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Recreational drugs

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Anna Lee

First posted June 2006

Classified by effects on CNS

CNS Stimulants

  • Example - Amphetamine, Cocaine

  • Cause release of endogenous catecholamines and serotonin resulting in sympathomimetic toxidrome.

  • Complications include

  • CNS toxicity – agitation, seizure, CVS accidents

  • CVS toxicity – arrhythmia, hypertension

  • Respiratory – pulmonary oedema, pulmonary hypertension

  • Metabolic – hyperthermia, rhabdomyolysis

CNS Depressants

  • Example - Ethanol, Benzodiazepines, Organic Solvent, Opioids (Dologesic)

  • Complications include

    • CNS and CVS depression

    • Respiratory depression and risk of aspiration

    • Complications from prolonged immobilization including compartment syndrome, compressive neuropathies


  • Example - Phencyclidine, Ketamine, Lysergic acid diethyamide, Cannabis

  • Drugs which precipitate visual hallucinations, may cause signs of sympathomimetic overstimuation and should be suspected in patients with fluctuating behaviour – violent, bizarre and psychotic

Clinical Features suggestive of recreational drug abuse

  • Past history of drug abuse / Suicidal attempt

  • Agitation, hallucination, delirium, coma,

  • Unexplained cardiac arrhythmia, cardiopulmonary arrest

  • Muscle rigidity, dystonia, rhabdomyolysis

  • Hyper-/hypothermia

  • Unexplained multi-organ failure

General Management

  • ABCs

  • Gastric lavage, Activated charcoal

  • Toxidrome identification based on physical examination – stimulant, depressant, or hallucinogenic

  • Laboratory test to exclude co-ingestion of toxins. Qualitative urine drug screening for documentation. Most of the street drugs however, do not required serum quantification to assist therapeutic decision

  • Supportive care

© Anna Lee June 2006

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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