Every few years, a fresh wave of synthetic drugs turns up on the market, sold as legal, novel or somehow safer than the substances they mimic. The data say otherwise. A fourteen-year analysis of calls to the Dutch Poisons Information Center, published in July 2026, tracked new psychoactive substance poisonings across the Netherlands from 2012 through to 2025, and the trend line only goes one way.

New psychoactive substances, usually shortened to NPS, are synthetic drugs built to copy the effects of established substances such as amphetamines, cocaine or cannabis while staying just outside existing drug laws. They tend to be marketed as experimental or cutting edge. What actually happens once they reach real people is a different picture entirely, and the Netherlands has more data on this than almost anywhere else in Europe.

Fourteen Years, One Direction

Between 2012 and 2025, healthcare professionals in the Netherlands reported 19,316 recreational drug poisonings to the country’s Poisons Information Center. Of those, 4,289 involved an NPS. Cases climbed from just 32 in 2012 to 829 in 2025, a twenty-six-fold rise over the study period.

The annual incidence rate of NPS poisonings increased by nineteen percent every year, with researchers reporting an incidence rate ratio of 1.19 and a confidence interval of 1.15 to 1.23. This was not one bad year or one substance causing a spike. It was sustained and compounding. More than half of all NPS poisonings recorded across the full fourteen years, 53 percent, happened in just the last three.

The variety involved says as much as the volume. In 2012, the poison centre recorded poisonings linked to seventeen distinct substances. By 2025, that number had reached 176. Sixty-two percent of all NPS poisonings involved more than one substance taken together, which makes both diagnosis and treatment harder in practice.

Which Substances Are Behind It

Three categories accounted for the bulk of cases: cathinones, benzodiazepines and phenethylamines, together making up 83 percent of everything recorded. Which one led shifted repeatedly. Benzodiazepines topped the list in 2012 and again in 2024. Phenethylamines led from 2013 through 2018. Cathinones took over from 2019 to 2023, and again in 2025.

Five individual substances stood out. 3-methylmethcathinone, known as 3-MMC, was involved in 965 poisonings, 22 percent of the total NPS caseload and by far the single most common substance recorded. Bromazolam followed with 378 cases, roughly 9 percent, alongside 4-fluoroamphetamine (4-FA) and 2C-B, each around 5 percent, and 4-MMC, also known as mephedrone, at a similar share.

Bromazolam shows how fast a substance can take hold. It was not reported to the poison centre at all before 2021. Within three years, annual cases had risen nearly tenfold, from fourteen to 123. Designer benzodiazepines like this one are often sold in tablet form and can easily be mistaken for prescription medication, which makes accidental poisoning a real risk rather than something limited to people knowingly seeking out something new.

Opioid-related NPS made up a small share overall, 131 poisonings across the whole study, but the direction of travel is concerning. Seventy percent of all opioid NPS cases occurred in just the last two years, and since 2024 the centre has recorded poisonings involving nitazenes, a class of synthetic opioids linked to a high risk of fatal respiratory depression. The same pattern has already driven a disproportionate share of drug deaths elsewhere in Europe and North America, despite representing a small fraction of overall use.

Bans Don’t Make a Substance Disappear, They Just Change What Replaces It

Regulation clearly shapes what shows up in the data. Phenazepam poisonings appeared only between 2014 and 2018, tailing off after the Netherlands formally scheduled the substance in 2017. A similar pattern followed 4-FA, which peaked at fifty cases in 2016 before nearly vanishing between 2020 and 2022, alongside its regulation and heavy media coverage of its dangers.

3-MMC tells a messier version of the same story. After it was banned in the Netherlands in 2021, reported poisonings fell at first, then climbed back up by 2023. Testing through Dutch drug-checking services later found that many products sold as 3-MMC actually contained other, related cathinones such as 3-CMC or 2-MMC, substances with different strength and effects on the body. Demand rarely disappears when a substance is banned. It usually just resurfaces under a different name, often with less predictable effects than whatever it replaced.

The COVID-19 pandemic also shows up as a turning point in the data. NPS poisoning rates rose noticeably from 2020 onwards, alongside documented shifts in online drug markets and changes in what was available. Researchers are careful not to claim a direct cause, but the timing is hard to miss. There is also a clear seasonal rhythm to the figures, with poisonings peaking every July and December, in line with festival season and the holiday period.

Why a Poison Centre Matters More Than It Sounds

Researchers describe the Dutch Poisons Information Center’s role as toxicovigilance, an early warning system that can flag dangerous new substances well before they show up in wider public health statistics. That early signal matters most for the substances people least expect: novel benzodiazepines that resemble legitimate medication, synthetic opioids mixed into products sold as something else entirely, and semi-synthetic cannabinoids such as hexahydrocannabinol turning up in edibles, a category that has grown sharply in the Netherlands since 2023.

What fourteen years of Dutch data make clear is that novelty and unpredictability tend to travel together. A substance being new to the market does not mean it has been tested or is well understood, by the people using it or often by the people selling it. Many of the products behind the sharpest rises in poisonings were sold under the belief that they were something else, or turned out to be adulterated with substances of unknown strength.

For families, educators and communities, the practical takeaway is straightforward: the substances circulating today are frequently not what people think they are. Staying aware of how quickly this market moves, and treating unregulated substances as carrying real, evolving risk regardless of how they are marketed, remains one of the most useful things a community can do to keep young people safe before harm happens.

The Netherlands Is Not an Outlier for Long

New psychoactive substance poisonings are not a niche issue confined to one country. The Netherlands currently has the highest documented rate of NPS poisonings in Europe, but researchers have identified over 1,400 such substances across 153 countries, with roughly fifty new ones still emerging worldwide every year. Dutch data simply offer one of the longest, clearest windows available into how this market behaves once it reaches real people, rather than how it looks on a drug-checking table or in a seized shipment.

Fourteen years of steadily rising figures is not noise. It is a pattern, and nothing in the data suggests it is close to levelling off.

Source: dbrecoveryresources