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    Neurologists must recognize illicit drug-related neurologic injuries, especially from potent synthetic opioids like fentanyl. Emerging agents and misinformation pose risks, highlighting the need for updated clinical awareness and harm reduction.

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    Area of Science:

    • Neurology
    • Toxicology
    • Public Health

    Background:

    • Illicit drug use causes diverse neurologic injuries.
    • Emerging synthetic opioids, particularly fentanyl, are prevalent and highly potent.
    • Misinformation regarding fentanyl exposure risks hinders harm reduction.

    Purpose of the Study:

    • To update neurologists on current neurologic injuries from illicit drug use.
    • To focus on emerging drug agents and their neurotoxic effects.
    • To address the impact of misinformation on patient care and harm reduction.

    Main Methods:

    • Literature review of neurologic complications associated with illicit drug use.
    • Analysis of recent trends in drug-related fatalities and neurotoxicity.
    • Clinical feature recognition of traditional toxidromes and idiosyncratic drug effects.

    Main Results:

    • Synthetic opioids like fentanyl are leading causes of overdose fatalities.
    • High potency of fentanyl increases unintentional overdose risk, especially as an adulterant.
    • Neurologic effects vary widely and some novel agents evade standard drug screens.

    Conclusions:

    • Practicing neurologists need to be aware of emerging illicit drug neurotoxicity.
    • Recognizing clinical features of toxidromes is crucial for diagnosis.
    • Addressing misinformation is vital for effective harm reduction strategies.