Fatalities associated with NPS stimulants in the Greater Cologne area

  • Sabrina Lehmann
  • Tobias Kieliba
  • Mario Thevis
  • Markus A. Rothschild
  • Katja Mercer-Chalmers-BenderEmail author
Original Article


This study centres on the prevalence of new psychoactive substances (NPS) stimulant use, and its relevance as a cause of death amongst individuals between the ages of 12 and 35 in the greater Cologne area. An automated solid-phase extraction-liquid chromatography-tandem mass spectrometry method was developed for the determination of 97 stimulants in urine (including conventional stimulants, e.g. amphetamine and MDMA), of which 68 analytes were fully validated for quantification. Samples of urine or kidney tissue (in cases where urine was unavailable) of 268 deceased were collected, during autopsy, between January 2011 and May 2017 and analyzed. Blood (if available) was also investigated in cases where urine/kidney samples were tested positive for NPS. An intake of stimulants (including NPS stimulants) was proven in 50 cases. In 33 cases, only conventional stimulants were detected. A total of 17 cases were tested positive for NPS. Of the 17 NPS-positive cases, 13 were also tested positive for other conventional drugs of abuse (mostly amphetamine and MDMA). In six NPS-positive cases, at least three different NPS were proven to be ingested. Due to the determined blood concentrations, NPS was assigned as the leading cause of death, or of toxicological relevance, in the cause of death in only 5 cases. In two of the cases, NPS was judged to be a component of a multidrug poisoning, but of minor relevance.


New psychoactive substances Fatalities In-line solid-phase extraction-liquid chromatography-tandem mass spectrometry Urine Prevalence 



The authors wish to thank Scientific Instruments Manufacturer GmbH (Oberhausen, Germany) for generously providing the ITSP-SPE system for this research. We thank Dr. June Mercer-Chalmers-Bender for editorial support. This work was supported by the Federal Ministry for Economic Affairs and Energy on the basis of a decision by the German Bundestag, grand no. KF2429613MD3.

Compliance with ethical standards

Ethical approval

All experiments comply with the current laws of the Federal Republic of Germany. All performed analytical tests were part of the state prosecutors’ requested investigation on the cause of death, and are therefore not subject to the requirements for ethical approval. The state prosecutor gave his approval to publish the results under the condition of complete anonymization of individual data. The article does not contain any studies on animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

414_2019_2193_MOESM1_ESM.docx (119 kb)
ESM 1 (DOCX 119 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Legal Medicine, Faculty of Medicine, University of CologneCologneGermany
  2. 2.Institute of Biochemistry, German Sport University CologneCologneGermany
  3. 3.Institute of Forensic Medicine, Health Department Basel-StadtUniversity of BaselBaselSwitzerland

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