Introduction: Illicit alcohol is spiked with various substances e.g. methanol, solvents, pesticides, sedatives and plant extracts. Patient with poisoning due to illicit alcohol are usually brought to the hospital in inebriated state and diagnosis in these patients becomes a challenge for the emergency physicians. We report our successful management of four patients who presented to us with illicit alcohol poisoning. We also tabulate the differential diagnosis, management and systematic approach to these patients. Material and Method: In July 2018, four patients were admitted in emergency department after consuming illicit alcohol and were managed expectantly. Retrospective review of the hospital record was done to retrieve the emergency department and ICU data. Results: Out of four patients, two were admitted in unconscious state on ventilator while other two were conscious and sober. Apart from methanol, other commonly associated poisoning with illicit alcohol were ruled out. Urine toxicity screen was negative. Two patients on ventilator were managed conservatively in the absence of definitive diagnosis. Both patients gradually improved and recovered uneventfully. On personal communication with bootleggers, it was observed that illicit alcohol is usually spiked with Nitrazepam to enhance the sedative effect. Nitrazepam is usually not detected by routine urine toxicology screen. Conclusion: Apart from methanol, illicit alcohol is spiked with several known and unknown substances. Emergency department physician should be aware of poisoning due to these substances and an approach to an unconscious patient due to consumption of illicit alcohol.