The epidemic spread of illicit substance abuse in the United States and the adaptation of novel modes of drug delivery have increased the incidence of pulmonary complications of drug addiction. Chest manifestations of drug abuse relate not only to the particular substance used, but also to the route of administration, the presence of contaminating foreign material or microbiologic pathogens host response, and the practice of sharing drug paraphernalia. This article outlines the important lung disorders linked to drug addiction and discusses pathophysiologic mechanisms, diagnosis, and management.