• Michael E Nelson, Sean M Bryant, and Steven E Aks.
• Department of Emergency Medicine, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL 60201, USA; Department of Emergency Medicine, John H. Stroger Jr. Hospital of Cook County, Toxikon Consortium, Illinois Poison Control Center, 1900 West Polk Street, 10th Floor, Chicago, IL 60612, USA. Electronic address: menelson4@gmail.com.
• Emerg. Med. Clin. North Am.. 2014 Feb 1;32(1):1-28.

AbstractMany new emerging drugs of abuse are marketed as legal highs despite being labeled "not for human consumption" to avoid regulation. The availability of these substances over the Internet and in "head shops" has lead to a multitude of emergency department visits with severe complications including deaths worldwide. Despite recent media attention, many of the newer drugs of abuse are still largely unknown by health care providers. Slight alterations of the basic chemical structure of substances create an entirely new drug no longer regulated by current laws and an ever-changing landscape of clinical effects. The purity of each substance with exact pharmacokinetic and toxicity profiles is largely unknown. Many of these substances can be grouped by the class of drug and includes synthetic cannabinoids, synthetic cathinones, phenethylamines, as well as piperazine derivatives. Resultant effects generally include psychoactive and sympathomimetic-like symptoms. Additionally, prescription medications, performance enhancing medications, and herbal supplements are also becoming more commonly abused. Most new drugs of abuse have no specific antidote and management largely involves symptom based goal directed supportive care with benzodiazepines as a useful adjunct. This paper will focus on the history, epidemiology, clinical effects, laboratory analysis, and management strategy for many of these emerging drugs of abuse.Copyright © 2014 Elsevier Inc. All rights reserved.

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