Acute pulmonary alveolitis in narcotics abuse

Lungs of 17 narcotic abusers from medical-legal autopsies were studied to determine the pathological basis for regional alterations of ventilation and perfusion. Postmortem pulmonary angiographic and histological techniques demonstrated acute alveolar wall inflammation with exudation of fluid and cells into the alveoli in all eight abusers dying of narcotism and in six of nine dying of other causes. All abusers had extensive focal chronic intersititial inflammatory infiltrates. Vascular obstruction due to foreign material occurred only with intravenous use of oral pharmaceuticals, and then only in the microcirculation. Lungs of ten young adults dying suddenly with no history or evidence of narcotics abuse showed no acute alveolitis or intravascular foreign material. Intravenous narcotics injection produces transient acute alveolar inflammation that may account for respiratory manifestations and death. Permanent injury to the lung parenchyma or larger vessels with the usual forms of narcotic abuse is not common.