Background Since the classification of miaow miaow (mephedrone) as a class B drug in April this year, a new drug is emerging as a so-called ‘legal high’. Deaths have already been attributed to ivory wave in different parts of the country.

Method A case study is presented, and relevant literature is explored in order to better understand the drug and its effects in the human body.

Results Overstimulation of the nervous system can cause acute paranoid psychosis, dizziness, hyperthermia and potential fitting. Effects on the cardiovascular system include tachycardia, chest pains, S-T segment changes, and blood pressure variations with potential renal implications.

Conclusion Ivory wave's popularity seems to be growing and it seems quite plausible that this drug could become ‘the next mephedrone’. Clinicians should be aware of its likely presentations, dangers, and management.