Drug abuse inflicts a great deal of damage on society. According to the National Institute on Drug Abuse, the cost of illicit drug abuse is estimated at $97.7 billion annually. This figure includes  health care costs and crimes that are associated with drug abuse,  the cost of imprisoning drug offenders, and the cost of lost productivity. It does not include the thousands of addicts every year who are killed by illicit drugs.

Illicit drugs are associated with a wide range of health effects, including cardiovascular disease. Injected drugs (e.g., heroin) have been shown to cause heart attack and stroke. The needles used to inject the drug have been connected to potentially fatal infections such as human immunodeficiency virus (HIV), blood poisoning (septicemia) and an inflammation of the lining of the heart and valves (endocarditis). Cocaine, meanwhile, has been associated with a wide range of cardiovascular problems, including heart attack and abnormal heart rhythms.

People who have a drug problem or who know someone with a drug problem are urged to seek help immediately. The first step is to talk with a primary care physician, a trusted friend, a counselor or a religious advisor. This article documents the serious cardiovascular risks associated with using illicit drugs.

Both cocaine and its derivative, crack, are powerful stimulants of the central nervous system (the brain and spinal cord) and the peripheral nervous system that runs through the rest of the body, including the heart. Regardless of whether cocaine is snorted, injected, smoked, dissolved on the tongue or taken in various other ways, it is quickly absorbed into the bloodstream to give the user a sudden surge of energy. Cocaine or “coke” is extremely addictive, and animal studies have shown that addicted animals will continue using cocaine, without stopping to eat, until they die. According to the National Survey on Drug Use and Health (NSDUH), in 2002 an estimated 1.5 million Americans could be classified as cocaine dependent.

The heart-related deaths of numerous celebrities who used cocaine have clearly shown its danger. People put themselves at risk by using even one low dose of cocaine, and long-term users are at even greater risk. In addition to a long list of potential problems unrelated to the heart (e.g., seizures), cardiovascular dangers include:

Recent research has discovered that cocaine may cause an abnormal buildup of protein and calcium in the heart muscle. This buildup can trigger irregular heart rhythms that can lead to sudden cardiac death. Additional research is being conducted to determine reasons for cardiac hypertrophy occurring with cocaine use.

Furthermore, cocaine increases the risk of aneurysm and aortic dissection, both of which can be fatal. Because of these many associated dangers, heart patients are particularly urged to avoid using cocaine.

Heroin, an opiate, is related to morphine, a narcotic painkiller first extracted from the opium poppy in 1802. Users typically snort, smoke or inject heroin into one of their veins, which tend to collapse over time. After an initial “rush,” heroin produces a relaxed effect on the entire body, lowering blood pressure and slowing both breathing and pulse (heart rate).

The person may develop  a bluish tint to the skin, lips, fingernails and other body parts because of a lack of oxygen-rich blood circulating through the slowed bodily system. Heroin is extremely addictive, because it rapidly replaces chemical in the brain that are responsible for mood. Regular users will go into withdrawal if the drug is out of their system for only a short time.

According to the 2003 National Survey on Drug Use and Health (NSDUH), nearly 4 million people have used heroin at some point in their lives. Heroin users face a serious risk of overdose, and in 2002, there were nearly 94,000 heroin-related cases in U.S. emergency rooms. The rate of deaths from heroin overdose is currently on the rise, according to a 2000 article published in Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention.

Heroin users face potential problems with their cardiovascular system, such as:

Some of the more damaging side effects of heroin abuse are associated with the injection of the drug. Infectious diseases including hepatitis and human immunodeficiency virus (HIV/AIDS) can be  transmitted by sharing needles. These diseases can have devastating cardiovascular effects.

Heroin is dangerous to everyone, and heart patients are especially urged to avoid using the drug because of its life-threatening risk.

Cigarette smoking is the leading contributor to preventable deaths in the United States. Many people think that smoking marijuana is safer than smoking cigarettes because relatively less marijuana is smoked. However, marijuana contains many of the same harmful chemicals as cigarettes, in addition to the psychoactive compound THC. THC is also present in hashish and hash oil, both of which are derived from the marijuana plant.

Marijuana is the most commonly used illicit drug among Americans, according to the 2003 National Survey on Use and Health (NSDUH). More than forty percent of Americans – 94 million – aged 12 and older have tried marijuana at least once.

In recent years, marijuana has become embroiled in legal battles concerning its use as a medicinal for people who suffer from glaucoma or nausea due to chemotherapy. A number of states, including California, have passed laws that physicians can legally prescribe marijuana to their patients. These laws, however, stand in direct contrast to federal drug laws, which still maintain that the cultivation, possession and use of marijuana is a crime. While the legal issues continue to wind through the courts and ballot boxes, researchers are also continuing to study the effects of illicit marijuana use.

Because it is smoked, usually without a filter, marijuana deposits tar and other carcinogens into the lungs, the same as cigarettes. Most researchers believe that this will increase the risk of lung cancer, especially considering that marijuana smoke has up to four times as much tar and 50 percent more carcinogens than tobacco smoke. However, studies have yet to show that marijuana actually increases overall lung cancer mortality. This is probably because many marijuana users also smoke cigarettes, and many marijuana users smoked for a period in their youths then quit. Similarly, marijuana smokers are considered at increased for chronic obstructive pulmonary disease, although no documented cases specifically linking marijuana with COPD have been found. Heavy marijuana smokers, who consume three to four marijuana cigarettes daily, experience the same cough, wheezing and sputum production of a pack-a-day smoker.

Finally, marijuana is known to increase the heart rate (e.g., tachycardia). This may worsen underlying heart disease or aggravate existing high blood pressure. One study has shown that the risk of suffering a heart attack increases almost five times in the hour after smoking marijuana. People with existing heart disease are strongly encouraged to avoid marijuana.

Ecstasy, the synthetic drug methylenedioxymethamphetamine [MDMA], is produced in illegal underground labs.It has been associated as a “club drug” (i.e., taken at clubs, parties and concerts) that acts as a stimulant.  Researchers at the National Institutes of Health (NIH) noted that drug use appears to be following the pattern of addictive drugs and moving into the general population. In 2004, the NSDUH estimated that 13.8 percent of Americans 12 years and older had tried Ecstasy in their lifetime.

Users report a variety of effects, from pleasant acceptance of self and others to psychotic breaks, sweating, shaking, chills and collapse. As a mild stimulant, Ecstasy is associated with hours of intense physical activity. The dangers of this effect are compounded by the drug itself, which raises blood pressure and reduces pumping efficiency of the heart. Additional doses can worsen the effects due to the body’s slow breakdown of the drug. It has been linked to extreme elevation of body temperature and heart failure. High blood pressure, arrhythmia and inefficient blood pumping can all lead to heart failure and death.

There are more than 1,000 different inhalants that are currently being abused. These inhalants range from nail polish remover to gasoline. Because they are cheap and easy to buy, they are frequently abused by teenagers. Users get a high by:

Prolonged “sniffing” episodes are extremely dangerous. It can lead to an abnormally rapid heart rate (tachycardia) that causes heart failure and sudden cardiac death. This is known as “sudden sniffing death” and may occur in otherwise healthy young people who are experimenting with inhalants for the first time.

Although certain anabolic steroids may be legally prescribed by a physician, a number of people (e.g., some athletes) abuse them to build muscle mass. A number of problems have been reported from abusing anabolic steroids, which include infertility and liver cancer. The National Institute of Drug Abuse (NIDA) estimates between 1 and 6 percent of athletes have abused anabolic steroids.

Anabolic steroid use has been associated with a wide range of medical conditions. It may cause the following problems related to the cardiovascular system:

All people are discouraged from using anabolic steroids unless prescribed by a physician as treatment for a medical condition. Anabolic steroids can be particularly dangerous for those who already have high blood pressure, high cholesterol, or other risk factors for a stroke or heart attack (e.g., carotid disease artery, coronary disease artery).

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to illegal drugs and the heart:

1. What cardiovascular problems am I at risk for from using illegal drugs?
   
   
2. How can I determine if I have damaged my heart from illegal drugs?
   
   
3. Am I currently taking any legal medications that increase my health risks if I use illegal drugs?
   
   
4. Will I have problems if I use these drugs on an occasional basis?
   
   
5. Am I abusing any legally prescribed medications? How can this harm me?
   
   
6. How will I know if I have a medical emergency while using these drugs?
   
   
7. Can past drug use affect my heart health now?
   
   
8. Is there way to prevent problems from past drug use?
   
   
9. Should I spee a specialist for my medical problems?
   
   
10. Can you recommend a program that can help with my drug problem?