heroin and Lung-Diseases

Several substances besides tobacco are inhaled for recreational purposes, including marijuana, crack cocaine, amyl and butyl nitrites, heroin, methamphetamine, and phencyclidine. Abuse of most of these inhaled substances has risen in recent years, thereby increasing concern about potential pulmonary and other medical complications. Regular marijuana use can lead to extensive airway injury and alterations in the structure and function of alveolar macrophages, potentially predisposing to pulmonary infection and respiratory cancer. Crack cocaine use can lead to a variety of acute pulmonary complications, including severe exacerbations of asthma and an acute lung injury syndrome associated with a broad spectrum of histopathologic changes ("crack lung"). Habitual cocaine smoking may also produce more subtle long-term pulmonary consequences due to chronic alveolar epithelial and microvascular lung injury. Heroin inhalation can induce severe and even fatal exacerbations of asthma. Pulmonary consequences of inhaled amyl and butyl nitrites, crystalline methamphetamine (ice), and phencyclidine have been less well documented.

Topics: Animals; Cannabinoids; Crack Cocaine; Heroin; Humans; Illicit Drugs; Lung; Lung Diseases; Marijuana Smoking; Methamphetamine; Phencyclidine; Smoking

Medical complications of heroin overdose and the diseases of addicts play an increasingly important role in the daily routine of hospital medical departments. The percentage of drug-related admissions to the Medical Clinic of the University Hospital, Zürich, increased from 0.18% to 4.45% between 1972 and 1983. During this 12-year period, 492 patients were admitted 569 times because of heroin overdose or intoxications combined with other drugs, and 191 drug addicts were hospitalized 226 times for a variety of medical problems. Certain complications, such as heroin pulmonary edema and talc granulomas of the lung, occur only in parenteral drug addiction. Other diseases such as right heart endocarditis, Candida-endophthalmitis, septic arthritis and osteomyelitis are almost exclusively observed in intravenous drug abusers. Sexually transmitted infections and hepatitis B are frequently diagnosed in addicts.

Topics: Adolescent; Adult; Age Factors; Arthritis, Infectious; Candidiasis; Cardiovascular Diseases; Endocarditis, Bacterial; Female; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Humans; Length of Stay; Lung Diseases; Male; Nervous System Diseases; Osteomyelitis; Pulmonary Edema; Rhabdomyolysis; Sex Factors; Sexually Transmitted Diseases; Skin Diseases; Switzerland

Topics: Amines; Amitriptyline; Beclomethasone; Drug-Related Side Effects and Adverse Reactions; Heroin; Humans; Hydantoins; Lung Diseases; Methadone; Naloxone; Oxazoles; Pneumonia, Aspiration; Respiratory Therapy; Sulfasalazine; Ventilators, Mechanical

Topics: Anti-Bacterial Agents; Anticoagulants; Antihypertensive Agents; Bleomycin; Busulfan; Chlorpropamide; Cyclophosphamide; Hemorrhage; Heroin; Humans; Hydrochlorothiazide; Hypertension, Pulmonary; Inhalation; Leukemia, Lymphoid; Lipids; Lung; Lung Diseases; Methotrexate; Methysergide; Nitrofurantoin; Phenytoin; Pulmonary Edema

Topics: Adrenal Cortex Hormones; Aerosols; Analgesics; Aspirin; Autonomic Agents; Bleomycin; Busulfan; Contraceptives, Oral; Cyclophosphamide; Dextropropoxyphene; Drug Hypersensitivity; Heroin; Humans; Lung Diseases; Lupus Erythematosus, Systemic; Methadone; Methotrexate; Mineral Oil; Nitrofurantoin; Oxygen Inhalation Therapy; Paraquat; Pituitary Gland, Posterior; Pleural Effusion; Sulfonamides; Tissue Extracts

Topics: Adult; Aged; Blood Pressure; Body Temperature; Body Weight; Cardiovascular Diseases; Female; Gastrointestinal Diseases; Heroin; Humans; Liver Diseases; Lung Diseases; Lymphatic Diseases; Male; Middle Aged; Morphine Dependence; Pulse; Skin Diseases; Splenic Diseases; Substance-Related Disorders; Urologic Diseases

Topics: Adolescent; Adult; Endocarditis; Female; Hepatitis; Heroin; Humans; Lung Diseases; Male; Middle Aged; Substance-Related Disorders; Tetanus

We present a case of a woman who had progressive shortness of breath and wheezing with a mild restrictive pulmonary function pattern. She was initially diagnosed with eosinophilic granulomatosis with polyangiitis on the basis of peripheral eosinophilia, bronchoalveolar lavage eosinophilia (47%) and surgical lung biopsy findings. Six months following her diagnosis, the patient returned because of persistent symptoms, and a second review of the lung biopsy revealed thrombotic lesions in the pulmonary vessels with polarisable foreign body materials, associated giant cell reactions and numerous eosinophil infiltrates, consistent with intravenous drug abuse. Further investigation showed that she had a history of intravenous heroin overdose, and the diagnosis of excipient lung disease was made. This case highlights the importance of expert pathological, radiological and clinical review of complex presentations and the need for a thorough medication and drug use history review.

Topics: Churg-Strauss Syndrome; Eosinophilia; Excipients; Female; Granulomatosis with Polyangiitis; Heroin; Humans; Lung Diseases

Diffuse alveolar hemorrhage (DAH) is a clinical syndrome characterized by pulmonary hemorrhage, respiratory failure, and high early mortality rates. DAH typically appears on chest radiographs as bilateral parenchymal consolidations. To our knowledge, pulmonary hemorrhage associated with heroin overdose has not been reported. We report the clinical and radiographic findings in two cases of acute DAH following heroin overdose. We speculate that an adulterating agent may be the underlying etiology in these cases. While pulmonary edema as a consequence of heroin overdose is well-documented and usually first suspected when consolidations are present on a chest radiograph in a patient with a history of recent heroin use, we believe that DAH should also be considered in the proper clinical context.

Topics: Adult; Drug Overdose; Hemorrhage; Heroin; Humans; Lung Diseases; Male

Clinical and scintigraphic findings are described in a patient with unexpected diffuse lung uptake on bone scan after a heroin overdose.. The patient's Tc-99m MDP bone scan is reviewed along with the pertinent clinical history and laboratory findings.. Marked diffuse and symmetric lung uptake is present on bone scintigraphy in a patient with a history of acute renal failure and a markedly elevated calcium-phosphate product but normal renal function and laboratory values at the time of the examination.. The incidental observation of metastatic calcification by bone scintigraphy is important, because it may aid in the diagnosis of a previously unsuggested elevated calcium-phosphate product, renal failure, or both. Furthermore, the intensity of tracer localization on bone tracer-specific imaging may help evaluate the activity of the metastatic calcification process.

Topics: Acute Kidney Injury; Adult; Bone and Bones; Calcinosis; Drug Overdose; Heroin; Heroin Dependence; Humans; Lung Diseases; Male; Narcotics; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyolysis; Technetium Tc 99m Medronate

Topics: Adult; Biopsy; Fatal Outcome; Female; Granuloma; Heroin; Humans; Lung; Lung Diseases; Microscopy, Electron; Pneumothorax; Radiography; Substance Abuse, Intravenous

To explore if cocaine or heroin smoking was positively associated to acute respiratory complications (ARC).. We collected data from medical records for 717 cocaine users who were attended in 14 hospital emergency rooms. The association was studied by logistic regression.. The most frequent ARC were respiratory infections and complications with chest pain or dyspnea. Cocaine smokers (OR = 3.3; CI 95% = 1.5-6.9) and cocaine sniffers (OR = 2.5; CI 95% = 1.1-5.6) had greater risk of ARC than cocaine injectors. Heroin smokers (OR = 3.5; COI 95% = 1.8-7.0) and heroin sniffers (OR = 2.8; CI 95% = 1.4-5.6) had greater risk of ARC than non heroin users.. These results suggest that cocaine or heroin smoking increases the risk of ARC.

Topics: Acute Disease; Cocaine; Heroin; Humans; Lung Diseases; Smoking

Postpneumonic empyema (EMP) may develop in substance abuse patients, requiring prolonged hospitalization. An algorithm that provides quality care and a rational basis for timely surgical intervention would be advantageous. We report our five-year experience with EMP in substance abuse patients and present such a treatment plan. Sixty-one substance abuse patients were treated for EMP. Posteroanterior, lateral, and decubitus x-ray studies were obtained before treatment to assess fluid movement. Chest tubes were placed to drain frank pus and to obtain material for positive smears. X-ray studies and computed tomography were done 24 hours later to assess parenchymal pathology and to detect any multiple loculations. Thirty-three substance abuse patients recovered following initial tube thoracostomy and 7 after a second chest tube was introduced. Twenty-one had multiple loculations and underwent thoracotomy. Twenty of the 21 required extensive debridement or decortication, or both; 2 required lobectomy and 1 pneumonectomy. Chest tubes were removed on an average of 6 +/- 1.5 days. Average postoperative stay was 10.7 +/- 2 days. There were 2 early deaths and 1 late death and no recurrent EMP. Bacteriology findings were nonspecific and often polymicrobial. We conclude that early thoracotomy can be lifesaving in the presence of a benign clinical course.

Topics: Adolescent; Adult; Aged; Empyema; Female; Heroin; Humans; Lung Diseases; Male; Middle Aged; Radiography; Substance-Related Disorders

A 50-year-old man, a "mainline" heroin abuser for 25 years, with a five-year history of x-ray findings compatible with asbestosis is presented. Multiple open biopsies failed to prove a diagnosis of asbestosis. The microscopic analyses of tissues revealed the presence of granulomatosis, secondary to talc from chronic intravenous heroin abuse. The need for open lung biopsy in establishing a diagnosis is emphasized, as x-ray findings can be and often are misleading. A tissue diagnosis is necessary, particularly in cases in which drug abuse is suspected.

Topics: Asbestosis; Diagnosis, Differential; Granuloma; Heroin; Humans; Injections, Intravenous; Lung Diseases; Male; Middle Aged; Radiography; Substance-Related Disorders; Talc

Drug-induced lung diseases may present themselves as bronchial reactions (e.g. bronchial asthma), diseases of the parenchyma (e.g. pulmonary infiltrates with eosinophilia, diffuse fibrosing alveolitis), of the pulmonary vasculature (vasculitis) and of the pleura (e.g. pleurisy or pleural fibrosis). Pathogenetically the two most pertinent types of reaction are hypersensitivity or toxic reactions, and less often biologic reactions such as opportunistic infections after cytotoxic and immunosuppressive therapy. Many drug-induced respiratory diseases are reversible upon withdrawal of the offending agent; others may be irreversible or even progress.

Topics: Aspirin; Asthma; Bronchitis; Busulfan; Contraceptives, Oral, Hormonal; Dose-Response Relationship, Drug; Drug Hypersensitivity; Drug Interactions; Drug Tolerance; Heroin; Humans; Iodides; Lung Diseases; Methysergide; Pituitary Hormones, Posterior; Pleural Diseases; Polyarteritis Nodosa; Pulmonary Edema; Pulmonary Embolism; Pulmonary Eosinophilia; Trypsin

Topics: Analgesics; Anti-Bacterial Agents; Heroin; Hormones; Humans; Lung Diseases

Topics: Acute Kidney Injury; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Electrocardiography; Female; Fetal Diseases; Fetus; Heart Diseases; Hepatitis A; Heroin; Heroin Dependence; Humans; Hypertension, Pulmonary; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Lung Diseases; Male; Maternal-Fetal Exchange; Methods; Neurologic Manifestations; Pneumonia, Aspiration; Pregnancy; Pulmonary Edema; Pulmonary Embolism; Respiratory Insufficiency; Skin Diseases

Topics: Abscess; Aneurysm, Infected; Arteritis; Arthritis; Chemical and Drug Induced Liver Injury; Drainage; Endocarditis; Gastrointestinal Diseases; Hand; Heart Valve Prosthesis; Heroin; Heroin Dependence; Humans; Injections, Intra-Arterial; Injections, Intravenous; Injections, Subcutaneous; Lung Diseases; Myositis; Narcotics; Pancreatitis; Phlebitis; Substance-Related Disorders; Surgical Procedures, Operative

Complications resulting from drug abuse more frequently affect the lung than any other organ. The spectrum of pulmonary complications associated with drug abuse is wide. The current practice of using mixtures of drugs is mainly responsible for the increase in pulmonary complications. The chief complications observed in a series of 241 drug abuse patients were aspiration pneumonitis (12.9 percent), pulmonary edema (10.0 percent), and pneumonia (7.5 percent).

Topics: Adult; Alcoholism; Barbiturates; Cannabis; Cocaine; Coma; Female; Heroin; Humans; Lung Abscess; Lung Diseases; Male; Pneumonia; Pneumonia, Aspiration; Pulmonary Atelectasis; Pulmonary Edema; Pulmonary Embolism; Pulmonary Fibrosis; Substance-Related Disorders

Topics: Adult; Bronchography; Drug-Related Side Effects and Adverse Reactions; Granuloma; Heart Valve Diseases; Heroin; Heroin Dependence; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lung; Lung Diseases; Male; Narcotics; Pulmonary Edema; Respiratory Tract Infections; Sepsis; Substance-Related Disorders; Syringes; Talc; Tricuspid Valve; Tuberculosis, Pulmonary

Topics: Abscess; Adolescent; Adult; Chemical and Drug Induced Liver Injury; Chromosomes; Endocarditis; Female; Heroin; Heroin Dependence; Humans; Liver; Lung Diseases; Male; Methadone; Nephrotic Syndrome; Nervous System Diseases; Osteomyelitis

Topics: Aneurysm, Infected; Arterial Occlusive Diseases; Cardiomegaly; Edema; Endocarditis, Bacterial; Hand; Heroin; Humans; Injections, Intra-Arterial; Injections, Intravenous; Ischemia; Lung Diseases; Lymphadenitis; Pneumonia; Pneumonia, Aspiration; Pulmonary Edema; Pulmonary Embolism; Substance-Related Disorders; Tuberculosis, Pulmonary; Vascular Diseases; Venous Insufficiency

Topics: Adult; Alcoholism; Child; Female; Hepatitis A; Heroin; Humans; Liver Cirrhosis; Liver Diseases; Lung Diseases; Male; Middle Aged; Oxygen Inhalation Therapy; Pneumonia; Respiratory Insufficiency; Syndrome

Topics: Acute Disease; Autopsy; Chronic Disease; Granuloma; Heroin; Humans; Lung; Lung Diseases; Morphine Dependence; Talc

Topics: Adult; Arm; Autopsy; Foreign Bodies; Granuloma; Heroin; Humans; Injections, Intravenous; Lung; Lung Diseases; Male; Tablets

These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California, San Francisco. Taken from transcriptions, they are prepared by Drs. Sydney E. Salmon and Robert W. Schrier, Assistant Professors of Medicine, under the direction of Dr. Lloyd H. Smith, Jr., Professor of Medicine and Chairman of the Department of Medicine. Requests for reprints should be sent to the Department of Medicine, University of California, San Francisco, San Francisco, Ca. 94122.

Topics: Bacterial Infections; Chemical and Drug Induced Liver Injury; Endocarditis, Bacterial; Heroin; Humans; Lung Diseases; Malaria; Substance Withdrawal Syndrome; Substance-Related Disorders; Tetanus

Topics: Adult; Amphetamine; Barbiturates; Foreign Bodies; Granuloma; Heroin; Humans; Lung; Lung Diseases; Male; Microscopy, Electron; Pulmonary Embolism; Substance-Related Disorders

Topics: Adult; Aneurysm; Aneurysm, Infected; Endocarditis, Bacterial; Female; Heroin; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lung Diseases; Male; Methylphenidate; Middle Aged; Pneumonia; Pneumonia, Aspiration; Pulmonary Edema; Pulmonary Embolism; Radiography; Substance-Related Disorders; Thrombophlebitis; Thrombosis; Tuberculosis, Pulmonary; Vascular Diseases

Topics: Animals; Cocaine; Drug Synergism; Heroin; Lung; Lung Diseases; Male; Mice; Organ Size; Quinine

Topics: Amphetamine; Barbiturates; Condiments; Drug Synergism; Hallucinations; Hallucinogens; Hepatitis A; Heroin; Humans; Lung Diseases; Lysergic Acid Diethylamide; Mental Disorders; Petroleum; Psychomotor Disorders; Psychoses, Substance-Induced; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Adult; Chronic Disease; Heroin; Humans; Lung; Lung Diseases; Male; Pulmonary Edema; Respiratory Function Tests; Substance-Related Disorders

Topics: Adolescent; Adult; Cocaine; Female; Heroin; Humans; Infections; Lung Diseases; Male; Radiography; Sepsis; Substance-Related Disorders