The drug abuse epidemic continues to sweep across America. New and previously unknown designer drugs are being created and finding their way into the headlines with new toxicities, symptoms and dangers. Although once sold in gas stations and head shops, synthetic marijuana, bath salts and similar designer drugs can cause severe toxicity, organ damage and death. Emergency Physicians are tasked with treating people using these new chemicals, without a clear understanding of exactly what new toxin they are treating. We will discuss the new and emerging drugs of abuse, what is out there, where they came from, their effect on the body in the acute and chronic user, as well as treatment strategies.