Experimental and regular use of psychostimulants has been associated with severe adverse consequences including cardiovascular and cerebrovascular emergencies, acute behavioural disturbances, psychosis and serotonin toxicity. While some evidence regarding the emergency management of complications related to cocaine toxicity is available, studies related specifically to the management of amphetamine and MDMA toxicity are few. Despite a lack of strong evidence, it is widely accepted that skilful management of behavioural disturbance, psychosis and other manifestations of toxicity involves accurate assessment in a safe environment, adequate monitoring, a prompt response, attention to special precautions and the use of urgent sedation when indicated. Further studies into the efficacy of rapid sedation, particularly in regard to short-term effects, are required to improve emergency responses for this group.