#Farsky large chest series#
A series done by Baldwin and colleagues demonstrated that illicit drug-related intensive care unit (ICU) costs were 10 % of the total ICU costs. The direct financial cost is difficult to measure. Cocaine had the highest rate of involvement, being associated with 158 emergency room visits per 100,000 of the population. In fact, the US Department of Health and Human Service reported 1,171,024 illicit drug-related emergency department visits in 2010, which was higher than any of the six previous years. Despite the overall decrease in prevalence of stimulant abuse in the last 5 years, the detrimental effects associated with highly addictive stimulant drugs like cocaine and methamphetamine continue to take toll on our health care resources, as reflected by persistently high numbers of emergency department visits related to medical, psychiatric, and social consequences of cocaine abuse. Cocaine usage among those aged 12 years or older has decreased from 2.4 million in 2006 to 1.4 million in 2011, and methamphetamine usage has decreased from 731,000 in 2006 to 353,000 in 2010 but has then again increased to 439,000 in 2011. The rate of illicit drug use in the USA itself is alarming: according to the most recent National Survey on Drug Use and Health, in the year 2011, an estimated 22.5 million Americans over the age of 12 years were current or recent illicit drug users, comprising 8.7 % of this age group. Methylenedioxymethamphetamine (MDMA or “ecstasy”) has a global prevalence of 0.2–0.6 %, similar to that of cocaine in this age group. In terms of annual global prevalence in this age group, other than cannabis (2.6–5.0 %), amphetamine-type stimulants (ATS) besides ecstasy appear to be the most common drugs of abuse (0.3–1.2 %), followed closely by opioids (0.6–0.8 %) and cocaine (0.3–0.4 %). According to the United Nations report published in 2012, globally, 3.4–6.6 % of the population between ages 15 and 64 years used an illicit substance at least once in 2010. Substance abuse continues to be a major health care and socioeconomical problem in the USA and is increasing in developing countries. Now more than ever, health care providers must be familiar with the multitude of respiratory toxidromes as well as the diverse pathophysiology related to commonly abused stimulants to provide timely diagnosis and effective treatment. A persistent challenge to studies involving stimulant-associated respiratory toxidromes is the high prevalence of concomitant usage of various substances by drug abusers, including tobacco smoking. Recent studies have also demonstrated the effects of stimulants on autoimmune-mediated injuries of the respiratory tract, such as cocaine-induced midline destructive lesions. Mounting evidence in the past decade has demonstrated that adulterants coinhaled with these substances (e.g., levamisole) and the metabolites of these substances (e.g., cocaethylene) are associated with specific forms of systemic and respiratory complications as well. Stimulants are all rapidly absorbed substances that can also significantly alter the patient’s systemic acid–base balance and central nervous system, thereby leading to further respiratory compromise. Both inhaled and intravenous forms of these substances of abuse can result in a variety of acute and chronic injuries to practically every part of the respiratory tract, leading potentially to permanent morbidities as well as fatal consequences-including but not limited to nasal septum perforation, pulmonary hypertension, pneumothorax, pneumomediastinum, interstitial lung disease, alveolar hemorrhage, reactive airway disease, pulmonary edema, pulmonary granulomatosis, infections, foreign body aspiration, infections, bronchoconstriction, and thermal injuries. The US Department of Health and Human Service reported over one million illicit drug-related emergency department visits in 2010, which was higher than any of the six previous years. Illicit stimulants, such as cocaine, amphetamine, and their derivatives (e.g., “ecstasy”), continue to exact heavy toll on health care in both developed and developing countries.
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