Illicit Drug Use Revisited: What a Long, Strange Trip It's Been

The first apparent reference to a medical complication of illicit drug injection was an article in the 1876 Lancet entitled Tetanus after hypodermic injection of morphia [1]. This brief report describes a woman who had been taught the use of the hypodermic syringe some years before for the relief of the vomiting of pregnancy, and there was some reason to believe that she had practiced the injection surreptitiously where no actual occasion for it existed. Since this description of an apparent medical curiosity, the medical literature has burgeoned with reports on the adverse sequelae of illicit drug injection, involving every major organ system and various infectious agents. (Although previously denoted as intravenous drug abuse, the practice of parenteral injection of nonprescribed pharmaceuticals or illicit drugs is now more precisely and less pejoratively referred to as injection drug use.) An estimated 1.1 to 1.8 million illicit drug injectors exist in the United States; recent household survey data from the National Institute on Drug Abuse indicated that approximately 2.5 million people had ever used illicit drugs by injection [2]. Thus, nonprescribed injection drug use must be considered not a bizarre or aberrant behavior but rather an important social phenomenon with major clinical and public health consequences.

To help understand injection drug use in its current context, two observers who first called attention in the 1960s to the health effects of illicit drug use [3, 4] provide, in this issue of Annals, a comprehensive and well-referenced update on the medical consequences of drug injection [5]. As they note, the major changes that have occurred during the intervening years have been the advent of AIDS and the emergence (or re-emergence) of cocaine as a major drug of …