Clinicians, both in emergency and other clinical settings, are increasingly faced with the challenge of identifying and treating patients who have used or abused substances of unknown origin and composition. This presents a difficult dilemma, forcing clinicians to rely largely on clinical assessment, experience, and intuition to treat an ever-expanding array of chemical substances created in illegal drug labs.

Bath salts, synthetic cannabinoids, and synthetic hallucinogens such as 25I-NBOMe are relatively new designer drugs that have become popular drugs of abuse, especially among young adults. Though chemically different, they are similar in that they are continually altered in order to avoid legal issues and detection on drug tests. They are also similar in that adverse reactions are common, especially clinically significant psychotic reactions (Weaver et al., 2015).

Detection of these drugs with urine tests is challenging, so when young adults present with agitation and psychosis clinicians should consider designer drugs as a causative factor. Treatment is primarily supportive, and benzodiazepines may be beneficial. When those who use designer drugs come into contact with the healthcare system, clinicians need to link their patients to specific treatment for substance use disorder (Weaver et al., 2015).

The growth and widespread use of synthetic designer drugs is truly, as Bertha Madras says, “human experiments without informed consent.”

Resources

American Society of Addiction Medicine
http://www.asam.org

American Academy of Addiction Psychiatry
http://www.aaap.org/patient-resources/find-a-specialist/

National Association for Alcohol and Drug Abuse Counselors
http://www.naadac.org

Substance Abuse and Mental Health Services Administration
Behavioral Health Services Treatment Locator
https://findtreatment.samhsa.gov