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Some do. It depends on the degree of cross-tolerance between the illegal substance and the [legal] drug. Vivienne Marcus' answer is right--this is exactly how I would answer this question. Instead of duplicating her answer, I will simply post some links to articles that support her answer.Cross-toleranceCross-tolerance has been observed with pharmaceutical drugs such as anti-anxiety agents and illicit substances, and sometimes the two of them together. Often, a person who uses one drug [this may be an illicit drug] can be tolerant to a drug [this may be one of the hospital-administered drugs] that has a completely different function. This phenomenon allows one to become tolerant to a drug that they have never even used before.The anesthetic implications of illicit opioid abuseWhen such patients [opioid abusers] require anesthetic services, they may present with increased tolerance, in withdrawal, or with any number of associated side-effects and complications.Duration of Spinal Anesthesia with Bupivacaine in Chronic Opium Abusers Undergoing Lower Extremity Orthopedic SurgeryThe study suggests a shortened duration of spinal block with bupivacaine in opium abusers. The results can propose a number of possible mechanisms including cross-tolerance mechanisms between local anesthetics and opioid compounds at the level of spinal neurons. Further molecular studies at the level of spine are suggested.Acute cross tolerance to midazolam, and not pentobarbital and pregnanolone, following a single dose of chlordiazepoxide in monkeys discriminating midazolamDecreased sensitivity to midazolam demonstrates that acute cross tolerance develops following chlordiazepoxide administration, although it does not develop to drugs acting at other sites. These differences among positive GABAA modulators suggest that even short-term benzodiazepine administration changes GABAA receptors, and those changes impact modulatory sites differently.Choice of Sevoflurane and Its Subjective and Psychomotor Effects In Light and Moderate DrinkersAlcohol-drinking status affected sevoflurane choice. The results are consistent with several studies comparing light and heavier drinkers, using other drugs. Although both drinking groups were similarly impaired by sevoflurane, the moderate drinkers reported less of a subjective response than light drinkers, suggestive of cross-tolerance.[Even though alcohol is not labeled as an "illegal drug", alcohol abuse mimics abuse of benzodiazepines acquired by illegal means.]Anesthetic management of the illicit-substance-using patientChronic opioid abuse leads to cross-tolerance of anesthetic drugs and other depressants, usually a result of chronic receptor stimulation. Postoperatively, due to decreased pain tolerance secondary to decreased production of endogenous opioids, these patients may experienceexaggerated pain. Perioperative management of the opioid-dependent patient poses a challenge to anesthesiologists and pain specialists due to the conflict between the patient’s rights and concerns for safety and abuse, raising ethical issues.Cross-tolerance has been seen with cannabis and alcohol, barbiturates, opioids, benzodiazepines and phenothiazines.Substance abuse remains one of the biggest societal problems around the world despite education on prevention and rehabilitation of illicit drugs. Anesthesiologists should be aware of this problem and the most likelyeffects and potential risks associated with the abuse of illicit substances. Some of these patients may present at preadmission testing, emergency situations (even critical care) or in the obstetric suite for anesthesia or analgesia. It is very important to inquire in a nonjudgmental way about addiction and substance abuse, obtain toxicology screens, and identify these patients in order to minimize the adverse effects of anesthetic agents and other drugs provided while in care. It is equally important to minimize postoperative risks from inadequate analgesia. Due to the diverse clinical presentations that may arise from substance or polysubstance abuse, the anesthetic management should be tailored to each individual and universal precautions should always be followed when providing care.If such a person was to be operated upon, does his doctor need to know that he is a drug user? Yes (see quoted text in bold typeface above).T4DA2A Pooja Chauhan