Background New psychoactive substances (NPS) are of global concern accounting for increasing deaths in the UK. We conducted a retrospective analysis of patients attending Leeds Teaching Hospitals NHS Trust with NPS abuse during 2016–2017 and report neurological presentations and outcomes.

Methods We identified 227 records of NPS attendances through electronic searches using Symphony electronic software. Demographic and clinical data were obtained from case-note review.

Results Average age was 34, 82% were male. Two thirds were unemployed, 17% prisoners, 9% students and 4% prison workers. ‘Spice’ accounted for the majority of presentations (90%). 4-methyl methcathinone (‘MCAT’) accounted for 8% of presentations. The remainder reported nitrous oxide (NOS) use. In the spice subgroup, 52% had low GCS, 20% had seizures. Ventilatory support was required in two cases (1%). In the MCAT subgroup, average GCS was 14 and 20% of patients presented with seizure. Psychiatric disturbance was higher in MCAT group (30%). Most patients (62%) were observed in the emergency department and then discharged. Only 3% were referred to the drug and alcohol team.

Conclusions Spice accounted for the majority of NPS presentations. Unemployed single men were particularly at risk. Low GCS and seizures were the commonest presentations, with most requiring observation only.