The pulmonary pathology of illicit drug and substance abuse

Abstract

Illicit substance abuse causes diverse pulmonary manifestations that relate to specific agents as well as their mode of delivery, chronicity of use, and the presence of additives. The major categories of substances are cannabinoids, stimulants, and narcotics. The pulmonary effects of marijuana smoking include alveolar macrophage exudation, epithelial remodelling of airways, allergic bronchopulmonary fungal disease, and barotrauma. Inhalation of alkaloidal cocaine may also trigger pulmonary haemorrhage and haemosiderosis, interstitial pneumonia and fibrosis, eosinophilic pneumonia or exacerbations of asthma, in addition to epithelial remodelling and barotrauma. Life-threatening oedema is an important pulmonary complication of intravenous narcotic use. Foreign body emboli, angiothrombosis, and pulmonary hypertension result from intravenous injection of oral pharmaceutical tablets. A variety of tablet fillers—including talc, cornstarch, microcrystalline cellulose, and crospovidone—are discernible histologically. Panacinar emphysema or massive fibrosis are infrequent complications of this practice. Among all categories of substances there is broad overlap of associated lung pathology.