Background and Objectives: Over the past decade, non-medical use of novel drugs has proliferated worldwide.
In most cases these are synthetic drugs first synthesized in academic or pharmaceutical laboratories for research or drug
development purposes, but also include naturally occurring substances that do not fit the typical pharmacological or behavioral
profile of traditional illicit substances. Perhaps most unique to this generation of new drugs is that they are being
sold over the counter and on the Internet as “legal highs” or substitutes for traditional illicit drugs such as cannabis, cocaine,
amphetamines, MDMA, and LSD. The purpose of this review is to provide an overview of novel drugs in current
use, including the epidemiology of use and toxicologic and pharmacological properties, and to offer some guidelines to
clinicians who see patients experiencing adverse effects from these drugs.
Method: We review the known scientific literature on recently introduced synthetic drug types, synthetic cannabinoids and
synthetic cathinones, and the hallucinogen Salvia divinorum.
Results: These substances comprise part of a rapidly evolving and controversial drug market that has challenged definitions
of what is legal and illegal, has benefitted from open commercial sales without regulatory oversight, and is noteworthy
for the pace at which new substances are introduced.
Conclusions: This emerging trend in substance use presents significant and unique public health and criminal justice challenges.
At this time, these substances are not detected in routine drug screens and substance-specific treatment for cases of
use-related toxicity are not available. Clinicians are encouraged to learn characteristic signs associated with misuse of
novel drugs to recognize cases in their practice, and are recommended to use a symptom-specific approach for treatment
in each case.