What's new in… Toxicity of drugs of abuse

Toxicity caused by drugs of abuse is a frequent reason for presentation to hospital. Cannabis is the most widely used recreational agent. Although not often associated with acute toxicity requiring hospital admission, there is increasing recognition of its cardiovascular, respiratory and central effects. Strong opioids like heroin and methadone are still the most common causes of fatal recreational drug poisoning, but morbidity and mortality caused by cocaine has been increasing. Numerous hospital presentations continue to occur following ecstasy use. Although less common, episodes of toxicity relating to other drugs of abuse, such as newer stimulants (e.g. piperazines), gamma hydroxybutyrate and its precursors, and ketamine, are increasingly encountered by medical staff. This article is an update on the toxicity of recreational drugs, concentrating on recent research findings and emerging issues.