Designer drugs 2015: assessment and management

Designer drugs, marketed as 'legal highs,' include substituted cathinones (e.g., mephedrone, methylone, MDPV), synthetic cannabinoids (e.g., Spice), and synthetic hallucinogens (e.g., 25I-NBOMe). Their availability changes rapidly to evade legal controls and detection. Young adults are the main users, with growing use in the military. Acute toxicity frequently causes severe psychiatric and medical effects such as anxiety, agitation, psychosis, and tachycardia, and deaths have been reported for each drug type. Clinicians should consider these drugs when evaluating substance use in young adults or patients with acute neuropsychiatric symptoms. Treatment of acute intoxication is supportive, while long-term treatment of designer drug use disorder lacks evidence-based guidance.

Study at a glance

Abstract

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.