BACKGROUND: The prevalence of recreational drug use in myocardial infarction (MI) patients without standard modifiable cardiovascular risk factors (SMuRF) namely hypercholesterolemia, hypertension, diabetes and smoking, remains unknown. METHODS: All patients enrolled in The Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study, a French multicenter prospective observational study which systematically assessed the use of recreational drug within 2 h of admission, and presenting with MI but without known coronary artery disease were included. We compared patients with and without SMuRF. RESULTS: Among the 243 patients included, 31 (12.8 %) had no documented SMuRF. Recreational drugs were detected in 1 SMuRF-less patient (3 %) compared to 29 (14 %) patients in those with ≥1 SMuRFs (p = 0.17). When considering only ST-elevation MI patients (n = 77), none of the SMuRF-less patients (n = 13) had detected recreational drugs contrary to those with ≥1 SMuRFs (12 %, p = 0.40). CONCLUSION: Recreational drug use was scarce in SMuRF-less MI patients and not different when compared to those with ≥1 SMuRF. Further research to explore non-traditional risk factors as an important cause of first MI are still needed.