Designer drugs 2015: assessment and management.
Recent designer drugs, also known as "legal highs," include substituted cathinones (e.g., mephedrone, methylone, and methylenedioxypyrovalerone, often referred to as "bath salts"); synthetic cannabinoids (SCs; e.g., Spice); and synthetic hallucinogens (25I-NBOMe, or N-bomb). Compound availability has evolved rapidly to evade legal regulation and detection by routine drug testing. Young adults are the primary users, but trends are changing rapidly; use has become popular among members of the military. Acute toxicity is common and often manifests with a constellation of psychiatric and medical effects, which may be severe (e.g., anxiety, agitation, psychosis, and tachycardia), and multiple deaths have been reported with each of these types of designer drugs. Clinicians should keep designer drugs in mind when evaluating substance use in young adults or in anyone presenting with acute neuropsychiatric complaints. Treatment of acute intoxication involves supportive care targeting manifesting signs and symptoms. Long-term treatment of designer drug use disorder can be challenging and is complicated by a lack of evidence to guide treatment.
The University of Texas Health Science Center at Houston, 1941 East Road, BBSB 1222, 77054, Houston, TX, USA. Michael.F.Weaver@uth.tmc.edu.
Michael F
MF
Weaver
St. Joseph Mercy Hospital, 5333 McAuley Drive, Suite R-3009, 48197-1014, Ypsilanti, MI, USA. John.Hopper@stjoeshealth.org.
John A
JA
Hopper
The University of Virginia, Center for Wellness and Change, 1007 East High Street, 22902, Charlottesville, VA, USA. EWG2N@hscmail.mcc.virginia.edu.
Erik W
EW
Gunderson
D000470:Alkaloids / Q000494:pharmacology; D002186:Cannabinoids / Q000494:pharmacology; D015928:Cognitive Behavioral Therapy; D003376:Counseling; D015198:Designer Drugs / Q000009:adverse effects / Q000494:pharmacology*; D006213:Hallucinogens / Q000494:pharmacology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008991:Monitoring, Physiologic; D010353:Patient Education as Topic; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000494:pharmacology*; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy*
D000470:Alkaloids; D002186:Cannabinoids; D015198:Designer Drugs; D006213:Hallucinogens; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs; C023665:cathinone