Clinicians have limited reliable data to guide management of patients with toxicity from emerging recreational drugs. The harms of these substances are not fully documented, though they are clearly not without risk. Current acute management is pragmatic, primarily extrapolated from experience with longer-established stimulant or hallucinogenic drugs such as amphetamines, MDMA, and LSD.
Acute toxicity from recreational use of alpha methyltryptamine (AMT) in the UK, reported to the National Poisons Information Service from March 2009 to September 2013, involved 63 telephone enquiries, mostly in 2011 and 2012. Most patients were male (68%) with a median age of 20 years; ingestion was the most common route. Compared to mephedrone users, AMT users more frequently experienced acute mental health disturbances (66% vs. 32%), stimulant effects (66% vs. 40%), and seizures (14% vs. 2%). Toxicity from AMT has been encountered since January 2011, though still infrequent.
In seven men who presented to hospitals in England between July and October 2015 after smoking 'legal high' products, analytically confirmed exposure to the synthetic cannabinoid receptor agonist MDMB-CHMICA was associated with acidosis (respiratory in three, metabolic in three, mixed in one), reduced level of consciousness (six of seven), dilated pupils (five of seven), fast heart rate (five of seven), slow heart rate (two of seven), convulsions (two of seven), and agitation (three of seven). Recovery occurred within 24 hours in all but one case where methiopropamine was also present.
Between April 2010 and August 2012, the UK National Poisons Information Service received 47 telephone enquiries and 298 online database sessions about methoxetamine, a dissociative drug. After the UK placed methoxetamine under a Temporary Class Drug Order in April 2012, online sessions fell by 79% (from 151 to 32) and telephone enquiries by 80% (from 15 to 3). Clinical features reported included stimulant effects (36%), reduced consciousness (17%), dissociative effects (11%), cerebellar signs (6.4%), and acute mental health disturbances (43%). The pattern suggests reduced presentations to healthcare services, though whether the legal order caused the decline is unclear.