The most commonly abused drugs include opioids, amphetamines, marijuana, ketamine and other hallucinogens, caffeine, solvents, tobacco, alcohol, and cocaine. Maternal drug abuse can have significant economic implications and also implications for being involved in criminal activities. Mothers who abuse drugs are 80% more likely to require the involvement of the anesthesiologist for analgesia and anesthesia in labor. Recognition of substance abuse is important due to the potential consequences for fetal death, premature labor and withdrawal symptoms in both the mother and baby. Venous access may be notoriously difficult and there are high prevalences of transmittable viral diseases, such as hepatitis viruses and human immunodeficiency virus (HIV), in populations who self-inject drugs of abuse. Chronic alcohol ingestion, acute intoxication, and withdrawal can all pose a challenge to the anesthesiologist. Gamma-hydroxybutyrate (GHB) has a short half life and the absence of toxic metabolites reduces its detectability.