• loss of motor control.
• impaired judgment.
• lack of quality control in preparing illegal drugs.
• possibility of added substances (such as talc, poisons, herbicides or other particles). Some of these don't dissolve in the bloodstream and may become particles that block blood flow. Others may cause a toxic reaction.
• the toxic effects of the drugs themselves. For example, cocaine and inhalants can cause fatal arrhythmia (abnormal heartbeat). Heroin and opiates (opium) may cause fatal respiratory depression (lung failure).

How does cocaine affect the heart?

Cocaine use kills many people in the United States. Many are killed by cocaine's effect on the heart.

Several cardiovascular complications are closely related to cocaine use. They include chest pain syndromes, heart attacks, strokes, and fatal and nonfatal arrhythmias. Others include

• myocarditis (inflammation of the heart muscle)
• endocarditis (inflammation of the inner lining of the heart)
• pulmonary edema (eh-DE'mah) (fluid in the lungs)
• vascular thrombosis (blood clots in blood vessels)
• dilated cardiomyopathy (an enlarged heart)

Some of these potentially fatal complications can occur in a first-time user. Older people with abnormal coronary arteries and diseased blood vessels in the brain vessels are at even greater risk.

Cocaine is doubly dangerous for pregnant women. Not only can it cause cardiovascular complications, but evidence is accumulating that cocaine can cause birth defects.

Today law enforcement agencies and the medical community recognize cocaine as one of the most dangerous illicit drugs in common use. Because it's increasingly popular and easily bought, the number of cocaine-related cardiovascular disabilities and deaths may be expected to rise. Furthermore, smoking crack cocaine, which is cheaper, more potent and widely available, will lead to even more strokes and heart attacks in younger people not normally "at risk."

How do intravenous (IV) drugs affect the heart?

Injecting drugs into the veins can cause an infection of the heart called endocarditis. Treatment requires a hospital stay and medication for several weeks. This infection may lead to heart failure, a heart attack or a stroke, all of which can kill you. IV drugs can also cause liver damage from hepatitis and increase the chance of infection with HIV, which can lead to AIDS.