Heroin use in the US is at epidemic levels. It is cheaper than prescription drugs and readily available. One way in which people use heroin is by smoking it. Aside from the obvious reasons to avoid heroin addiction, smoking heroin appears to lead to early findings of emphysema seen on CT scans of the lungs and on pulmonary function testing.

Disturbingly, these finding are being found in young patients sometimes who are only in their 20’s. Remember that emphysema is a disease in which lung tissue is actually destroyed and there is no treatment on the horizon to restore this lung function. The reason that smoking heroin is causing this problem to occur is unclear, but may have something to do with the way in which heroin is smoked. Individuals smoking heroin often inhale very deeply and then hold their breath, while bearing down on it, in order to enhance absorption of the drug. Heroin, as well as other drugs, often burn at higher temperatures which has the potential to cause damage deep inside the lung.

When pulmonary physicians see younger patients with significant fixed lung disease we often suspect some type of genetic disorder such as a deficiency of alpha one antitrypsin. This deficiency (which can be tested for easily) has specific and effective treatment. With the widespread use of heroin as a recreational drug, it is worthwhile for all physicians to question all patients about possible drug use, but especially young patients with findings consistent with emphysema.