Effects of illegal drugs on the heart: ACLS certification guide

Illegal drug abuse and addiction are very serious problems that can affect people of all ages, ranging from adults to infants born to mothers who regularly use drugs. Illegal drugs are drugs that are sold, often for recreational purposes, even though they are not legally approved. These are typically dangerous, with many of them causing health problems, including difficulties with the heart. The type of heart complications a person may potentially suffer from depend on the drug itself as well as other factors. These problems may include a worsening of current heart conditions, a change in heart rate that is either slower or faster, heart failure, or even death.


Opium is a highly addictive narcotic with a long history. It is derived from the opium poppy, which was referred to as the "Joy Plant" by the Sumerians as far back as 3400 B.C. Like heroin, it is an opiate; however, it is an opiate in its crudest form. It comes from the sap of the opium poppy seed, which is a milky fluid. Exposure to air changes the opium so that it is hard and dark brown or black. At this point, it may be smoked, or some may take it orally. It is very similar to heroin in that the user often feels relief from anxiety or pain and may experience an increased feeling of being relaxed. These effects usually last for about 3–4 hours. Using opium excessively and for prolonged periods of time can lead to a tolerance of the drug. Over time, side effects may include an impairment of coordination, heightened anxiety, mental deterioration, weight loss, nausea, impaired vision, and constipation. Smoking opium can also lead to long-term damage of the heart, lungs, liver and kidneys. In the event of an overdose circulatory collapse, convulsions, coma, and death may occur due to respiratory failure. Opium use may affect one's heart by initially reducing their heart rate, however, in the case of overdose the opposite is true and can lead to cardiac failure.

  • OpiumAsk Alice, Columbia University's health professionals Q&A page answers the question of what is opium, and what are the effects/dangers of smoking it.
  • OpiatesLSU Health, New Orleans handout explaining what opiates are, its effects, dangers, addiction, and treatment.
  • The relationship of opium addiction with coronary artery diseaseInternational Journal of Preventive Medicine article on a study performed regarding the effects of opium addiction on coronary artery disease (CAD).

For information on other cardiac drugs that are used clinically, please see our advanced life support courses. We provide training for life support.


Heroin is an opium-based drug that is related to morphine but is two to four times stronger. In its various forms, this drug may be injected intravenously, snorted, or smoked. Short-term effects of heroin include euphoria and a relaxed state, which are what attract certain people to use it illicitly. Other short-term effects include dry mouth, slowing of cardiac function and respiratory rate, decreased mental state — frequently going between conscious and unconscious states — muscle weakness, skin infections, and scarring along veins due to repeated injections. Long-term effects of heroin use include addiction, collapsed veins, abscesses, decreased liver function, a high risk of kidney disease or failure, and increased risk of blood-borne pathogens and infections such as hepatitis B, C, and HIV. This drug also impacts the body's immune system, leaving it more vulnerable to diseases such as tuberculosis and pneumonia. Chronic heroin users also run the risk of developing pulmonary edema and empyema. Cardiovascular effects include bacterial infections of the blood vessel linings and valves of the heart. Addicted users may experience vomiting, diarrhea, and pain in the muscles and bones when attempting to detox which can lead to relapse if not properly treated. The risk of overdose and death from heroin is fairly high. Death rates have climbed due to the recent resurgence in the popularity of this drug across the U.S. and worldwide.

  • Drug facts: HeroinThe National Institute on Drug Abuse Drug Facts page on heroin. Includes information on what it is, how it is used, its effects on the brain, short and long-term effects, overdose, addiction, and treatment.
  • HeroinUniversity of Delaware informational handout on Heroin. It includes statistics of heroin use in the U.S., effects of opiates on the brain, short and long-term effects, and medical complications of chronic heroin use.
  • Health risks associated with the use of illicit drugs and alcohol (PDF)Union University page about the health risks of several illicit drugs. Information includes alternative names for each drug listed, dangers, health risks, and the effects of these drugs.
  • Drug guide: HeroinBrief article by the Partnership for Drug-Free Kids for families to find out the facts about heroin, signs of usage, and what it looks like. Also provides help and support in dealing with substance abuse in children.
  • Heroin's dangerous effects on the lungsInformative article regarding the effects of heroin on the lungs and resulting conditions which include pulmonary edema, empyema, pneumonia, and bronchiectasis.


Cocaine is an appetite suppressant and a powerful stimulant drug that comes from the coca plant, from which it derives its name. Cocaine is typically taken by injection into the bloodstream, snorting through the nose, or rubbing it into the gums. Sometimes it is processed and turned into a crystallized rock, otherwise known as crack, from which it is then heated and smoked. It is used for a variety of immediate effects that it produces, including delusions of supremacy, euphoria, increased energy, and alertness. As these effects wear off, restlessness, anxiety, and paranoia can set in, as well as higher body temperatures, an elevated pulse rate and blood pressure, and shortness of breath. Long-term usage of cocaine can not only lead to addiction but also dehydration and a dry mouth, which may result in damage to the teeth. Kidney failure, autoimmune diseases like lupus, severe bowel decay, a greater chance of contracting blood-borne diseases, malnourishment, strokes, and a greater chance of contracting blood-borne diseases are other risks that come with the prolonged use of cocaine. Cardiovascular risk involves stiffer arteries and thicker heart muscle walls. The increase in blood pressure alone caused by cocaine can cause a heart attack in some cases. In some instances, it can also cause an irregular heart rhythm, a problem known as arrhythmia, which can be fatal. Cocaine is especially damaging to the heart because it carries with it the risk of sporadic heart attacks in the small vessels of the heart. Additionally, it interferes with cardiac drugs such as beta blockers that doctors use to treat heart attacks.

  • Cocaine use and its long-term effectsInformational article by the National Institute on Drug Abuse regarding the long-terms effects of cocaine.
  • Drug facts: CocaineCocaine Drug Facts sheet by the National Institute on Drug Abuse. Includes information about what cocaine is, how it is used, how it affects the brain, short and long-term effects, addiction, and treatment.
  • Can cocaine affect my risk of heart failure? Brief informational video by National Geographic on cocaine-induced heart attacks.


Methamphetamine, or meth, is a form of stimulant and aphrodisiac that is chemically related to medications that doctors use to treat problems such as attention deficit disorder and obesity. Meth is typically used by snorting, swallowing, injecting, or smoking. Recreational usage is due to a variety of effects that the drug offers, including euphoria, increased sexual desire and function, uplifting one's mood, and an increase in concentration, alertness, personal energy, and stamina. Harmful side effects include but are not limited to twitchiness and hyperactivity, excessively high or low blood pressure, diarrhea or constipation, and rapid/irregular heart rates. It can also cause psychosis, irritability, depression, restlessness, and even suicidal thoughts. In addition to the high risk of addiction, long-term damage includes damage to teeth due to issues with dry mouth, an increased chance of contracting Parkinson's disease, and even brain damage. Methamphetamine usage can also cause congestive heart failure, arrhythmia, and damage to heart muscles and blood vessels via inflammation. This illicit drug not only reduces blood flow to vital organs and the heart itself, but it also speeds up the body's heart rate, putting stress on the heart and further elevating the risk of heart failure or a stroke. Methamphetamine is sometimes produced in “meth labs” using over-the-counter cold and cough medicines that include ephedrine, pseudoephedrine, and phenylpropanolamine. Because meth has been the number one drug problem in many states across the U.S., the Combat Methamphetamine Act of 2005 was implemented to assist in reducing the production of this illegal drug by limiting the amount of cold and cough medicines that can be sold to one person in a single day. This is also why identification is required for these medicines as pharmacies must keep a log of purchases made.


Rohypnol is a powerful central nervous system depressant that is commonly referred to as a "club drug" or "date-rape drug." These white tablets are also frequently referred to as "roofies." It is odorless and colorless, and has been given the label of a date-rape drug because it can easily be slipped into a drink for the purpose of sexual assault. The effects of the drug can be felt within minutes and can last up to eight hours. The victim often has little, if any, recollection of the events. It is also used as a sedative to cause people to sleep and to reduce anxiety. It has many side effects, including difficulty breathing, slurred speech, headache, vomiting and nausea, mood swings, and memory loss. A person under the influence of Rohypnol will appear as though they are very drunk and will often lose consciousness within roughly two hours after the drug has been ingested. When combined with other drugs, particularly depressants, it can affect the heart by causing it to slow down severely resulting in potential heart failure. In extreme cases, Rohypnol may result in coma or death. Long-term effects of the drug, for those who use it recreationally, includes physical and psychological dependence. When detoxing the user will suffer withdrawal symptoms such as hallucinations, confusion, headaches, and possible seizures.

  • Date rape drugsBrown University's fact page on "date rape" drugs.
  • Date rape drugs: XTC, Rohypnol, ketamineUniversity of Notre Dame's Student Well-Being Center offers an informational FAQ sheet on date rape drugs.
  • Drug facts: RohypnolThe Department of Justice DEA handout on drugs of abuse. Includes information on what the drugs look like, common street names, how its abused, and its effects on the mind and body.
  • The truth about club drugs (PDF)The Office of Justice Programs offers a printable PDF for parents to know what club drugs are, the possible effects of each drug, and where to get help.


Lysergic acid diethylamide, or LSD, is a powerful illegal drug derived from ergot that, when used, alters how people perceive reality. Classified as a hallucinogen, the drug is taken as a tablet or capsule. In liquid form, LSD may be placed in small amounts on items such as stamps, gelatin sheets, or small squares of paper. Once the medium is dried, the user licks or swallows the LSD from the stamp, paper, etcetera. The drug affects the heart by causing an increase in both the user's heart rate and their blood pressure. If the dosage is high enough, heart failure may occur, resulting in death. In addition to how it affects the heart and hallucinations, there are other side effects of LSD that include appetite loss, dry mouth, sweating, elevated body temperatures, dramatic mood swings, and dilated pupils. Long-term effects of LSD include vivid flashbacks without taking the drug and tend to occur in times of high stress, memory problems, and potential paranoia.

  • LSDLSD fact sheet from United States Drug Enforcement Administration. Includes information about what LSD is, side effects, effect on the mind, signs and symptoms of abuse, and how it is used.
  • LSD (Acid)NIH fact sheet on LSD substance abuse. Includes information on effects on the brain, harmful effects, tolerance, treatment options, recovery, and resources.
  • National Institute of Drug Abuse — HallucinogensInformational Drug Facts sheet on hallucinogens.


MDMA, known by its street name, Ecstasy or XTC, is an empathogenic, or psychoactive drug, that recreational users rely on to produce an altered emotional state. It is typically consumed as a tablet or capsule. However, some may snort the powder or swallow it in liquid form. The positive effects of using this drug include euphoria, a reduced sense of anxiety, extroverted behavior, a positive mood, intimacy, and hallucinations. Some of the negative side effects that come with using ecstasy consist of depression, paranoia, fatigue, anxiety, irritability, loss of appetite, insomnia, and excessive grinding of the teeth. Lack of hydration during usage of the drug, especially combined with alcohol usage, can lead to excessive body temperatures, a condition known as hyperthermia. Heart palpitations, increased heart rate, inflammation of the heart wall, and excessively high or low blood pressure may also result from using ecstasy, which can potentially lead to heart failure. Physical heart damage, pulmonary hypertension, severe heart attacks, strokes, or liver and kidney damage can also occur as a consequence of ecstasy. Additionally, ecstasy that is sold as “Molly” may consist of other drugs including bath salts, cocaine, ketamine, or OTC cough medicine. In this case, if mixed with MDMA or alcohol, there is a higher risk of potential death.

  • MollyPoison Control's informational article about Molly, what it is, its dangerous effects, long-term effects, and what to do in the event of an emergency.
  • Club drugsNational Institute for Drug Abuse club drugs statistics and trends.
  • MDMA may increase the risk for cardiac valve diseaseInformational article by The Endowment for Human Development about a study performed by NIDA that showed a potentially increased risk for valvular heart disease in MDMA users.

Synthetic cathinones (bath salts)

Synthetic cathinones, otherwise known as “bath salts,” is the newest drug to hit the streets. “bath salts” are not a bathing product, as the name might imply. It is a man-made, dangerous psychoactive substance chemically related to cathinone, a stimulant found in the khat plant that is indigenous to East Africa and southern Arabia. The most common ingredient found in “bath salts” is methylenedioxypyrovalerone, although mephedrone and methylone are also frequently noted. This substance, in the form of white or brown crystal-like powder, is typically used by smoking, swallowing, snorting, or injection. Synthetic cathinones can produce side effects such as nosebleeds, muscle tension, nausea, confusion, excessive sweating, lowered inhibition, anxiety, and depression. Many times more severe side effects have occurred in users such as extreme violence, paranoia, excited delirium, hyperthermia, seizures and shock. Cardiovascular effects can include increased blood pressure and heart rate, hypotension (low blood pressure), chest pain, arrhythmia (irregular heart beat), myocardial infarction (heart attack), or cardiac arrest. Long-term effects such as a breakdown of skeletal muscle tissue, kidney failure, liver damage, and brain swelling can also occur.

This page was written by on Oct 12, 2016.
This page was last reviewed and updated by on Jun 7, 2020.