William Osler described the first reported case of narcotic-induced pulmonary edema in 1880. The description is that of autopsy findings of a patient who died of narcotic poisoning. Since that time, noncardiogenic pulmonary edema has come to be known to accompany overdose with a number of drugs, most notably heroin. Clinical manifestations and radiographic findings vary. The exact pathogenesis is unclear, although the mechanism is known to involve increased alveolar capillary permeability. Treatment consists of reversal of respiratory depression, oxygenation, and respiratory support. Rapid improvement with treatment is the rule.