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Nitrous oxide has been utilized in medicine for over 150 years, with current applications in emergency medicine, dentistry, and obstetrics. It is a commonly utilized anesthetic and analgesic that is well-tolerated among adult users. Outside of medicine, nitrous oxide is a frequently inhaled recreational drug, typically used among teenagers and young adults. Within the last decade, nitrous oxide has been found to have antidepressant effects similar to ketamine, thought to be related to its effect on N-methyl-D-aspartate receptors (NMDARs). Though there is limited evidence about its therapeutic effects in mood disorders, recent studies support that nitrous oxide has the potential to treat resistant unipolar depression. In this chapter, we discuss nitrous oxide’s putative mechanism of action, administration, current use in psychiatry, and possible future psychotropic applications.

This chapter reviews observational studies of the effects of maternal exposure to tobacco smoke, consumption of alcohol, and use of recreational drugs on the health of the mother and baby. Studies of tobacco exposure are evaluated separately for active maternal smoking and passive exposure to other smokers. Alcohol consumption is also separated into studies of binge (high-dose episodes) and regular, more modest drinking behaviors. The recreational drugs reviewed include caffeine, marijuana, narcotics (opioids), stimulants like cocaine and amphetamines, and hallucinogens like LSD and magic mushrooms. The mother and baby health outcomes reviewed are similar to those in other pregnancy chapters but also include withdrawal symptoms in the baby and the child’s long-term brain development and behavior.

Pulmonary toxicity can occur therapeutic agents as well as recreational drug abuse. Common imaging patterns of lung injury due to therapeutic drugs are highlighted in a table, and lung injury patterns from recreational drugs of abuse are also discussed, with imaging examples of both categories provided.

Cannabis is the most frequently abused recreational drug worldwide. Its major psychoactive component, ∆9-tetrahydrocannabinol (∆9-THC), interacts with specific cannabinoid (CB) receptors in the brain. Until today distinct neuropathological alterations have not been described.

Drug-induced hypertension is often underestimated. Several drugs prescribed for conditions other than hypertension as well as some herbal remedies, over-the-counter drugs, or recreational drug use (cocaine, anabolic steroids, etc.) can increase blood pressure or blunt the blood pressure-lowering effect of antihypertensive treatments. Some drugs induce sodium retention associated with extracellular volume expansion. Others directly or indirectly activate the sympathetic nervous system, act directly on arterial smooth muscle tone, or have no clear mechanism of action. Other drugs may directly or indirectly interfere with the pharmacokinetic and/or pharmacodynamic profile of the antihypertensive drugs and thus can reverse their blood pressure-lowering effect. Careful evaluation of the drugs taken by patients for conditions other than cardiovascular diseases, through the completion of a standardized questionnaire or the use of drug–drug interaction-checking websites, can help to identify drug-related hypertension.

The use of different drugs in clinical practice has enhanced the importance of pharmaco-EEG (P-EEG) studies in recent years.

Pediatric pharmacological cognitive enhancement (PPCE) refers to children’ and adolescents’ nonmedical use of prescription and recreational drugs for enhanced performance at school. Adolescents’ own intentional decision for substance use to compete with fellow students must be distinguished from parental decisions to enhance their children’s performance as an investment in their children’s or in their own future, respectively. While several recent studies have examined the prevalence and the correlates of pharmacological cognitive enhancement among healthy students and employees, only little is known about PPCE among school students. Given that decision-making in adolescence is strongly modulated by emotional and social factors, peer influence, and availability, the theory of self-medication might best explain intentional PPCE in late adolescence. In addition, regular recreational drug use is likely to lower the barriers for PPCE in populations interested in enhancing their performance at school. To ensure equal developmental opportunities for today’s school students, an individual-centered approach should focus on strengthening adolescents’ resources and self-efficacy.

The Swedish STRIDA project on new psychoactive substances (NPS) monitored the occurrence and health hazards of novel recreational drugs in Sweden through evaluation of analytically confirmed adverse events presenting in emergency departments and intensive care units. During a ~6-year period from 2010 to early 2016, about 2,600 cases of suspected NPS intoxications were included in the project. About 75% of patients were men and the total age range was 8–71 (median 24) years and 57% were 25 years or younger. A large number of NPS belonging to many different drug classes were identified in project samples of urine and blood (serum/plasma) submitted for free drug testing, including synthetic cannabinoid receptor agonists, stimulants, cathinones, hallucinogens, dissociative drugs, benzodiazepines, and opioids, and also in drug materials from the cases forwarded to the laboratory along with the biological samples. The STRIDA project has been shown to serve as an effective early warning system for NPS by collecting data on incidence, distribution, and adverse effects and has supported healthcare professionals in the knowledge and critical care of intoxications caused by a wide range of novel substances. The results of the STRIDA project have also illustrated how drug regulations can drive the NPS market.

The use of performance enhancing drugs and supplements in sport and physical activity has been around for decades; however, the impact of these drugs and supplements on performance in the heat has been garnering new attention. Although there are some drugs and supplements that can enhance performance in the heat, there are also many that may hinder performance, even potentially increasing the risk of serious illness or death in select circumstances. This chapter will describe and discuss specific drugs and supplements and their effects on performance and safety in the heat.

Acute intoxication with recreational drugs is a very common reason for visits to the emergency room. These intoxications cause both medical and psychiatric symptoms which must be approached simultaneously. Intoxication with multiple drugs is common and clinicians must exert extreme caution when assessing patients. Intoxications with a single drug does not follow typical clinical presentation: Users often genuinely think they’re taking one drug but take another → E.GL: user purchases “Liquid Ecstasy” (GBL) believing he’s taking Street drugs can contain mixing products and byproducts that are active. Clinical assessment can orient toward a particular drug (see diagnosis orientation tree) but clinicians must be ready to reconsider their diagnosis as a patient’s presentation evolves. Clinicians must be particularly cautious when managing psychiatric symptoms, especially agitation: Use of antipsychotics is ill-advised in case of intoxication with many drugs because of: Risk of QTc prolongation Increased risk of NMS with certain drugs Benzodiazepines are often the safest choice Caution in risk of respiratory depression Some clinical presentations can appear as intoxication when they are in fact withdrawal syndromes. All patients must be reassessed psychiatrically once medically stable/clear “the next day” to evaluate for: Suicidal risk Persisting psychiatric symptoms (psychosis, mood disorder…) resulting from intoxication with the drug Untreated psychiatric disease independent of drug use All patients must be counseled Detox and rehab options vary by drug use and user All users must benefit from HIV/STIs risk reduction strategy: Evaluate risk taking behavior in general and for current visit (i.e.: did patient have unprotected sex immediately prior to visit). Educate about safe sex practices Follow guidelines and consider Post-Exposure Prophylaxis. Encourage repeat users to consider Pre-Exposure Prophylaxis.

The plant Cannabis sativa has been widely used by humans over many centuries as a source of fibre, for medicinal purposes, for religious ceremonies and as a recreational drug. Since the discovery of its main psychoactive ingredient, Δ9-tetrahydrocannabinol (THC), significant progress has been made towards the understanding (1) of the in vitro and in vivo pharmacology both of THC and of certain other cannabis-derived compounds, and (2) of the potential and actual uses of these “phytocannabinoids” as medicines. There is now extensive evidence that the pharmacological effects of some widely-studied phytocannabinoids, are due to their ability to interact with cannabinoid receptors and/or with other kinds of pharmacological targets, including non-cannabinoid receptors, and this makes the pharmacology of the phytocannabinoids rather complex and interesting. In this chapter, we provide an overview of the in vitro pharmacology of five selected phytocannabinoids and report findings that have identified potential new therapeutic uses for these compounds.

Cannabis sativa, commonly referred to as marijuana, is popularly recognized as a medicinal and recreational drug. Although the legal status of the plant and its derivatives has been debated in numerous social and legal forums, very little is known about the immunological effects following personal and more recently, occupational exposure. Current studies have shown that direct handling and consumption of C. sativa and its derivatives can elicit allergic reactions and in very rare cases, life-threatening anaphylaxis. Initially, Δ9-THC and cannabinol were suggested to be the potential allergic sensitizers; however, recent reports have demonstrated that allergic reactions to C. sativa may be driven by type I hypersensitivity mechanisms. In this chapter, we will examine the scenarios and routes of exposure to C. sativa that may result in allergic sensitization and provide insights into the key allergic determinants. Finally, the methodological challenges associated with studying the plant and the biotechnological advances in exposure assessment will be additionally discussed.

This chapter puts the modern prescription drug epidemic into historical context. The fact that the drugs prescribed for mental health problems are psychoactive substances is not widely recognised, but when it is, their use can be viewed through the prism of mankind’s long relationship with mind-altering substances. The chapter describes how the controls placed on the availability of drugs like opium and cocaine set the scene for the rise of prescription psychopharmaceuticals in the mid-twentieth century. In turn, the widespread prescription of psychoactive drugs helped usher in the recreational drug scene in the 1950s. The medical profession reacted by concocting a view of their drugs as specific, disease-targeting treatments, thereby obscuring their psychoactive effects. This view continues to impede a balanced appraisal of the longstanding human habit of using chemicals to dull emotional pain.

A number of neurotoxins have been found in herbal medicines and it is likely that others with more subtle or complex effects remain to be discovered. Severe poisoning by herbal products may be due to factors such as misidentification, adulteration, and poor processing of the plant material, and CNS “herbal” toxicity in particular may also be the result of the illicit use of recreational drugs. Any risk assessment must be considered in the context that herbal medicines are very variable both in quality and the way they are used, and also bearing in mind that a whole herb extract may produce test results quantitatively and qualitatively different than those of a constituent tested in isolation. The problems involved in assessing herbal neurotoxicity are similar to those in other areas of neurotoxicology, but are even more complex given the role of the CNS in controlling other systems of the body, and the fact that many neurotoxicity tests are not yet validated. Testing for developmental neurotoxicity is now recognized to be of crucial importance, but requires developing adapted methodologies. Increasing attention is being devoted to the development of in vitro systems for screening, but validation studies remain to be done to correlate in vitro results with neurotoxicological responses in whole animals.

In small quantities, cocaine has been used for local anesthesia, predominantly used for nasal and lacrimal duct surgery. Until 1903, cocaine was widely available and promoted as a “brain tonic” and “Coca-Cola” in the form of the caffeinated beverage. Otherwise, cocaine in its hydrochloride and alkaloid forms is currently an illicit recreational drug used for stimulant effects and euphoria.

The lasting research on the endocannabinoid system (ECS) has now provided solid and convincing evidence that proves the detrimental effects of recreational drug abuse (a growing habit among teenagers) on fertility. Endocannabinoids (eCBs) affect reproductive events from gametogenesis to fertilization, from embryo implantation to the final outcome of pregnancy and, thus, they have been proposed as suitable biomarkers to predict the reproductive potential of male and female gametes in clinical practice. Novel tools for reproductive medicine are highly sought after, and here we report the latest findings on the impact of the ECS on fertility, demonstrating how basic research can be translated into new medical strategies.

Recreational drugs are an important part of the Australian lifestyle. The 2004 national survey on drugs (NDSHS 2005a) shows that the majority of Australians consume alcohol on a regular basis, one fifth of the population uses tobacco regularly and two out of five people have used some illicit drug at some point in their lives (Fig. 3.1). The alcohol and tobacco industries are significant contributors to the Australian economy in terms of employment and tax revenue. In 2004–2005, some AUD11.8 billion was received by the Australian Government in alcohol and tobacco taxes (AIHW 2007).

Recreational drugs are habit-forming substances and are therefore often consumed in a consumption bundle. For instance, the probability of using marijuana in the general Australian population is 13 %. However, in a subpopulation of tobacco smokers, nearly 32 % consume marijuana, and among those who consume hard drugs such as cocaine, heroin and amphetamines, nearly 96 % use marijuana.