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xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the latest street drugs, their clinical effects, and unique aspects of treatment based on recent literature, as well as highlights overall trends in drugs of abuse.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EToxicology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEmergency Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EToxicology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EMark B. Mycyk, MD, Cook County Health and Hospitals System, Chicago, Illinois, USA, discussed the latest street drugs, their clinical effects, and unique aspects of treatment based on recent literature. He also highlighted overall trends in drugs of abuse. According to Dr Mycyk, the United States comprises 60% of the world drug market. The National Survey on Drug Use and Health estimates that in the United States, 166 000 people abuse heroin, 2.0 million abuse cocaine, and 6.2 million abuse prescription drugs [Substance Abuse and Mental Health Services Administration. \u003Cem\u003ENational Survey on Drug Use and Health\u003C\/em\u003E. 2013]. Dr Mycyk estimated that in the past decade, emergency department (ED) visits for traditional drugs of abuse increased from about 29% to 48% and that although complications from heroin use have increased in recent years, complications from new drugs have increased up to 5800%.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EMany adolescents and young adults perceive prescription drugs as safer than street drugs and will ingest any number of unidentified pills passed around at \u201cpharm parties,\u201d including stimulants, antidepressants, anticonvulsants, and \u201canything that affects the brain.\u201d Peer pressure is one of the main reasons for increasing drug use among young people in the United States. It is also notable that the number of new drug users has increased substantially since 1995 when Internet use became common [Wax PM. \u003Cem\u003EPediatrics\u003C\/em\u003E. 2002].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EA popular Web site for information about new drugs of abuse is \u003Ca href=\u0022http:\/\/www.erowid.org\u0022\u003Ewww.erowid.org\u003C\/a\u003E, which, in addition to testimonials, includes links to credible research articles and hospital systems to go to for help. Other Web sites include \u003Ca href=\u0022http:\/\/www.lycaeum.org\u0022\u003Ewww.lycaeum.org\u003C\/a\u003E, \u003Ca href=\u0022http:\/\/www.shroomery.org\u0022\u003Ewww.shroomery.org\u003C\/a\u003E, and \u003Ca href=\u0022http:\/\/www.talktofrank.com\u0022\u003Ewww.talktofrank.com\u003C\/a\u003E. People also share information about new drugs using instant messaging and via social media Web sites [Boyer EW et al. \u003Cem\u003ECyberpsychol Behav\u003C\/em\u003E. 2007, Chary M et al. \u003Cem\u003EJ Med Toxicol\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EDr Mycyk presented 9 brief case studies of patients who presented to the ED after using new drugs of abuse. The case presentations are summarized below, and the drug features are described in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15540\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15540\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15540\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ECase Studies of Patients Presenting in the ED After New Drug Use\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECASE 1: CLUB ZOMBIE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EA young adult aged 19 years acting \u201czombie-like\u201d arrived from a club with a needle in his arm. His vital signs were the following: blood pressure (BP), 168\/95 mm Hg; heart rate (HR), 125 beats per minute (bpm); temperature, 98.9\u00b0F. He had 6-mm pupils with rotatory nystagmus, was not rigid, and was \u201cstaring off into space.\u201d He had taken methoxetamine [Corazza O et al. \u003Cem\u003EHum Psychopharmacol\u003C\/em\u003E. 2012; Hofer KE et al. \u003Cem\u003EAnn Emerg Med.\u003C\/em\u003E 2012].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECASE 2: A DESIGNER HIGH\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EA man, aged 24 years, presented seizing after snorting a drug bought online. He was agitated, aggressive, hallucinating, and foaming at the mouth. His vital signs were the following: BP, 175\/100 mm Hg; HR, 111 bpm; temperature, 101\u00b0F. He would not cooperate for a neurologic examination. He had taken the designer amphetamine 2,5-dimethoxy-4-iodophenethylamine.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECASE 3: NATURALLY BETTER\u003C\/h2\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EA \u201cformer\u201d heroin addict aged 41 years presented with dyspnea and altered mental state. His vital signs were the following: BP, 90\/65 mm Hg; HR, 80 bpm; temperature, 98.6\u00b0F. He was sleepy with small pupils and shallow respiration and did not improve with naloxone. His friend identified the drug as ibogaine [Alper KR et al. \u003Cem\u003EJ Forensic Sci.\u003C\/em\u003E 2012] on \u003Ca href=\u0022http:\/\/www.erowid.org\u0022\u003Ewww.erowid.org\u003C\/a\u003E.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECASE 4: TAKING THE CINNAMON CHALLENGE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EA man, aged 43 years, became dyspneic while trying to complete the \u201ccinnamon challenge.\u201d His vital signs were the following: BP, 110\/72 mm Hg; HR, 120 bpm; temperature, 98.6\u00b0F. He developed shock, acute respiratory distress syndrome, and was hospitalized for 3 days. The \u201ccinnamon challenge\u201d involves swallowing a tablespoon of cinnamon without drinking anything [Grant-Alfieri A et al. \u003Cem\u003EPediatrics\u003C\/em\u003E. 2013].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECASE 5: SEIZING AT THE VET\u003C\/h2\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EA man, aged 22 years, brought his dog to the veterinarian for new-onset seizures and started seizing during the dog evaluation [Gugelmann H et al. \u003Cem\u003EClin Toxicol (Phila)\u003C\/em\u003E. 2014]. His vital signs were the following: BP, 167\/102 mm Hg; HR, 106 bpm. He was agitated and combative and was intubated because emergency antidotes were ineffective. A urine drug screen was negative. The offending drug was PB-22, a new-generation synthetic cannabinoid.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-6\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECASE 6: MEOW MEOW\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EA woman, aged 22 years, presented with agitation, tachycardia, and hypertension (all adverse effects reported by users of mephedrone [Vardakou et al. \u003Cem\u003EToxicol Lett\u003C\/em\u003E. 2011]) after seizing at a nightclub. She admitted to using mephedrone after obtaining it online.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-7\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECASE 7: QUICKSILVER\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EA patient aged 27 years presented with palpitations, anxiety, and visual hallucinations [Lee H et al. \u003Cem\u003EJ Med Toxicol\u003C\/em\u003E. 2014]. The patient\u0027s vital signs were the following: BP, 109\/77 mm Hg; HR, 80 bpm; temperature 98.4\u00b0F. The patient\u0027s pupils were dilated 5 mm. Friends reported that the patient had taken the drug methiopropamine.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-8\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECASE 8: FUNNY BUT \u2026\u003C\/h2\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EA man aged 25 years was found unconscious by his roommate after using a new drug purchased online for 4 days [O\u0027Connell CW et al. \u003Cem\u003EAmer J Med.\u003C\/em\u003E 2014]. His vital signs were the following: BP, 110\/50 mm Hg; HR, 69 bpm; temperature, 97.2\u00b0F. His pupils were reactive and equal and the examination was not focal. He had been taking phenibut.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-9\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECASE 9: SNAKE BITE HIGH\u003C\/h2\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EA man aged 44 years with a history of polysubstance abuse subjected himself to a \u003Cem\u003ENaja naja\u003C\/em\u003E snake bite on his foot [Katshu MZ et al. \u003Cem\u003ESubst Abus\u003C\/em\u003E. 2011]. He blacked out and felt a sense of well-being and lethargy.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EConventional drug tests do not identify most of these new drugs. However, Dr Mycyk recommended performing basic diagnostic tests, including serum electrolytes and an electrocardiogram, if a patient is symptomatic. Dr Mycyk suggested that health care providers question patients\u0027 friends to identify new drugs of abuse. He recommended subscribing to social media and reading online materials to become more knowledgeable in the new \u201clingo.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EManagement is largely focused on supportive care and symptom control. If patients are dehydrated, they should be rehydrated. If they are tachycardic and agitated, they can be relaxed with benzodiazepines. Patients should be observed until they are asymptomatic, and drug counseling prior to discharge is important. Studies among patients who abuse alcohol have shown that by linking the ED visit to the alcohol abuse, future ED visits and other morbidity can be reduced.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/46\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzogpd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzogpd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}