night club medicine

introduction

in many cities, the dangers of night clubbing - both traumatic from accidental or criminal events, burns from major fires and pharmacological from the increasing use of both old and new drugs - is becoming a major issue for communities and emergency departments and fuelling the need for development of “night club medicine” to address the rapidly changing and increasing types of emergency presentations.
the prime concerns have always been, and continue to be:
- alcohol
- cocaine
- crime
- conflagration
these have been compounded by the ever increasing variety and complexity of novel substances, most of which have little known regarding their risks and toxicologic management
novel drugs abused in night clubs can be grouped into:
- stimulants:
  - piperazines
  - cathinones
  - synthetic cocaine
  - pipradols
- depressants:
  - GHB, GBL
  - 1,4-butanediol
  - novel opiods and opioid metabolites
- hallucinogenics:
  - glaucine
  - TFMPP
  - tryptamines
  - “spice”
  - methoxetamine
    - Acute toxicity is similar to ketamine ( K hole) but in addition:
      - Stimulant features - hypertension, tachycardia
      - agitation
      - cerebellar features