Smoking heroin increases risk for chronic respiratory symptoms

Heroin smokers experienced a significant increase in respiratory impairment with a continuous decline in lung function over time, according to a cohort study published in CHEST.

This study followed a cohort of heroin smokers with COPD for 18 to 24 months. Participants were current or previous smokers of heroin (75.8% smoked crack) and were currently or recently treated with methadone or buprenorphine. The majority of participants were unemployed with high levels of socioeconomic deprivation.

“At follow-up, participants completed a questionnaire which evaluated self-reporting medication prescriptions, health care access and ongoing tobacco and illicit drug use,” Rebecca Nightingale, MSc, a respiratory physiotherapist at Liverpool School of Tropical Medicine, U.K., and colleagues wrote. “Oxygen saturations were measured, and pre- and post-bronchodilator spirometry was completed.”

Of the 161 participants assessed at follow-up (mean age, 51 years; 46% women), 106 completed post-bronchodilator spirometry. All participants were taking opiate substitution therapy, with 47.2% reporting current heroin use.

Participants reported a significant increase in respiratory symptoms, with the Medical Research Council dyspnea score and COPD Assessment Tool increasing by a median of 0.48 and 1.6, respectively, per year (P < .001 for both). FEV₁ declined annually by 90 mL, but this deterioration was not associated with a change in tobacco or heroin smoking use or use of inhaled medications. Since baseline, 31.2% of participants reported a decrease in heroin smoking and 46.5% reported unchanged usage.

These results showed a high burden of lung disease in an evaluated population of heroin smokers. During the 24-month follow-up period, the participants classified as having severe or very severe disease increased from 25% to 36%. These results suggest that heroin users are at a high risk for COPD and their decline is worse than that of tobacco smokers.

“Our findings show the significant respiratory impairment with which heroin smoking is implicated and a concerning accelerated rate of decline over time,” the researchers wrote. “These results combined with previous studies support the call for enhanced screening for inhaled drug users.”

Future studies with larger cohorts are needed to assess whether specific subgroups are especially vulnerable and how associated costs with chronic respiratory illness could be prevented, they wrote. – by Erin T. Welsh

Disclosures: Nightingale reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.