Substance abuse and anesthesia

Recreational drugs are substances used without medical justification, causing changes in consciousness, habituation, and, in some cases, addiction (Table 14.1). The illicit use of these substances, which include alcohol, cocaine, amphetamines, marijuana, and opioids, is common; it is estimated that almost 10% of the US population >12 years of age have ingested recreational drugs in the past month. Acute and chronic substance abuse affect anesthetic care through the associated physiologic derangements and interactions with perioperative medications. The following discussion highlights the epidemiologic, pharmacologic, and anesthetic implications of recreational drug use; in addition, the effects on pregnant women and their developing fetuses are highlighted.