Solid phase microextraction (SPME) has experienced rapid development and growth in number of application areas since its inception over 20 years ago. It has had a major impact on sampling and sample preparation practices in chemical analysis, bioanalysis, food and environmental sciences. A significant impact is expected in clinical analysis as well as pharmaceutical and medical sciences in the near future. In this review, recent developments of SPME and related technologies are discussed including an in-vial standard gas system for calibration of SPME in high throughput mode; a thin film geometry with high extraction efficiency SPME for gas chromatography (GC) and liquid chromatography (LC) analyses; and couplings of SPME with portable instruments permitting on-site measurements. Also, the latest advances in the preparation of sorbents applicable for direct extraction from complex biological matrices as well as applications of these extraction phases in food analysis and biomedical studies such as therapeutic drug monitoring and pharmacokinetics are described. Finally, recent trends in metabolomics analysis and examples of clinical monitoring of biomarkers with SPME are reviewed.