Previous reports have indicated the association of marijuana and cocaine abuse along with prolonged Valsalva maneuvers and the use of positive pressure devices. In most cases, the use of a single drug has been related to barotrauma. We present an adolescent male who developed this complication after alternate use of marijuana and cocaine without positive pressure devices. The increasing problem of drug abuse in the adolescent population in the United States is known to all of us. Clinicians who deal with adolescent patients should include questioning about drug abuse in the standard evaluation of chest pain.