A new comprehensive review published in Open Forum Infectious Diseases warns of a growing public health concern: a sharp rise in severe fungal infections among people who use drugs, especially those who inject them. The review, led by Dr Jose Portugal Gonzales and Dr Luis Ostrosky-Zeichner of the University of Texas Health Science Center at Houston, calls for urgent attention from healthcare providers, policymakers, and the public.
According to the United Nations’ 2024 World Drug Report, 292 million people worldwide used illicit drugs in 2022 – a 10% increase over the past decade. In the US alone, drug use has surged to 47.7 million people, with 13.9 million injecting drugs. This trend is also fuelling a rise in life-threatening fungal infections.
The review reveals that up to one-third of candidemia cases – a serious bloodstream infection caused by Candida species – are now linked to injection drug use, particularly in adults aged 19-44. In these patients, complications such as endocarditis, osteomyelitis, and vision-threatening infections are alarmingly common.
Equally concerning is the role of cannabis. With 228 million users globally, contaminated marijuana has been shown to harbour harmful fungi including Aspergillus, Mucorales, and Cryptococcus. Cannabis users are 3.5 times more likely to develop mould-related infections.
The review also highlights the potential for life-threatening drug–drug interactions. Many antifungals and illicit drugs are metabolised by the same liver enzymes, raising the risk of overdose and treatment failure.
As substance use continues to rise, the authors urge increased clinical vigilance, investment in public health interventions, and updated treatment guidelines tailored for this high-risk population.
A drug user with disseminated candida rash.