The number of substances used/misused in the United States has expanded significantly in the past decade.  Substance use/misuse has gone global and has spread rapidly via Internet markets.  EMS providers will encounter patients inebriated by a variety of these novel abused substances.  This lecture is factual case-based, highlighting the variety of inebriated patients that may be encountered and the associated signs and symptoms.  Potential complications will be discussed.  Review of appropriate treatments will be noted, specifically emphasizing various options in pre-hospital pharmacotherapy.