The Pulmonary Edema of Heroin Toxicity—An Example of the Stiff Lung Syndrome

Effects of Heroin, Morphine, Methadone, and Propoxyphene on the Lung

“…Even with adequate mechanical ventilation, patients die from heroininduced pulmonary edema. 1 Hypotension is usually not due to heroin, and a search for other causes is appropriate if hypotension persists. 15…”

Secretory Cells of the Peripheral Pulmonary Epithelium as Targets for Toxic Agents

“…For example, type II cells which are relatively resistant to the effects of the oxidant gases, oxygen, ozone, and nitrogen dioxide, nevertheless proliferate in response to injury inflicted upon the type I cell by these gases (56)(57)(58)(59). Proliferative responses by the type II cell have been observed following exposure of animals to numerous toxicants such as cadmium (60), busulphan (61), bleomycin (62), heroin (63), silica (64), and urethane (65). However, with most toxic agents reasons for the proliferative response of the type II cell are not clear.…”

“…The manner in which the lining is affected and the extent to which its functions are impaired has received very little attention. Extreme reductions in pulmonary compliance associated with heroininduced edema (63) and oxygen toxicity (75) and the appearance of hyaline membranes similar to those found in premature infants with respiratory distress syndrome suggest that the extracellular lining may have been severely altered although other mechanisms are also possible. Edema fluid which is often present in lungs exposed to toxic materials further complicates the issue, since edema fluid can affect the surfactant properties of the extracellular lining (76).…”