Drugs of Abuse and the Nervous System

This article discusses the neurologic complications of traditional, nontraditional, and emerging drugs of abuse.

The manufacture, distribution, and use of so-called designer drugs are increasing. These agents can induce dramatic neurologic manifestations and can evade identification on conventional drug-screening assays. Additionally, gabapentinoids, drug agents that are very familiar to neurologists, are being abused in the general population at increasing rates to achieve euphoric highs and potentiate the effects of opiates. Furthermore, even well-known illicit narcotics such as heroin are posing dangers above their baseline because of "lacing" with additives or substitutes such as fentanyl and related compounds. These clandestine agents increase the potency of what are thought to be typical dosages to lethal levels, thus leading to more unintentional overdose deaths.

The potential for short- and long-term nervous system injury from drug abuse is well established. However, it is important for the practicing neurologist to possess awareness of the features and observed sequelae of the toxidromes of both traditional and nontraditional drugs of abuse. This is because the use of both is widespread in our society and conventional drug screening can miss detection of some powerful agents, thus forcing us to maintain a high index of suspicion based on recognition of the clinical features.