We describe a new etiology for vocal cord paralysis. Two patients, chronic drug abusers, had in time lost access to the usual peripheral veins, and proceeded then to have the drugs injected repeatedly into the jugular veins in the neck. Both presented with persistent hoarseness and were found to have a unilateral vocal cord paralysis. Neck exploration was undertaken to evaluate this pathology, to rule out other obscure disease, and to decompress the recurrent laryngeal nerve within the carotid sheaths. Severe fibrosis was encountered in the neck of one patient and mild fibrosis in the other. A biopsy specimen from the adjacent autonomic portion of the vagus nerve was submitted. Although the follow-up period was short, no definite return of function was observed. A discussion of injection injuries to nerves is presented.