Recreational drug use is common, with a prevalence of 4.7% among Dutch outgoing people. Stimulant drugs and cannabis are associated with cardiovascular complications such as, palpitations, chest pain, syncope, hypertension, tachycardia, QRS-widening, QTc-prolongation, arrhythmia, acute coronary syndrome, and even sudden cardiac death. The self-reported drug use reliability is mostly poor, although specific questioning might increase this reliability. For risk stratification in chest pain patients, the HEART-score can be used, without adjustment. A prolonged observation duration, as previously advised, seems unnecessary. Treatment includes sedatives, antihypertensives, coronary angiography, and specific antiarrhythmics followed by the appropriate intervention for acute coronary syndrome. For arrhythmia, labetalol, carvedilol, lidocaine and sodium bicarbonate can be considered. The use of beta-blockers is still under debate but should be considered in patients with heart failure with reduced ejection fraction. Therefore, always question patients with cardiovascular complaints about recreational drug use, know this changes management, and provide drug counselling.