Clinical Approach to Acute Recreational Drug Intoxication in the Emergency Setting: A Practical Guide Based on Swiss...

Area of Science:

• Emergency Medicine
• Toxicology
• Pharmacology

Background:

• Acute intoxications from recreational drug use pose a significant and increasing challenge to emergency departments (EDs) globally.
• Illicit drug consumption causes over 600,000 deaths annually, with stimulants being a major cause of acute presentations in European EDs.
• Emerging novel psychoactive substances and polysubstance use complicate management, highlighting the need for updated clinical guidelines.

Purpose of the Study:

• To provide a narrative review of current evidence and recommendations for the clinical management of acute recreational drug intoxications.
• To support emergency physicians in the structured and evidence-based management of these complex cases.
• To highlight recognition of typical toxidromes and common pitfalls associated with recreational drug use.

Main Methods:

• A literature search was conducted using PubMed, EMBASE, and Cochrane Library.
• Grey literature, including MonAM, Infodrog, and Tox Info Suisse, was incorporated for the Swiss context.
• The review synthesizes evidence on clinical presentations, toxidromes, and management strategies for acute drug intoxications.

Main Results:

• Stimulants, opioids, cannabis, and hallucinogens are common causes of acute presentations, with stimulants predominating.
• Typical toxidromes include sympathomimetic effects from stimulants, respiratory depression from opioids, and effects from hallucinogens/dissociatives.
• Management strategies involve oxygen, benzodiazepine sedation for agitation, and specific antidotes like naloxone for opioids.

Conclusions:

• Standardized emergency protocols and enhanced understanding of pharmacological profiles are critical for improving patient outcomes, especially with rising trends in cocaine and novel psychoactive substance use.
• Novel psychoactive drugs present unique challenges due to limited data, complicating the establishment of typical clinical pictures and standardized care.
• This review aims to equip emergency physicians with the knowledge to manage acute recreational drug intoxications effectively, despite treatment limitations for many substances.