Heroin Poisoning Research Articles

A7 “Near miss” poisonings: a national picture

IntroductionNon-fatal poisoning is one of the commonest reasons for general hospital admission in the UK. We know that following an episode of non-fatal poisoning people are at increased risk of...

Myoglobin clearance by continuous venous-venous haemofiltration in rhabdomyolysis with acute kidney injury: A case series

BackgroundClearance of circulating myoglobin is a critical measure to prevent further damage in patients with rhabdomyolysis (RM) and acute kidney injury (AKI). Continuous venous-venous haemofiltration has emerged to be a novel approach for this purpose. The objective of present study is to evaluate the efficacy and safety of CVVH in myoglobin clearance for patients with RM complicated with AKI. MethodWe prospectively analysed 15 patients with acute RM and AKI due to crush syndrome (n=7), bee stings (n=5), polymyositis (n=2) and heroin poisoning (n=1). All of them presented oliguria with high serum myoglobin and creatine kinase concentration. They were treated by CVVH for at least 48h until the conditions turned to be stable, then replaced by intermittent renal replacement therapy (intermittent haemofiltration or haemodialysis). Meanwhile intravascular volume expansion, urinary alkalinisation, and forced diuresis were administered. During the procedure, serum and effluent concentrations of myoglobin and creatinine were measured simultaneously at 2, 6, 12 and 24h. ResultThe mean sieving coefficients for myoglobin were 0.28±0.06, 0.21±0.06, 0.15±0.02 and 0.11±0.02 during 2, 6, 12 and 24h of CVVH intervention, whilst mean clearance of myoglobin was 14.3±3.1ml/min during 2h and reduced to 11.5±3.2, 7.5±0.9, 5.6±1.0ml/min during 6, 12 and 24h. In contrast to myoglobin, the sieving coefficient for creatinine remained stable at 0.95±0.25, 1.02±0.12, 0.89±0.32, 0.98±0.27 during 24h of CVVH. In all of the 15 patients, serum myoglobin and creatine kinase were dramatically decreased in 24h (−56.2 and −32.1%), 3 days (−72.9 and −50.3%) and in 7 days (−97.6 and −96.7%). Seven patients (46.7%) complicated with hypophosphatemia during CVVH intervention improved in natural course after the cessation of CVVH. After 16±12 days, all of 15 patients came to polyuria stage and finally, discharged with normal renal function after 31±15 days. ConclusionOur study showed CVVH can be employed to clear myoglobin effectively in patients with RM and AKI and presented oliguria. This indicate that CVVH would be better than other modes of renal replement treatment in acute RM with AKI because of the additional benefit of myoglobin removal, but large sample randomised controlled trials are still required to confirm it.

Packers, pushers and stuffers—managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review

Body packing, pushing and stuffing are methods by which illicit drugs may be carried within the human body. Patients involved in these practices may present UK emergency departments with complex...

Etiological characterization of acute poisonings in the emergency department

Introduction:An investigation of emergency department (ED) poisonings was conducted to characterize poisoning demographics and evaluate correlations with select co-morbidities.Methods:The study population evaluated consisted of 649 poisoning cases admitted between 2004 and 2007 to an inner-city, level 1 emergency department.Results:Ethnicity, age, and gender had a substantial impact on the population distribution as poisoning cases were predominantly African Americans (79.9%) between 36 and 45 years old with a 1:3 male to female ratio. Intentional illicit drug overdose was the most prevalent cause of poisoning, heroin being the most frequent substance found in 35.4% (n = 230) of cases, followed by cocaine overdose at 31.7% (n = 206), concomitant heroin and cocaine overdose at 4.3% (n = 28), multiple drug poisoning at 5.5% (n = 36), and antidepressant/antipsychotic poisoning at 6% (n = 39). Significant correlations were found between heroin poisoning and asthma (F = 20.29, DF = 1, P = 0.0001), cocaine poisoning and hypertension (F = 33.34, DF = 1, P = 0.0001), and cocaine poisoning and cardiovascular disease (F = 35.34, DF = 1, P = 0.0001). A change in the pattern of illicit drug use from injection to inhalation was detected and the resulting increase of inhalation and insufflation of illicit substances may partially explain the correlation found between heroin use and asthma.Conclusions:These results provide supporting evidence that deliberate poisoning with illicit drugs remains a serious healthcare issue that significantly aggravates co-morbidities and raises treatment costs by increasing both the rate of hospitalization and hospital length of stay.

Hospitalizations for opioid poisoning: a nation‐wide population‐based study in Denmark, 1998–2004

To assess hospitalization rates (HR) for poisoning with heroin, methadone or strong analgesics and relate them to quantities of prescribed methadone and strong analgesics in Denmark between 1998 and 2004. Population-based ecological study. We extracted data on all emergency department visits and hospital admissions registered in the Danish National Patient Registry with a diagnosis of poisoning with heroin (n = 1688), methadone (n = 173) or strong analgesics (n = 384). To ascertain sale of prescribed medications we used data from the Danish Medicines Agency. Age- and gender-standardized HR and defined daily doses (DDD) per 1000 people per day. HR for heroin poisoning was 4.4 [95% confidence interval (CI): 3.8-4.9] per 100,000 person-years (p-y) in 1998 and 4.6 (CI: 4.0-5.2) per 100,000 p-y in 2004. HR for methadone poisoning increased from 0.1 (CI: 0.0-0.2) per 100,000 p-y in 1998 to 1.1 (CI: 0.8-1.4) per 100,000 p-y in 2004. HR for poisoning with strong analgesics increased from 0.6 (CI: 0.4-0.9) per 100,000 p-y in 1998 to 2.1 (CI: 1.8-2.6) per 100,000 p-y in 2004. The sale of prescribed strong analgesics (5.0 DDD per 1000 people per day in 1998 to 5.9 DDD in 2004) and methadone (3.0 DDD per 1000 people per day in 1998 to 3.4 DDD in 2004) increased slightly between 1998 and 2004. Increasing sale of prescribed methadone and strong analgesics coincided with increasing HRs of poisoning with these drugs, whereas HR of heroin poisoning varied. Further longitudinal studies are important for the guidance of future policy making.

Postmortem sole incisions – A new sign of heroin overdose?

Postmortem sole incisions have been observed in a number of heroin overdose fatalities. Acqueintance of those victims confessed to producing those incisions as a life saving procedure in a futile attempt to help the comatose overdose victim. They thought that bleeding the unconscious victim would remove the overdose, in manner similar to bloodletting or phlebotomy which is still popular in the Gulf region. The presence of such wounds has become a first indication or rather “sign” of heroin poisoning. In such cases, laboratory investigation confirmed the pathologist’s preliminary suspicion. In Dubai, postmortem sole incisions are important sign of death from heroin overdose even in the absence of other classical signs. This sign becomes more credible when accompanied by other signs and/or circumstantial evidence suggestive of heroin use. It is suggested that this should be called “bloodletting sign” of death from heroin overdose. The sign should not be confused with the self-inflicted cuts seen on the arms and forearms of drug misusers which are caused for other reasons.

Blood Levels of 3-Methylfentanyl in 3 Fatal Poisoning Cases

Three fatal poisoning cases due to 3-methylfentanyl are described. In each case, the death was accidental and occurred after injection of the opioid combined with amphetamine, heroin, or other drugs. The victims' ages, ranging from 30 to 41 years, were higher than those typically found in heroin poisonings in Finland. The blood concentrations of cis-3-methylfentanyl, measured here for the first time by a specific tandem mass spectrometric method, ranged from 0.3 to 0.9 microg/L (mean 0.5 microg/L). These values are significantly lower than the levels reported for alpha-methylfentanyl and fentanyl in fatal poisonings. Repeated seizures of fentanyl and its analogs have been reported in Europe close to the Russian border.

Pulmonary edema in acute heroin poisoning: Report of four cases

1. 1. Four cases of pulmonary edema secondary to acute heroin poisoning are reported. The characteristic features of this rare cause of pulmonary edema are mentioned. 2. 2. The pathogenesis of heroin-induced pulmonary edema is not clear. It is a manifestation of acute opium alkaloid toxicity.

Treatment of acute heroin intoxication with nalorphine (Nalline) hydrochloride.

Numerous reports have appeared in the literature demonstrating that in animals nalorphine (Nalline) hydrochloride is an effective antagonist to the toxic effects of morphine and other of its derivatives. Preliminary experimental studies with human beings showed that nalorphine reversed the respiratory depression caused by morphine, dihydromorphinone (Dilaudid) hydrochloride, methadone, meperidine, and the proprietary preparation containing alkaloids of opium, Pantopon. Patients suffering from overdoses of methadone, racemorphan (Dromoran) hydrobromide, or dihydromorphinone have been successfully treated. It seemed reasonable to believe, therefore, that nalorphine would be of benefit in treating heroin toxicity since heroin is a diacetyl derivative of morphine. This report is concerned with the treatment of a patient suffering from acute heroin poisoning. To my knowledge, no instance of acute heroin toxicity treated with nalorphine has appeared in the literature. REPORT OF A CASE A 22-year-old married mulatto woman entered Kings County Hospital on May 1, 1953, at 10:35 p.

The action of respiratory stimulants in morphine and heroin poisoning.

In the experiments on cats previously reported, it was apparent that the action of morphine and heroin on respiration was limited to a depression of expiration, and that an extremely slow rate and respiratory failure depended on a primary depression of the circulation. These observations have been confirmed in every case in experiments on dogs, and in most experiments on rabbits, though in one experiment heroin caused temporary respiratory failure and asphyxial effects on the blood pressure of a rabbit, and circulatory depression was usually less marked in rabbits after morphine or heroin than in dogs or cats. The extremely slow regular breathing of advanced morphine or heroin poisoning never occurred, in dogs or rabbits, unless circulation was definitely depressed, and the appearance was that of vasomotor failure.As respiratory stimulants, atropine, caffeine, and camphor were tried; digitalis was used as a circulatory stimulant; and inhalations of CO2, of 7 to 10 per cent strength, were also used, when r...