ArticleJournal of analytical toxicology2026
Complementary insights from wastewater surveillance and the toxicology findings of clinical presentations involving new psychoactive substances in Australia.
Article in Journal of analytical toxicology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The growing emergence of new psychoactive substances (NPS) challenges traditional approaches to drug monitoring, highlighting a need for innovative surveillance strategies. We explored the potential to better understand the NPS market in Australia by combining wastewater analysis with toxicosurveillance programs. Focussing on a time of year of likely higher NPS and drug use, influent wastewater samples were collected from four Australian states (South Australia, Victoria, Queensland, and New South Wales) over the New Year period from 2019-2020 to 2024-2025. Clinical samples presenting between 15 December and 15 January each period from the toxicosurveillance systems Emerging Drugs Network of Australia (including Western Australia, South Australia, and Queensland), Emerging Drugs Network of Australia Victoria (Victoria) and Prescription, Recreational and Illicit Substance Evaluation-PRISE (New South Wales) were extracted. In total, 294 wastewater and 117 clinical samples were included in this work. A total of 46 individual NPS were found in both datasets. This included: 21 only in wastewater, 36 only in clinical, and 12 in both. Overall, 743 instances of NPS were found in all wastewater samples and 171 in clinical data. In wastewater samples, N, N-dimethylpentylone (54%), mitragynine (52%), and bromazolam (45%) were the most frequently detected. In the clinical samples, the most common were bromazolam (44%) and clonazolam (21%). Overall, synthetic cathinones and plant-based compounds were more prevalent in wastewater, and synthetic opioids and benzodiazepines in clinical samples. Differences in detected NPS classes illustrate the complementary nature of these surveillance systems. Higher wastewater concentrations may indicate broader use and lower acute harm than drugs identified clinically. Integrating these datasets with additional sources such as surveys, coronial records, police seizures, and drug-checking services can strengthen NPS monitoring.
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