Pre-hospital guideline: Illicit substance-induced hyperthermia

This is one of four Pre-hospital Guidelines NSW Health has prepared to guide clinical management and decision-making in the music festival context. The intended audience is healthcare professionals who provide clinical care onsite at music festivals. These will support the early identification of substance-induced toxicity, together with initiation of appropriate pre-hospital care and early transfer to tertiary health facilities.

Last updated: 03 October 2024

Hyperthermia is the elevation of core body temperature above 38°C secondary to a hypermetabolic state [excessive heat production] +/- impaired heat dissipation which is most commonly due to environmental exposure [heat stress/stroke] and/or drugs.

Some of the more common illicit substances which can precipitate hyperthermia include:

Amphetamines: methamphetamine, Methylenedioxymethamphetamine (MDMA), Para-methamphetamine (PMA, PMMA)
Cocaine
Synthetic Cathinones (i.e. “bath salts”)
Novel Psychoactives
Dinitrophenol (DNP)

Patients with elevated temperature following illicit substance use are at high risk of serious pathology and death. Early recognition and urgent targeted management of hyperthermia in these patients can prevent rapid progression to multi-organ failure and cardiac arrest.