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.