{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:13:30Z","timestamp":1787505210873,"version":"build-2736575974"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T00:00:00Z","timestamp":1742169600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Excipient lung disease (ELD) arises from the intravenous (IV) injection of crushed oral tablets, leading to acute or chronic pulmonary complications. Despite its significance, ELD is under-recognized, particularly in countries like India, where over-the-counter availability of pharmaceutical drugs contributes to rising abuse rates. This study investigates sudden deaths among young adults due to ELD, emphasizing the need for increased awareness and preventive measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This case series examined 10 cases of sudden death in individuals aged 18\u201325 with a history of IV drug abuse. Data were collected from postmortem examinations, death scene investigations, and toxicological and histopathological analyses. The aim was to confirm ELD as the cause of death and understand its presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Deaths in these cases were strongly associated with drug overdoses. Death scene investigations revealed signs of IV drug use, such as track marks and drug paraphernalia. External and internal examinations showed consistent pathological findings, including edematous lungs with frothy secretions, granulomatous reactions in the pulmonary vasculature, and right ventricular hypertrophy. Toxicological analyses detected substances such as tapentadol and tetrahydrocannabinol, with excipients linked to ELD found in histopathological examinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>When injected, excipients such as talc and microcrystalline cellulose lead to granulomatous reactions and pulmonary complications. The study highlights the prevalence of ELD among young adults in India and the challenges in diagnosing this condition due to its nonspecific presentation and lack of disclosure of drug abuse history. Effective public health measures and stricter regulation of prescription drugs are crucial in preventing ELD-related deaths. This study underscores the severe health risks associated with IV drug abuse of oral tablets, leading to ELD. The findings emphasize the need for enhanced awareness, accurate documentation, and preventive strategies to address the rising substance abuse among youth in India.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aam.aam_210_24","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T07:00:17Z","timestamp":1742194817000},"page":"804-810","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Excipient Lung Disease and Fatal Outcome Among Young Adults: A Case Series on the Hidden Dangers of Intravenous Drug Abuse in India"],"prefix":"10.4103","volume":"24","author":[{"given":"Dhivya","family":"Prakash","sequence":"first","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, Government Stanley Medical College, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Vijay","family":"Balaji","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, Government Stanley Medical College, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Raguram","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, Government Stanley Medical College, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Narayanan","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, Government Stanley Medical College, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesh","family":"Janarthanan","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Kalyani, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senthil","family":"Kumaran","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,17]]},"reference":[{"key":"R1-20251015","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/PAF.0000000000000721","article-title":"Fatal excipients:An autopsy case series of excipient lung disease","volume":"43","author":"Hossein-Zadeh","year":"2022","journal-title":"Am J Forensic Med Pathol"},{"key":"R3-20251015","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0046-8177(80)80130-4","article-title":"The pulmonary vascular lesions of intravenous drug abuse","volume":"11","author":"Tomashefski","year":"1980","journal-title":"Hum Pathol"},{"key":"R4-20251015","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00408-010-9230-y","article-title":"Pulmonary talcosis:Imaging findings","volume":"188","author":"Marchiori","year":"2010","journal-title":"Lung"},{"key":"R5-20251015","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.cdip.2004.04.009","article-title":"The pulmonary pathology of illicit drug and substance abuse","volume":"10","author":"Tomashefski","year":"2004","journal-title":"Curr Diagn Pathol"},{"key":"R6-20251015","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/0002-9343(76)90508-8","article-title":"Intravenous injection of talc-containing drugs intended for oral use. A cause of pulmonary granulomatosis and pulmonary hypertension","volume":"60","author":"Arnett","year":"1976","journal-title":"Am J Med"},{"key":"R7-20251015","doi-asserted-by":"crossref","first-page":"2045894020907871","DOI":"10.1177\/2045894020907871","article-title":"Rapid development of pulmonary hypertension and right ventricular failure due to large vessel intravascular microcrystalline cellulosis in an intravenous drug user","volume":"10","author":"Amass","year":"2020","journal-title":"Pulm Circ"},{"key":"R8-20251015","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s00408-021-00456-4","article-title":"Excipient-induced pulmonary vascular disease:An underrecognized and deadly complication of opioid addiction","volume":"199","author":"Cook","year":"2021","journal-title":"Lung"},{"key":"R9-20251015","doi-asserted-by":"crossref","first-page":"W506","DOI":"10.2214\/AJR.14.12582","article-title":"Pulmonary effects of I. 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