Recreational drugs (RDs), sometimes called drugs of abuse or illicit drugs, are commonly used in many societies worldwide. Not all recreational drugs are illegal, but all are capable of being abused. The Australian Government estimates that in 2019, 43% of its citizens had illicitly used a drug in their lifetime, while 16.4% had used one during the prior 12 months.1 According to the European Monitoring Center for Drugs and Drug Addiction, the estimated prevalence of illicit drug use in 2017 to 2018 in the general population of England and Wales, as assessed by survey, is similar to a decade ago, with 1 out of 10 adults aged 16 to 59 years confirming use within the last year.2 As of 2016, almost 119 million people in the United States had used marijuana in their lifetime.3 The same report noted that about 39 million Americans had used cocaine, 9 million had used crack cocaine, 5 million had used heroin, 18 million had used Ecstasy, and 15 million had used methamphetamine. The Global Drug Survey estimates that 64% of the global population has used an illicit drug at least once.3
Recreational and illicit drugs of abuse are associated with health complications that affect many different organs. It is not surprising that admissions to emergency departments and hospitals and health-care utilization in general are several times higher for adults who use illicit drugs.4Table 66-1 outlines potential respiratory systems adverse effects or complications associated with the use and misuse of recreational drugs. The potential respiratory system anatomic areas of insult by recreational drugs can be divided into oral/airways, pleural space/extrapulmonary, pulmonary vasculature, and lung parenchyma/alveolar space.
TABLE 66-1Potential Recreational Drug Adverse Effects on the Lung ||Download (.pdf) TABLE 66-1 Potential Recreational Drug Adverse Effects on the Lung
Upper respiratory tract and airways
Foreign body aspiration
Emphysema/chronic obstructive pulmonary disease
Foreign body embolism
Lung parenchyma/alveolar space
Cardiogenic pulmonary edema
Noncardiogenic pulmonary edema/acute respiratory distress syndrome (ARDS)
Pneumonitis including aspiration
E-cigarette or vaping product use–associated lung injury (EVALI)
These pulmonary complications can result from an overdose of RDs, as a result of the dosing approach or route used, or as an effect of the drug itself.5 The pulmonary complications of drug use/abuse can also be classified as either infectious or noninfectious.6 Infectious complications are common, and include typical respiratory pathogens as well as tuberculosis,7 skin abscesses, endocarditis, and septic emboli to the lung. Mechanical noninfective and foreign body complications of RD use can be significant, as can the effects of inhalation or intravenous use of RD that have been diluted or “cut” ...