Retrospective analysis of clinical toxicology results from 2017 to 2023: exploring the characteristics and prevalence trends of detected drugs and poisons.

To characterize temporal trends in toxic substance patterns involved in clinical toxicology cases in Shanghai, while considering regulatory changes, and to benchmark these findings against data from other regions. The clinical toxicology results reported by the Academy of Forensic Science (AFS) from January 2017 to December 2023 were collated, summarized, and retrospectively analyzed for the types and blood concentrations of different drugs and poisons. Overall, 4422 clinical toxicology cases were recorded, accounting for an average of approximately 630 cases per year, with 62 % presenting positive results. The positively detected substances were mainly clinical drugs and pesticides. The detected clinical drugs were predominantly sedative-hypnotics, antidepressants, and antipsychotics. Estazolam (n = 347), midazolam (n = 272), bromadiolone (n = 265), clonazepam (n = 228), and quetiapine (n = 199) were the top five most frequently detected substances in clinical toxicological cases. Other cases related to plant poisons, toxic heavy metals, and toxic alcohols were also recorded. The blood concentrations of the various drugs showed significant variability. This study highlights a concerning rise in psychoactive drug use, particularly sedative-hypnotics and antidepressants, reflecting a growing mental health burden in the population. This pattern is further supported by the frequent detection of blood drug concentrations exceeding therapeutic upper limits, indicating widespread non-therapeutic exposure. In response, psychotropic drug prescribing practices must be comprehensively strengthened through stricter regulations and the establishment of prescription surveillance to ensure rational and safe medication use. Additionally, a decline in certain toxicants, such as paraquat, suggests the effectiveness of policy interventions. The findings also emphasize the risks of polypharmacy and the need for enhanced poisoning prevention and emergency response systems.