Non-medical drug use is common and numerous imaging manifestations have been described.

Terminology

More neutral terms such as ‘people who inject drugs’, ‘drug users’, or ‘people with substance use disorder’ (SUD) are preferred ⁶. Terms such as drug abusers, addict, junkie, etc. should not be used due to stigmatization, which affects people's willingness to seek treatment ⁶.

Epidemiology

Drug use is a global phenomenon that varies widely based on geography ¹. There is however a common global tendency of men to use drugs more than women ². While there is some evidence of decreasing or leveling off of drug use in high income countries, this is not a global trend ². Even in countries where data suggest decreasing drug use, it is still widespread. For example about 36% of the United Kingdom population between 16 and 59 years of age admit to having taken a recreational drug at some point and 8.2% within the previous 12 months ³.

The number of newly formulated drugs is increasing and global epidemiological studies of drug use may underestimate the phenomenon.

Pathology

There are many possible complications and medical conditions that may be associated with drug use depending on the drug, the formulation, and route and method of administration ^4,9. A few of the manifestations are specific for or highly associated with particular drugs or practices and have recognisable radiological manifestations.

Conditions include ^3,4: 

• general

  • body packing

  • intravenous drug use (IVDU)

  • vaping associated lung disease

  • shotgunning ⁹ (forcibly blowing a substance into someone else’s lungs)

• alcohol

  • ​neurologic

    • Wernicke encephalopathy

    • Marchiafava-Bignami disease

    • acquired hepatocerebral degeneration

    • subacute encephalopathy with seizures in alcoholics (SESA syndrome)

    • alcoholic cerebellar degeneration

    • hepatic encephalopathy

  • hepatopancreaticobiliary

    • steatotic liver

    • acute hepatitis

    • cirrhosis

    • pancreatitis

  • oncologic

    • head and neck squamous cell carcinoma (oral cavity, pharynx, larynx)

    • esophageal squamous cell carcinoma

    • hepatocellular carcinoma

  • musculoskeletal

    • gout

    • alcoholic myopathy

  • obstetric

    • fetal alcohol syndrome

  • cardiac

    • alcoholic cardiomyopathy

• tobacco

  • tobacco use

    • smoking-related lung disease

      • smoking-related interstitial lung diseases

• cocaine

  • cocaine-induced leukoencephalopathy (rare) ⁵

    • levamisole-induced leukoencephalopathy

  • crack lung

  • septal perforation

  • hard palate perforation (presence may help to differentiate from granulomatosis with polyangiitis ^7,8)

  • dilated cardiomyopathy

  • acute reversible pulmonary hypertension

• opioids

  • neurologic

    • "chasing the dragon" leukoencephalopathy

    • pediatric opioid use‐associated neurotoxicity with cerebellar edema (POUNCE) syndrome

    • opioid-associated amnestic syndrome

    • cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome

  • pulmonary

    • heroin-induced pulmonary edema

• cathinones/khat and new derivatives

  • white matter changes, leukoencephalopathy

• ketamine

  • ketamine bladder

• marijuana/cannabis

  • marijuana lung

• methamphetamine

  • "meth mouth"

  • intracerebral hemorrhage