Mr. Sprat is a 21-year-old patient who complains of nasal congestion. He admits to using recreational drugs. On examination, you have noted a septal perforation. Which recreational drug is commonly associated with nasal septum perforation?

Rationale: A. Heroin use is generally associated with intravenous use and is less commonly linked to nasal septum perforation. B. Ecstasy (MDMA) is primarily used in tablet form and is not typically associated with nasal use that would cause septal perforation. C. Cocaine is frequently snorted, which can lead to irritation and damage to the nasal passages and septum, resulting in perforation. D. Marijuana is usually smoked rather than snorted, and it is not commonly associated with nasal septum perforation.