Routine hospitalization of patients suspected of being exposed to NPSs

Is there a need for routine hospitalization of any patients suspected of being exposed to novel psychoactive substances (NPSs)?

Dan Perri: Most patients who do take NPSs present mostly with agitation, sometimes delirium or hallucinations. These can be monitored carefully in the emergency department, given benzodiazepines, as mentioned [see: Approaching a patient with extreme agitation after using an NPS]. The majority go on to not require hospitalization because the half-life of these drugs and the symptoms that they experience are fairly short-lived.

There are some complications, however, that do lead to hospitalization of patients. For sympathomimetic agents or agents that do have catecholamine effects, [it is] their increased heart rates and tachyarrhythmia risk, the potential for treating hypertensive urgencies or emergencies, even myocardial infarctions, potentially, which would lead to hospitalization. Similarly, in some patients the drug may trigger and/or worsen an underlying psychiatric disorder and the agitation, psychosis, hallucinations may not go away in a few hours and may take days of therapy, mostly because the agent has unmasked or worsened an underlying disease process. Most patients, though, are self-limiting with the small minority requiring hospitalization.