Drug-related diseases of the lungs have been noted with increasing frequency in urban patients. These entities are also being seen in smaller urban and suburban settings, however. The spectrum of pathology is also changing coincident with the marked increase in crack cocaine use. The incidence of abnormal chest radiographs in cocaine users admitted with pulmonary complaints has ranged from 12% to 55%. Findings have included focal air space disease, atelectasis, pneumothorax, pneumomediastinum, and pulmonary edema. Pulmonary complications related to injections of illicit drugs have included pulmonary infection, pulmonary edema, particulate embolism, and talcosis. The "pocket shot" places the patient at risk for a unique set of complications. Radiologists should be aware of this wide spectrum of pulmonary disease that may be related to this increasingly frequent social problem.