Emerging Agents of Substance Use/Misuse.

Over the last decade, the use of novel psychoactive substances (NPS) has increased. Some substances are derived from plants but an increasing number are synthetically produced. Examples include synthetic cannabinoids, synthetic cathinones, kratom, phenibut, designer opioids, and benzodiazepines. These substances have a wide variety of effects due to the varied potency with which they bind their targeted receptors. Routine immunoassay urine drug screens do not detect these substances and it is, therefore, important for clinicians to be aware of these substances to make accurate clinical diagnoses.