain scarce. MATERIALS AND METHODS: A literature search was conducted. Predefined inclusion and exclusion criteria were applied, resulting in the identification of 197 articles. RESULTS: We identified 446 cases of NPS-related deaths, involving a total of 176 different substances. Synthetic opioids were the most prevalent class (34%), followed by synthetic cannabinoids (22%) and cathinones (21%). Co-ingestion of NPS with other substances occurred in 77% of cases. Macroscopic findings varied across organs, with congestion and edema most observed in the brain (23%) and lung (56%), respectively. DISCUSSION: The existing literature lacks comprehensive descriptions of organs subjected to autopsy and histological examination in NPS-positive subjects. Despite this limitation, our findings underscore the prominence of lung pathology. Moreover, the prevalence of normal organs in cases of acute intoxication is a significant observation. We advocate for future research to provide more detailed insights to enhance our understanding of the multifaceted landscape of NPS-related deaths.