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Fungal Infections in People Who Use Drugs

Jose Portugal Gonzales1, Luis Ostrosky-Zeichner1

  • 1Division of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, Texas, USA.

Open Forum Infectious Diseases
|April 17, 2025
PubMed

Insights

Illicit drug use is linked to rising fungal infections, including candidemia and mold infections. Drug interactions with antifungals pose serious health risks, including overdose.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Illicit drug use is increasing in the U.S., leading to a rise in associated severe infections.
  • Intravenous drug use is a significant risk factor for candidemia, particularly *Candida albicans* infections.
  • Marijuana and other drug use are linked to increased risks of mold infections (*Aspergillus*, *Mucorales*) and other fungal infections.

Purpose of the Study:

  • To highlight the association between illicit drug use and various fungal infections.
  • To identify the specific fungal species and molds implicated in drug-associated infections.
  • To examine potential drug interactions between commonly used substances and antifungal medications.

Main Methods:

  • Review of surveillance data on candidemia and fungal infections.
  • Analysis of risk factors associated with intravenous drug use and marijuana use.
  • Investigation of metabolic pathways involving illicit drugs, antifungals (triazoles, terbinafine), and CYP enzymes (CYP3A4, CYP2D6).

Main Results:

  • 28%-34% of candidemia cases are linked to intravenous drug use, with *Candida albicans* being most common.
  • Marijuana use increases the risk of mold infections (3.5-fold) and other fungal infections (2.2-fold).
  • Intravenous drug use is a risk factor for *Aspergillus* and *Mucorales* infections.
  • Illicit drugs (cannabis, methamphetamines, opioids) share metabolic pathways with antifungals via CYP enzymes.
  • Antifungal drugs inhibit CYP3A4 and CYP2D6, increasing risks of adverse effects and overdose.

Conclusions:

  • Illicit drug use is a significant driver of serious fungal infections in the U.S.
  • Drug interactions between illicit substances and antifungals present a critical public health concern.
  • Awareness and management of these drug-drug interactions are crucial for patient safety.
Keywords:
comprehensive reviewdrug interactionsinvasive fungal infectionsinvasive mycosispeople who use drugs

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