Intravenous Drug Abuse (IVDA)

Exposure

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Adverse Manifestations

Cardiovascular Manifestations

Endocarditis (see Endocarditis, [[Endocarditis]])

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Infectious Manifestations

Human Immunodeficiency Virus (HIV) Infection (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])

  • Epidemiology: IVDA is a strong risk factor for the acquisition of HIV

Septic Embolism (see Septic Embolism, [[Septic Embolism]])

  • Epidedmiology
  • Physiology
    • Embolization from Endocarditis (see Endocarditis, [[Endocarditis]])
      • Right-Sided (Tricuspid Valve) Endocarditis is More Common Than Left-Sided Endocarditis in the Setting of IVDA
    • Embolization from Septic Thrombophlebitis (see Septic Thrombophlebitis, [[Septic Thrombophlebitis]])

Ophthalmologic Manifestations

Talc Retinopathy

  • Epidemiology: occurs in >50% of foreign body granulomatosis cases
  • Clinical: talc emboli near macula within small vessels

Pulmonary Manifestations

Amyloidosis (see Amyloidosis, [[Amyloidosis]])

  • Epidemiology: reported in intravenous drug abusers with HIV infection
  • Clinical

Chest Pain + Wheezing + Hemoptysis (see Chest Pain, [[Chest Pain]], Obstructive Lung Disease, [[Obstructive Lung Disease]], and Hemoptysis, [[Hemoptysis]])

  • Epidemiology: associated with acute intravenous methylphenidate abuse (see Methylphenidate, [[Methylphenidate]])
  • Physiology
    • Adrenergic Activity
    • Vasospasm

Foreign Body Granulomatosis (see Foreign Body Granulomatosis, [[Foreign Body Granulomatosis]])

  • Epidemiology
    • Associated with the Pulverization of Tablets (Which May Contain Fillers Such as Talc, Starch, Cotton, Cellulose), Dissolution in Water, and Subsequent Intravenous Injection
  • Physiology
    • Embolization of Filler Substances to the Pulmonary Capillaries with Formation of Foreign Body Granulomas
  • Clinical

Increased Risk of Candida Pneumonia (see Candida, [[Candida]]) (Thorax, 1990) [MEDLINE]

  • Physiology
    • Candida Contamination of Drug

Increased Risk of Community-Acquired Pneumonia (CAP) (see Community-Acquired Pneumonia, [[Community-Acquired Pneumonia]])

  • Epidemiology
    • Intravenous Drug Abuse Carries a 10x-Increased Risk of Community-Acquired Pneumonia (CAP) (Thorax, 1990) [MEDLINE]
  • Physiology
    • Altered Mental Status with Increased Risk of Aspiration
    • Bacteremia with Hematogenous Seeding of the Lung
    • Coexisting HIV Infection (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]])
    • Impaired of Local Pulmonary Defenses, Impaired Macrophage Activity, and Impaired Mucociliary Clearance Due to Concomitant Illicit Drug/Tobacco Abuse (see Tobacco, [[Tobacco]])
  • Most Commonly-Implicated Organisms

Increased Risk of Fatal Asthma (see Asthma, [[Asthma]])

  • Epidemiology: in intravenous drug abusers with a history of asthma

Increased Risk of Tuberculosis (see Tuberculosis, [[Tuberculosis]])

  • Epidemiology
    • Confounding Risk Factors in this Population

Non-Cardiogenic Pulmonary Edema/Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome, [[Acute Respiratory Distress Syndrome]])

  • Epidemiology
    • Associated with Intravenous Cocaine Injection (see Cocaine, [[Cocaine]])
    • Associated with Opiate (Heroin, etc) Injection (see Opiates, [[Opiates]])
    • Associated with Methadone Overdose (see Methadone, [[Methadone]])
  • Possible Physiologic Mechanisms
    • Central Nervous System Depression with Upper Airway Obstruction: resulting in negative-pressure pulmonary edema
    • Direct Effect of Drug with Resulting Increased Pulmonary Capillary Permeability
    • Cerebral Edema-Associated Neurogenic Pulmonary Edema (see Neurogenic Pulmonary Edema, [[Neurogenic Pulmonary Edema]])

Pneumothorax/Pneumomediastinum (see Pneumothorax, [[Pneumothorax]] and Pneumomediastinum, [[Pneumomediastinum]])

  • Epidemiology
    • Associated with Attempted Injection into the Subclavian or Jugular Veins (“Pocket Shot”)

Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])

  • Epidemiology
    • Associated with Sympathomimetics
  • Physiology
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References

  • Pulmonary complications of intravenous drug misuse. 2. Infective and HIV related complications. Thorax. 1990 Dec;45(12):957-61 [MEDLINE]