Aims: To evaluate the self-reported drugs/substances in the emergency department presentations with acute recreational drug toxicity in a tertiary hospital. Study Design: Cross sectional study. Place and Duration of Study: Clinical Toxicology Department, Tanta University. Between January 2019 and December 2020. Methodology: The data regarding the self-reported drug(s) / substance(s) in patients presenting to an Emergency Department in a tertiary hospital were collected and analyzed. The prevalence of each recreational drug/substance reported by the patients was calculated. Results: There were 373 recreational drugs/substances reported by 248 cases. The most frequently self-reported drug(s)/substance(s) were ethanol (reported by 122 cases), followed by cocaine (94 cases), opiates (36 cases), cannabis (30 cases), and amphetamine-like stimulants (29 cases). Other drugs/substances as spice (synthetic cannabinoids), benzodiazepines, pregabalin, methadone, and  others were reported by the patients as well. In the remaining 16 of the total 264 cases (6.1%), the recreational drug(s) that had been used were unknown to or not reported by the patients. Conclusion: In conclusion, this study revealed that in this tertiary hospital ED, the main recreational drugs leading to the ED presentation with acute recreational drug/substance toxicity as reported by the patients were ethanol followed by cocaine, opiates, cannabis and amphetamine-like stimulants. Other drugs/substances as spice (synthetic cannabinoids), benzodiazepines, pregabalin, methadone, and others were reported by the patients as well.