Hematological, Inflammatory, and Oxidative Stress Biomarker Profiles in Substance Abuse Combinations: A Comprehensive Evidence-Based Review

Keywords

Substance abuse, Hematological indices, Inflammatory markers, Oxidative stress, Systemic immunity, TOS, SII, NLR, Polydrug interaction

Document Type

Review Article

Abstract

A potential risk of polysubstance use in relation to substance abuse can involve the development of intricate pharmacological interactions affecting the immune system and oxidative stress responses of the body. The current review aims to present a synthesis of the existing literature about hematologic, inflammatory, and oxidative stress markers associated with three patterns of polysubstance use: (1) stimulants and cannabis, (2) stimulants/depressants and CNS depressants, and (3) multi-drug complex usage. This review explores markers such as a neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte ratio (ELR), total oxidant status (TOS), total antioxidant status (TAS), as well as C-reactive protein, interleukin-6, and tumor necrosis factor-alpha. Available evidence suggests that stimulant-cannabis combinations are associated with elevated neutrophil-driven inflammatory indices while maintaining aberrant thiol/disulfide homeostasis. Stimulant-depressant combinations appear to be associated with greater oxidative stress while simultaneously suppressing lymphocyte-mediated immunity. Polydrug use has been associated with more pronounced oxidative imbalance compared with single-substance use, with markedly elevated TOS and oxidative stress indices compared to single-drug abuse. These findings suggest that biomarker panels may serve as clinically valuable adjuncts for assessing addiction severity, monitoring treatment engagement, and identifying immunological complications in patients with substance use disorders; however, their clinical utility requires prospective validation.

Recommended Citation

Alenezi, Teif Naif Freeh and Barghash, Samia Soliman (2026) "Hematological, Inflammatory, and Oxidative Stress Biomarker Profiles in Substance Abuse Combinations: A Comprehensive Evidence-Based Review," Saudi Toxicology Journal: Vol. 3: Iss. 2, Article 1.
Available at: https://stj.researchcommons.org/journal/vol3/iss2/1

Subject Area

Clinical Toxicology

Data Availability Statement

This is a literature-based synthesized review, and all the supporting data are cited within the manuscript. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Ethical Approval

Not applicable. This article is a review of previously published literature and did not involve human participants, animals, or collection of primary data.