ABSTRACT
Drug abuse in the United States is endemic to all parts of society. In 1990 an estimated 28 million Americans used illicit drugs, and many of these individuals injected substances intravenously.[1] Recent statistics indicate that overall the incidence of drug abuse may be decreasing.[2-4]
Obviously, however, abuse of illicit drugs remains a major problem in the United States today. Cocaine-related emergency room episodes continue to increase, methamphetamine (“crank”) abuse has reached epidemic proportions in some areas,[5] and heroin use is spreading among the multiethnic populations of our major cities.[6]
The unfortunate persistance of parenteral drug abuse in our society provides surgeons with a challenging array of pulmonary, cardiac, and vascular complications, either directly or indirectly related to the drug injections.[7] The compulsion and ingenuity of drug addicts allows any part of the body to be a potential injury site.[7 – 12] Even the repeated intracardiac injection of illicit drugs has been reported.[13]
Heroin obviously is well recognized as a frequently abused intravenous drug, but the list includes cocaine, other narcotics, barbiturates, nonnarcotic analgesics, and amphetamines.[7,14] Various drug combinations are also popular. For example, intravenous cocaine users frequently combine the drug with heroin (“speedball”).[15] In addition to the systemic effects of these drugs, direct injections can cause vascular injury and limb ischemia by a variety of mechanisms, including local vascular trauma and infection, distal emboli, as well as chemical injury. Often the excipients (talc, cornstarch, or fillers) of oral preparations or the agent used to “cut” the heroin (quinine, barbiturates, or lactose) do as much or more vascular damage than the drug itself.[14,16] Surgeons should be aware of the myriad of vascular problems associated with drug abuse and be prepared to manage them. This chapter will review the spectrum of vascular injuries related to parenteral drug abuse, including pathophysiology, clinical presentation, and management.
