Over the last decades, new psychoactive substances (NPSs) have established a new pattern of drug synthesis and distribution. These compounds brought with them several challenges, including their analytical determination by known methodologies, the uncertainty of their toxicological effects, and the possible approaches used for control. In Brazil, the control of NPS started with a nominal list of proscribed compounds. But the variety of substances was so large that other strategies were implemented. Generic legislation was created as several groups began to emerge, such as phenethylamines, synthetic cathinones, and synthetic cannabinoids. The legislation also began to include salts and isomers of all listed substances and precursor chemical ingredients or plants that may be used to produce them. Those substances are known for the unpredictability of their effects, causing a wide range of symptoms, including seizures, aggression, and acute psychosis. Users under effect represent a high risk for themselves and others. In this study, we present an overview of the timeline in which NPSs were detected in Brazilian territory and the legislative approaches. A complete literature search was performed using PubMed, Scopus, the World Wide Web and Brazilian governmental websites employing relevant keywords such as NPS, legislation, and Brazil. Even with the high volume of legislative measures, the race against NPS intoxication cases and apprehensions continues to be fierce. There are limitations in the process of detection, identification, and prohibition of the substances in the country that demand a multifactorial approach, stronger public health measures, scientific research, as well as harm reduction strategies. Nevertheless, the Brazilian scenario on NPS arrival reflects a worldwide problem faced by many countries. In conclusion, it is stated that the use of multiple legislative strategies such as prohibition lists and generic controls can provide for better regulation of the NPS problem. However, this issue needs to be addressed by multiple organizations, including police departments and the public health system, and that effort needs to be coordinated and standardized for all Brazilian Federal states.

Background: Serotonin is a mediator of pulmonary hypoxic vasoconstriction. Experimental studies have shown that serotonin-mediated pulmonary vasoconstriction can be inhibited by cyproheptadine. The aim of this study is to assess whether treatment with cyproheptadine compared to usual care increases ventilatory support-free days during the first 28 days in patients with coronavirus disease 2019 (COVID-19) requiring ventilatory support. Materials and methods: This randomized, single-center, open-label clinical trial included patients who were admitted to the intensive care unit (ICU) requiring ventilatory support due to COVID-19. Patients allocated to the intervention group received cyproheptadine for 10 days. The primary outcome was ventilator-free days during the first 28 days.Results: Nineteen patients were randomized to receive cyproheptadine and 21 to the control group. The number of ventilatory support-free days during the first 28 days was not different between the two groups (15.0; 95% CI, 0.0-24.0 days in the control group vs 7.0; 95% CI, 0.0-19.0 days in the intervention group; p = 0.284).Conclusion: In patients with COVID-19 and in need of ventilatory support, the use of cyproheptadine plus usual care, compared with usual care alone, did not increase the number of ventilatory support-free days in 28 days.

Drug use affects a significant portion of the Brazilian population, which increases the likelihood of children being exposed to illicit drug environments, making them a particularly vulnerable group. This study describes the profile of illicit drug exposure in children up to 12 years in Rio Grande do Sul state, Brazil, based on emergency cases. Data were collected from suspected intoxication cases attended between 2018 and 2023 in children ≤12 years old. Urine samples were analyzed for cocaine and its metabolites, THC-COOH, and amphetamine-type stimulants using LC-MS/MS. Information about the cases was also collected. Of 286 suspected cases, 32.9% detected at least one illicit drug. Cocaine and its metabolites were the most common (24.8%), followed by THC-COOH (9.4%) and MDA/MDMA (2.1%). Among detected drug cases, 56.4% were male. The mean age was 3.4 ± 3.5 years, with the highest incidence in 1 to 4-year-olds (47.9%). Exposure circumstances included accidental (37.2%), mistreatment/violence (8.5%), and abuse (2.1%). Most exposures occurred at home (58.5%). A notable prevalence of illicit drugs, mainly cocaine, was found. These data show a worrying scenario of drug exposure, primarily involving children aged 1 to 4 years. Above all, it also demonstrates a high frequency of exposure to illicit drugs in their own homes. The findings provide a solid basis for toxicovigilance activities and the development of public health policies aimed at protecting the vulnerable pediatric population.