The histopathology of drugs of abuse

Abstract

The use of drugs for recreational purposes is widespread. The drugs used can be divided into groups including stimulants (cocaine, amphetamines, etc.), opiates and opioids (heroin, oxycodone, methadone, fentanyl, etc.), sedatives (benzodiazepines and related substances) and miscellaneous drugs, including ketamine and cannabis (marijuana). These drugs can have profound effects on all organ systems in the body. The method of administration, whether by injection or inhalation, can cause localized and systemic effects, including the transmission of infection and granulomata at the site of injection and in the lungs. Suppurative abscesses from injection can result in systemic amyloidosis. Stimulants have profound effects on the cardiovascular and cerebrovascular systems, with enlarged hearts with fibrosis seen microscopically and cerebral infarction and haemorrhage. Crack cocaine use is also associated with changes in the pulmonary system, including carbon pigmented intra-alveolar macrophages, emphysema and pulmonary arterial changes. Cannabis use is associated with brown pigmented macrophages in the lung as well as changes in the respiratory tract epithelium. Opiates/opioids are associated with inhalational pneumonitis and hypoxic brain damage due to their respiratory depressant effects. Heroin use has been associated with focal segmental glomerulonephritis (heroin-associated nephropathy: HAN). 3,4-Methylenedioxymethamphetamine (MDMA; ecstasy) use is associated with changes in the cardiovascular system. Its use can lead to hyperpyrexia, which results in systemic changes. Ketamine abuse has been associated with cystitis. Drugs of abuse may affect testicular function. In analysing the effects of drugs at autopsy a systematic approach to sampling of histology is required.

Side Effects of Cocaine Abuse: Multiorgan Toxicity and Pathological Consequences

“…The typical morphologic lesion in cocaine-related death is expression of catecholamine myotoxicity and is represented by contraction band necrosis (CBN), also referred to as coagulative myocytolysis, which is a necrosis of the myocardial cells in a hypercontracted state (tetanic death) characterized by rhexis of the myofibrillar apparatus, an anomalous hypereosinophilic crossband formed by segments of hypercontracted sarcomeres with extremely thickened Z lines [180][181][182]. This form of myocardial cell necrosis, both in experimental and human studies, is secondary to OS and is not related to ischemia, representing the histological hallmark of an acute adrenergic stress linked with malignant arrhythmia.…”

Khat use and appetite: An overview and comparison of amphetamine, khat and cathinone

“…MDMA has long been linked to serotonergic toxicity and dehydration, which may be important secondary appetite modulating effects (Parrott, 2001). Renal dysfunction has also been documented with other drugs such as heroin, cocaine and polysubstance abuse (Milroy and Parai, 2011) but relatively less often with AMPH abuse. Chronic kidney disease has also been linked to changes in ghrelin, leptin and cytokines leading to decreased appetite, weight loss and muscle wasting (Gunta and Mak, 2013; Suzuki et al, 2013).…”

Hypertension, end-stage renal disease and mesangiocapillary glomerulonephritis in methamphetamine users

“…[9] A review of the histopathological findings in drug users does not mention any renal effects in amphetamine users. [10] There have been isolated reports of adverse renal effects including necrotising renal vasculopathy, [8] an exaggerated decline in renal function over 15-year follow-up of patients who used methamphetamines, [11] an increased serum creatinine level 1 year after transplant in recipients of kidneys from donors who had used methamphetamines, [12] and early graft loss of two kidneys from donors who had used methamphetamines. [13] In Africa there is even less information on the health outcomes of methamphetamine use.…”