Table 1 Summary of major complications following illicit drug use

Respiratory compromise

Pneumothorax, haemothorax

Cocaine, cannabis

Barotrauma

Chest drainage

'Crack lung'

Cocaine

Interstitial and alveolar inflammatory infiltration

Systemic corticosteroid administration

Pulmonary oedema

Cocaine

Oxygen, diuretics, nitrates

Interstitial pneumonitis, BOOP

Cocaine

Ventilation where necessary

Chest pain/cardiovascular collapse

Pneumomediastinum, pneumopericardium

Cocaine, cannabis

Barotrauma

Drainage where necessary

Acute coronary syndrome

Cocaine

Alpha-adrenergic vasoconstriction, platelet aggregation

Sublingual nitrates, benzodiazepines

Arrhythmias and sudden death

Cocaine

Sodium channel blockade

Amphetamines

Sympathetic hyperstimulation

Cannabis

Confusion, convulsions, collapse, coma

With respiratory depression

Opioids, benzodiazepines, ethanol, GHB

Central sedation

Airway protection, ventilation

With hyponaturaemia

MDMA

Cerebral oedema (excess fluid consumption and ADH release)

Fluid restriction, hypertonic saline administration

Predominantly seizure activity

Cocaine, amphetamines

Central nervous system stimulation

Benzodiazepines

Opioids, GHB, benzodiazepines, ethanol

Withdrawal

Hyperthermia

With agitated and paranoid behaviour, collapse, and death

Cocaine (excited delirium)

Benzodiazepines, fluid resuscitation

In extremis without rigidity

MDMA (exertional hyperpyrexia)

Exertion, dehydration, arousal, environmental warming, alterations in skeletal muscle excitation-contraction coupling

Active cooling ± dantrolene

With rigidity

MDMA (serotonin syndrome)

Contraction of antagonistic muscle groups

Paralysis

Rhabdomyolysis

With coma

Opioids, benzodiazepines, ethanol, GHB

Pressure necrosis

Fluid administration, monitor for acute renal failure

With excessive muscle contraction

MDMA

Diffuse tissue disruption

Traumatic

Any

Impaired judgement, risk-taking behaviours