Philippe Camus, M.D.

Dijon, France

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Heroin (inhaled, insufflated, snorted)

Recent data indicate that heroin may be laced with fentanyl, potentially causing ventilatory depression that can be fatal (PMID 25869219)

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.a

Pneumonitis (ILD)
I.b

Pneumonitis (ILD), acute and/or severe (may cause ARDS)
I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
I.d

Acute eosinophilic pneumonia (AEP)

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)
II.b

Pulmonary edema, cardiogenic

IV - Airway involvement

IV.a

Bronchospasm - Wheezing - Asthma
IV.b

Severe or catastrophic bronchospasm or asthma attack (can be fatal)
IV.g

Airway hyperresponsiveness
IV.ag

Obstructive airway dysfunction (see also IVc, XVx)

VI - Pleural and/or pericardial involvement

VI.f

Pneumothorax

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.t

CNS involvement/dysfunction/damage

XI - Miscellaneous

XI.k

Pulmonary emphysema - Lung cysts or bullae

XII - Cardiovascular involvement / toxicity

XII.g

Cardiomyopathy (acute, subacute, chronic)

XVI - Imaging

XVI.b

Imaging: Ground-glass opacities (GGO) / shadowing