Acute recreational drug toxicity: An update

Toxicity due to recreational drug use is now considered more of a public health problem. There is a paradigm shift in usage from classical recreational substances like alcohol, cannabis, opioids, cocaine and benzodiazepines to new psychoactive substances like ecstasy, lysergic acid diethylamine, ketamine, gamma hydroxybutyrate and flunitrazepam. There is varied presentation with symptoms of toxicity due to drug use. This is so, as different types of drugs are coming up and it happens that more than one drug is taken at a time by users. Laboratory detection of these recreational drugs may be difficult in some cases as they remain for shorter time in body. There is significant morbidity and mortality associated with drug use. This may consist of hyperthermia, hypertension, electrolyte imbalances, seizures, intra-cerebral bleed, respiratory depression, cardiac arrest, acute renal injury, agitation, panic attacks, acute psychosis, delirium and coma. Management of cases of toxicity is mostly supportive as antidotes are available with few drugs only. Management consists of maintaining airway and oxygenation, hydration, calming the patient and treating the complications seen. As total abstinence from recreational use of drug is a utopia, harm reduction approach may be a useful option but this needs further research (C) 2018 Indian Journal of Medical Specialities. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.