The neuropathology of drug abuse

•Neuroimaging studies revealed widespread alterations in the brains of drug-abusers.•These findings have been ascribed to vascular complications or hypoxia-ischemia.•Neuropathological studies showed widespread impairment of the cellular elements.•Recent studies provided evidence of accelerated brain aging and neurodegeneration.

The predominantly abused illicit substances include cannabis, opiates, cocaine, amphetamine, methamphetamine and their derivatives. Recently, the abuse of new psychoactive substances has become an increasing problem. In human drug abusers a broad spectrum of changes affecting the central nervous system are seen. The main alterations have been assumed to result from the consequences of ischemia and cerebrovascular diseases. However, detailed post-mortem investigations have shown widespread morphological alterations in the brains drug abusers. Further studies related drug abuse with the risk of accelerated brain aging and the development of neurodegenerative conditions.