heroin and Acute-Disease

Intranasal drug administration is an easy, well-tolerated, noninvasive transmucosal route that avoids first-pass metabolism in the liver. The nasal mucosa provides an extensive, highly vascularized surface of pseudostratified ciliated epithelium. It secretes mucus that is subjected to mucociliary movement that can affect the time of contact between the drug and the surface. Absorption is influenced by anatomical and physiological factors as well as by properties of the drug and the delivery system. We review the literature on intranasal administration of fentanyl, meperidine, diamorphine, and butorphanol to treat acute pain. The adverse systemic effects are similar to those described for intravenous administration, the most common being drowsiness, nausea, and vomiting. Local effects reported are a burning sensation with meperidine and a bad taste.

Topics: Absorption; Acute Disease; Administration, Intranasal; Adult; Analgesia, Patient-Controlled; Analgesics, Opioid; Butorphanol; Child; Cross-Over Studies; Fentanyl; Heroin; Humans; Meperidine; Nasal Mucosa; Pain; Pain, Postoperative; Randomized Controlled Trials as Topic

To describe the eye misalignments that occur during heroin use and heroin detoxification and to give an overview of the management of persisting diplopia (double vision) which results from eye misalignment.. A literature review using Medline and the search terms strabismus, heroin and substance withdrawal syndrome is presented. General management of cases presenting to the ophthalmologist and orthoptist with acute acquired concomitant esotropia is described.. A tendency towards a divergence of the visual axes appears to be present in heroin users, although when present it may not always lead to diplopia. Following detoxification intermittent esotropia or constant esotropia (convergence of the visual axes) can occur; if intermittent the angle tends to be small and diplopia present when viewing distance objects. Occlusion of one eye to eliminate the second image could encourage the development of a constant deviation. The deviation is not caused by a cranial nerve palsy. Constant deviations of this type are classified as 'acute acquired concomitant esotropia'. Relief from the diplopia may be gained by prismatic correction, and the deviation may then resolve spontaneously. Botulinum toxin or surgical intervention may be necessary in cases that do not resolve.. Heroin use may lead to intermittent or constant exotropia and withdrawal may result in intermittent or constant esotropia. Awareness of the mechanism causing this may avoid referral to other specialties (e.g. neurology) and awareness of treatment modalities could encourage patients to seek appropriate help for relief of symptoms.

Topics: Acute Disease; Diplopia; Heroin; Heroin Dependence; Humans; Strabismus; Substance Withdrawal Syndrome

The neurological complications observed in 6 HIV negative intravenous drug users are reported. Four developed acute neuromuscular involvement in a lumbosacral or brachial distribution with rhabdomyolysis, myoglobinuria, hypovolemia, renal and hepatic failure in the 3 most severely affected patients. Despite evidence of immunologic abnormalities and especially presence of anti-heroin antibodies, we feel that causative mechanisms include mixed compression and ischemia with an underlying toxic myopathy, resulting in segmental myopathy with secondary compression of peripheral nerves. Two patients developed myelopathy with acute or chronic onset. The mechanisms were vascular with spinal cord infarction in the acute form and probably infectious with secondary compressive arachnoiditis in the chronic form. In these 2 patients with myelopathy, outcome was poor.

Topics: Acute Disease; Adult; Chronic Disease; Heroin; Humans; Male; Neuromuscular Diseases; Spinal Cord Diseases; Substance Abuse, Intravenous

Topics: Acute Disease; Adult; Bacteroides Infections; Cocaine; Eikenella corrodens; Heroin; Humans; Male; Pleurisy; Substance Abuse, Intravenous

An acute polyradiculoneuritis with tetraplegia and respiratory failure was observed in a 27 year-old heroin addict 3 hours after an intravenous injection of heroin. Full recovery was obtained after respiratory assistance and plasma exchanges. The biological and morphological changes (sural nerve biopsy) suggested an immune mediated mechanism. Three years after the recovery, the patient was tested for HIV antibody and was seropositive. The role of HIV infection and of the injection of heroin are discussed.

Topics: Acute Disease; Adult; Female; Heroin; HIV Seropositivity; Humans; Injections, Intravenous; Polyradiculoneuropathy; Time Factors

Topics: Acute Disease; Brain Diseases; Brain Injuries; Chronic Disease; Gas Poisoning; Heart Diseases; Heroin; Humans; Hypersensitivity; Iatrogenic Disease; Infusions, Parenteral; Kidney Failure, Chronic; Mountaineering; Pulmonary Edema; Radiography; Renal Dialysis; Sympathomimetics

The painful crisis is the commonest acute presentation of sickle cell disease (SCD), yet effective pain control in hospital is often delayed, inadequate and dependent on injected opiates. Intranasal diamorphine (IND) has been used in paediatric emergency departments for management of acute pain associated with fractures, but the analgesic effect is short lived. We evaluated its efficacy and safety when given in combination with intravenous or oral morphine for rapid analgesia for children presenting to our emergency department with painful crisis of SCD. In phase 1, nine patients received IND plus intravenous morphine. In phase 2, 13 received IND plus oral morphine. There was a rapid improvement in pain score; the proportions in severe pain at t = 0, 15, 30 and 120 minutes in phase 1 were 78%, 11%, 0% and 11%, respectively; in phase 2, 77%, 30%, 15% and 0%, respectively. There were no serious side effects and questionnaire scores indicated that children found IND effective and acceptable. IND can be recommended for acute control of sickle pain in children presenting to hospital.

Topics: Acute Disease; Administration, Intranasal; Administration, Oral; Adolescent; Analgesics, Opioid; Anemia, Sickle Cell; Child; Child, Preschool; Drug Therapy, Combination; Emergency Service, Hospital; Heroin; Humans; Infant; Infusions, Intravenous; Injections, Intravenous; Morphine; Pain; Pain Measurement

The aim of this study was to assess the safety of buprenorphine administered intravenously for the treatment of opioid withdrawal in medically ill hospitalized patients. Data regarding demographic information, number of doses of buprenorphine, and measures of buprenorphine's effects were collected via chart reviews for 30 heroin-dependent patients who received buprenorphine intravenously during their hospitalization for an acute medical problem. No respiratory depression was observed, and no patients reported feeling "high." All patients reported that buprenorphine decreased withdrawal symptoms. Thus, intravenous administration of buprenorphine appears to be safe for the treatment of opioid withdrawal.

Topics: Acute Disease; Adult; Buprenorphine; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Middle Aged; Narcotic Antagonists; Substance Withdrawal Syndrome

We have compared the i.v. and s.c. routes of administration for diamorphine infusions in children undergoing abdominal surgery. Subjects received general anaesthesia with extradural block and diamorphine up to 20 micrograms kg-1 h-1 after operation. There were no differences between the groups in diamorphine consumption, pain scores or incidence of side effects. The s.c. route appeared to be as effective and safe as the i.v. route for administration of diamorphine infusions in children undergoing elective surgery.

Topics: Abdomen; Acute Disease; Analgesia; Analgesics, Opioid; Anesthesia, General; Child; Child, Preschool; Heroin; Humans; Infant; Infusions, Intravenous; Infusions, Parenteral; Pain, Postoperative

A double-blind study comparing placebo and haem arginate was conducted in 12 patients with acute intermittent porphyria. 2 days after admission in attack patients were randomised to receive intravenous haem arginate 3 mg/kg per 24 h for 4 days or placebo. 9 patients were readmitted with a further attack and were given the alternative treatment. Before randomisation the paired attacks were of similar severity with respect to urinary porphobilinogen (PBG) excretion and clinical manifestations. With haem arginate the median PBG excretion of the 9 patients with two attacks (normal range 0-16 mumol per 24 h) fell significantly from 332 mumol per 24 h (range 137-722) on admission to a median lowest level of 40 (range 22-105). On placebo, median PBG excretion was 382 (range 196-542) on admission, falling to 235 (range 128-427). Median duration of admission after the start of treatment was 11 days (range 2-28) for placebo and 8 days (3-26) for haem arginate. Median total analgesic requirement between the start of treatment and discharge was 8150 mg pethidine equivalents (range 0-17,650) with placebo versus 6425 (range 50-20,650) with haem arginate. Phlebitis occurred in 5 patients on haem arginate and in 2 on placebo. Haem arginate effectively reduces porphyrin precursor overproduction in the acute porphyric attack but this reduction is not accompanied by striking resolution of the clinical manifestations of the attack.

Topics: Acute Disease; Adolescent; Arginine; Clinical Trials as Topic; Double-Blind Method; Female; Heme; Heroin; Humans; Infusions, Intravenous; Injections, Intravenous; Liver Diseases; Male; Meperidine; Pain; Phlebitis; Porphyrias; Random Allocation; Recurrence; Severity of Illness Index

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Clinical Trials as Topic; Female; Heroin; Humans; Methadone; Nausea; Placebos; Propranolol; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors; Vomiting

Topics: Acute Disease; Adult; Aged; Blood Pressure; Clinical Trials as Topic; Female; Heart Rate; Heroin; Humans; Injections, Intravenous; Male; Methadone; Middle Aged; Morphine; Myocardial Infarction; Pain; Pentazocine; Respiration

Acute disseminated encephalomyelitis (ADEM) is an immune demyelinating central nervous system (CNS) disorder, characterized by monophasic new onset neurological symptoms including encephalopathy, combined with neuroradiological evidence of multifocal demyelination. ADEM is extremely rarely diagnosed and is much more common in children and adolescents than in adults. The aim of this study is to present an extremely rare case of ADEM in a heroin-addicted patient with a very difficult diagnostic course. The results of the magnetic resonance imaging (MRI) examination in this patient were inconclusive. Fungal abscesses or inflammatory lesions of an unclear nature were suspected especially in a patient with impaired immunodeficiency. In view of the constantly deteriorating condition of the patient with disturbed consciousness and the unclear aetiology, the lack of effective treatment, a decision was made to perform a bilateral stereotactic biopsy and aspiration of brain abnormalities in order to obtain a neuropathological specimen and begin with the causal treatment. Neuropathological examination revealed the presence of Creutzfeldt-Peters cells characteristic of ADEM. Treatment with methylprednisolone significantly improved the patient's general and neurological condition. To our knowledge, the above case is the first in the world literature in which ADEM has been confirmed by bilateral stereotaxic aspiration for the treatment of symptoms of increased intracranial pressure as a lifesaving procedure. Neuropathological confirmation allowed for the implementation of appropriate treatment, which resulted in complete recovery. Moreover, this case is interesting because ADEM was diagnosed in a patient addicted to heroin, where opportunistic inflammation of a fungal aetiology was considered in the first place.

Topics: Acute Disease; Adolescent; Adult; Child; Encephalitis; Encephalomyelitis, Acute Disseminated; Heroin; Humans; Inflammation; Magnetic Resonance Imaging

As the opioid epidemic continues, understanding manifestations of abuse, including heroin-associated myelopathy remains essential. Here we describe a young man with a past medical history significant for polysubstance abuse who developed acute-onset, rapidly progressive myelopathy after resumption of intravenous heroin use. He had significant spinal cord involvement with findings suggestive of heroin-associated myelopathy. The salient features of this case include diffusion imaging of the spine and spinal angiography supporting a possible vasculopathy as the pathophysiologic mechanism underlying heroin-associated myelopathy. Additionally, CSF studies showed the transition from a neutrophilic pleocytosis to a lymphocytic pleocytosis suggesting an inflammatory component.

Topics: Acute Disease; Adult; Disease Progression; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Paraplegia; Spinal Cord Diseases

A man aged 33 years with previous heroin substance abuse was found unconscious lying in a bush. The patient had been without heroin for some time but had just started to use intravenous heroin again, 0.5-2 g daily. The patient had almost complete paraplegia and a sensory loss for all modalities below the mamillary level and a urine retention of 1.5 L. Acute MRI of the spine revealed an expanded spinal cord with increased intramedullary signal intensity, extending from C7-T9. The cerebrospinal fluid showed extremely high levels of nerve injury markers particularly glial fibrillar acidic protein (GFAP): 2 610 000/ng/L (ref. <750). The patient was empirically treated with intravenous 1 g methylprednisolone daily for 5 days and improved markedly. Very few diseases are known to produce such high levels of GFAP, indicating a toxic effect on astrocytes. Measuring GFAP could possibly aid in the diagnosis of heroin-induced myelopathy.

Topics: Acute Disease; Adult; Astrocytes; Biomarkers; Drug Users; Glial Fibrillary Acidic Protein; Heroin; Humans; Magnetic Resonance Imaging; Male; Methylprednisolone; Paraplegia; Sensation Disorders; Spinal Cord; Spinal Cord Diseases; Substance Abuse, Intravenous

Smoking heroin (chasing the dragon), is a method of inhaling heroin via heating the drug on a tin-foil above a flame. It also has been associated both with the indirect effects of heroin overdose and with direct pulmonary toxicity. We describe a case of acute eosinophilic pneumonia secondary to heroin inhalation in our medical intensive care unit. She presented with fever, cough, dyspnea and pleuritic chest pain. Chest radiograph showed bilateral infiltrations. Examination of bronchoalveolar lavage fluid revealed significant eosinophilia. She was diagnosed with acute eosinophilic pneumonia. After heroin abstinence and corticosteroid therapy, remission was achieved rapidly and the patient was discharge on the fourth day of her hospital stay.

Topics: Acute Disease; Bronchoalveolar Lavage Fluid; Female; Heroin; Humans; Prednisolone; Pulmonary Eosinophilia; Tomography, X-Ray Computed; Young Adult

Topics: Acute Disease; Administration, Inhalation; Heroin; Humans; Lung Diseases, Interstitial; Male; Middle Aged

Use of and acute poisoning by substances of abuse represent a major health problem and are often linked to social destitution. We describe associations between place of residence, living conditions and the incidence of poisoning by substances of abuse in Oslo.. All patients who were 12 years of age or older and resident in Oslo and who were treated for acute poisoning by substances of abuse at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) were included prospectively for a continuous period of one year, from October 2011 to September 2012. The 15 districts of Oslo were categorised into three groups of living conditions, from the best (I) to the poorest (III) living conditions, based on the City of Oslo's living conditions index. Homeless people were grouped separately. The incidence of poisoning by substances of abuse treated in the OAEOC was estimated.. Of a total of 1,560 poisonings by substances of abuse, 1,094 cases (70%) affected men. The median age was 41 years. The most frequent toxic agents were ethanol, with 915 cases (59%), and heroin, with 249 cases (16%). The incidence of poisoning by substances of abuse treated in the OAEOC per year per 1,000 inhabitants amounted to 1.75 in living conditions group I, to 2.76 in living conditions group II and 3.41 in living conditions group III. Living conditions group III had a significantly higher incidence than living conditions group II (p < 0.001), and living conditions group II had a significantly higher incidence than living conditions group I (p < 0.001).. The incidence of acute poisoning by substances of abuse was higher, the poorer the living conditions in the district.

Topics: Acute Disease; Adolescent; Adult; Aged; Ambulatory Care Facilities; Analgesics, Opioid; Benzodiazepines; Central Nervous System Stimulants; Child; Ethanol; Female; Heroin; Humans; Ill-Housed Persons; Male; Middle Aged; Norway; Poisoning; Prospective Studies; Social Conditions; Socioeconomic Factors; Sodium Oxybate; Substance-Related Disorders; Urban Population

Topics: Acute Disease; Adult; Compartment Syndromes; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male

It is known that heroin dependence and withdrawal are associated with changes in the hypothalamic-pituitary-adrenal (HPA) axis. The objective of these studies in rats was to systematically investigate the level of HPA activity and response to a heroin challenge at two time points during heroin withdrawal, and to characterize the expression of associated stress-related genes 30 min after each heroin challenge. Rats received chronic (10-day) intermittent escalating-dose heroin administration (3 × 2.5 mg/kg/day on day 1; 3 × 20 mg/kg/day by day 10). Hormonal and neurochemical assessments were performed in acute (12 h after last heroin injection) and chronic (10 days after the last injection) withdrawal. Both plasma ACTH and corticosterone levels were elevated during acute withdrawal, and heroin challenge at 20 mg/kg (the last dose of chronic escalation) at this time point attenuated this HPA hyperactivity. During chronic withdrawal, HPA hormonal levels returned to baseline, but heroin challenge at 5 mg/kg decreased ACTH levels. In contrast, this dose of heroin challenge stimulated the HPA axis in heroin naïve rats. In the anterior pituitary, pro-opiomelanocortin (POMC) mRNA levels were increased during acute withdrawal and retuned to control levels after chronic withdrawal. In the medial hypothalamus, however, the POMC mRNA levels were decreased during acute withdrawal, and increased after chronic withdrawal. Our results suggest a long-lasting change in HPA abnormal responsivity during chronic heroin withdrawal.

Topics: Acute Disease; Adrenocorticotropic Hormone; Animals; Chronic Disease; Corticosterone; Heroin; Hypothalamo-Hypophyseal System; Male; Pituitary-Adrenal System; Pro-Opiomelanocortin; Rats; Rats, Inbred F344; Substance Withdrawal Syndrome

This article reports the case of a patient demonstrating acute bilateral pneumonitis almost completely confined to the upper lobes as a result of inhaling heroin. We attribute this distribution to the patient performing the Valsalva manoeuvre immediately after inhaling heroin. This pattern has not been reported before and we believe it may be seen more frequently owing to a switch amongst drug users from intravenous to inhaled heroin.

Topics: Acute Disease; Acute Lung Injury; Administration, Inhalation; Blood Gas Analysis; Female; Heroin; Heroin Dependence; Humans; Middle Aged; Pneumonia; Radiography, Thoracic; Valsalva Maneuver

Environmental drug-related cues have been implicated as a cause of illicit heroin use during methadone maintenance treatment of heroin dependence. The authors sought to identify the functional neuroanatomy of the brain response to visual heroin-related stimuli in methadone maintenance patients.. Event-related functional magnetic resonance imaging was used to compare brain responses to heroin-related stimuli and matched neutral stimuli in 25 patients in methadone maintenance treatment. Patients were studied before and after administration of their regular daily methadone dose.. The heightened responses to heroin-related stimuli in the insula, amygdala, and hippocampal complex, but not the orbitofrontal and ventral anterior cingulate cortices, were acutely reduced after administration of the daily methadone dose.. The medial prefrontal cortex and the extended limbic system in methadone maintenance patients with a history of heroin dependence remains responsive to salient drug cues, which suggests a continued vulnerability to relapse. Vulnerability may be highest at the end of the 24-hour interdose interval.

Topics: Acute Disease; Adult; Analgesics, Opioid; Behavior, Addictive; Brain; Cues; Dose-Response Relationship, Drug; Female; Frontal Lobe; Functional Laterality; Heroin; Heroin Dependence; Humans; Magnetic Resonance Imaging; Male; Methadone; Oxygen; Secondary Prevention; Visual Perception

Topics: Acute Disease; Analgesics, Opioid; Anesthesia Recovery Period; Anesthesia, Spinal; Anesthetics, Intravenous; Anesthetics, Local; Arthritis, Rheumatoid; Bupivacaine; Cystocele; Female; Follow-Up Studies; Heroin; Humans; Hyperlipidemias; Hypertension; Midazolam; Middle Aged; Monitoring, Physiologic; Myoclonus; Rare Diseases; Severity of Illness Index; Spinal Cord; Uterine Prolapse; Vitamin B 12 Deficiency

Topics: Acute Disease; Adult; Esotropia; Heroin; Heroin Dependence; Humans; Inactivation, Metabolic; Male

Topics: Acute Disease; Adult; Basal Ganglia; Basal Ganglia Diseases; Female; Heroin; Heroin Dependence; Humans; Parkinson Disease, Secondary

Buprenorphine has been approved for heroin detoxification, but little is known about its impact on everyday practice. Concerns about buprenorphine include expense, limited knowledge about its use, patient limits, and social and clinical attitudes regarding opioid treatment for heroin dependence. On the other hand, randomized clinical trials suggest that buprenorphine is superior to clonidine with regard to withdrawal symptom relief. In June 2004, a community-based residential medical detoxification center switched from clonidine to buprenorphine treatment for all new and returning heroin clients. This study is a retrospective chart review of subject outcomes with clonidine (n = 100) versus buprenorphine (n = 100). Bivariate analysis suggested few cohort differences in pretreatment demographics and client characteristics. In contrast, buprenorphine was significantly associated with increased length of stay and treatment completion. The positive associations between buprenorphine and both treatment completion and length of stay persisted and were slightly enhanced after regression analysis adjusted for potential confounders. Additionally, clinical staff reported better subject engagement in treatment and psychosocial group sessions. This single-site study is an example of successful integration of an evidence-based treatment into community-based practice.

Topics: Acute Disease; Adult; Buprenorphine; Clonidine; Diffusion of Innovation; Female; Heroin; Heroin Dependence; Humans; Length of Stay; Male; Middle Aged; Narcotics; Oregon; Patient Acceptance of Health Care; Retrospective Studies; Substance Withdrawal Syndrome; Treatment Outcome

A 55-year-old Hispanic male found unresponsive at home was brought to our emergency department. The patient was found to have rapid atrial fibrillation and acute inferior ST-elevation myocardial infarction on electrocardiogram. Cardiac catheterization failed to reveal any significant stenotic lesions in the coronary arteries. Initial laboratory studies revealed leukocytosis, hypokalemia, hyperglycemia, an anion-gap metabolic acidosis, as well as an osmolal-gap. Initial toxicology screen was negative. The patient was admitted to the Cardiac Intensive Care Unit. After 24 hours of appropriate medical management the clinical picture had improved. Further blood analysis revealed the presence of clenbuterol. Clenbuterol is a long-acting B-2 agonist used in veterinary medicine. Several patients in the Northeast have recently presented with a similar constellation of symptoms attributed to use of heroin adulterated with clenbuterol.

Topics: Acute Disease; Clenbuterol; Drug Contamination; Emergency Service, Hospital; Heroin; Humans; Male; Middle Aged; Substance-Related Disorders

Topics: Acute Disease; Administration, Inhalation; Adolescent; Drug Overdose; Female; Hallucinogens; Heroin; Humans; Lumbosacral Region; Magnetic Resonance Imaging; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Paraplegia; Spinal Cord Diseases

Topics: Acute Disease; Administration, Inhalation; Adult; Asthma; Eosinophilia; Female; Heroin; Heroin Dependence; Humans; Male; Narcotics

We sought to identify prevalence and predictors of heroin-related overdose among young injection drug users (IDU).. A total of 795 IDU under age of 30 years were interviewed in four neighbourhoods in San Francisco, California, USA. Participants were recruited as part of a broader study of HIV, hepatitis B and C among injecting drug users in San Francisco using street outreach and snowball techniques. Independent predictors of recent heroin overdose requiring intervention were determined using regression analysis.. Of 795 injecting drug users under age of 30 years, 22% (174/795) of participants reported a heroin overdose in the last year. In stepwise multiple logistic regression, independent predictors of recent heroin overdose were lifetime incarceration exceeding 20 months (odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.52-5.88); heroin injection in the last 3 months (OR = 4.89, 95% CI = 2.03-11.74); cocaine injection in the last 3 months (OR = 1.67, 95% CI = 1.14-2.45); injection of heroin mixed with methamphetamine in the last 3 months (OR = 1.74, 95% CI = 1.15-2.65); ever tested for hepatitis B or C (OR = 1.66 per year, CI = 1.09-2.54) and ever having witnessed another person overdose (OR = 2.89, 95% CI = 1.76-4.73).. Individuals with high levels of incarceration are at great risk of overdose, and prison or jail should be considered a primary intervention site. Further research on the role of cocaine and amphetamine in heroin-related overdose is indicated.

Topics: Acute Disease; Adolescent; Adult; California; Catchment Area, Health; Drug Overdose; Female; Heroin; Heroin Dependence; Humans; Male; Methamphetamine; Prevalence; Prisoners; Resuscitation; Substance Abuse, Intravenous; Surveys and Questionnaires

We describe extended and repeat magnetic resonance (MR) examinations in the case of a 16-year-old male who developed acute left-sided sensorimotor hemiplegia after a single dose of inhaled heroin. MRI revealed symmetrical hyperintense signals in T 2 -weighted images and massive diffusion disorders in the diffusion weighted images predominantly in parieto-occipital subcortical white matter and both ventral globi pallidi with preservation of U fibers and no brain oedema. MR spectroscopy data were compatible with combined hypoxic and mitochondrial damage resulting in axonal injury without demyelination. Normal values and variations had been obtained from spectra of five age-matched subjects. This is the first reported MR follow-up study of leukoencephalopathy occurring acutely after a first inhaled dose of heroin. We postulate that toxic spongiform leukoencephalopathy in heroin addicts may be the outcome of a complex mechanism directly triggered by heroin and causing mitochondrial as well as hypoxic injury in specific and limited areas of white matter.

Topics: Acute Disease; Administration, Inhalation; Adolescent; Dementia, Vascular; Disease Progression; Follow-Up Studies; Heroin; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Narcotics

We report a case of acute respiratory distress syndrome (ARDS) and pulmonary granulomatosis after intravenous injection of heroin. This 46-year-old male had a 2-year history of heroin addiction. The recent admission was due to loss of consciousness after intravenous injection of diluted heroin with unknown filler. Initial chest X-ray revealed a picture of ARDS. Blood routine and biochemistry were normal except for leukocytosis. Urine morphine test was positive. The blood and sputum culture yielded no pathogens. After supportive treatment, his condition improved, and the follow-up chest X-ray showed diffuse micronodules in both lung fields. Subsequently, open-lung biopsy of the right upper and lower lobes on the 26th hospital day showed large amounts of foreignbody granulomas distributed over perivascular areas, bronchiolar areas and interstitium. Staining for bacteria, fungi, and mycobacteria was all negative. The morphology of foreign-bodies could be divided into 2 types: 1) periodic acid-Schiff (PAS)-positive, aggregated fine crystals in round form; and 2) PAS-negative, yellow long crystals. The pathological diagnosis of pulmonary granulomatosis was made based on the finding of filler foreign bodies. The nature of these foreign bodies remained undetermined. The case suggests that pulmonary granulomatosis with the radiographic appearance of chronic interstitial pneumonia can occur in patients with a history of heroin use.

Topics: Acute Disease; Drug Contamination; Granuloma, Foreign-Body; Heroin; Humans; Injections, Intravenous; Lung; Male; Middle Aged; Narcotics; Respiratory Distress Syndrome

Esotropia during opiate withdrawal is a new clinical syndrome that has only recently been reported in the literature.. Clinical case series.. Five patients with acute esotropia during opiate withdrawal are presented. In four there was evidence of underlying hyperopia and/or other strabismogenic features.. The precise cause of esotropia with heroin withdrawal is uncertain. Most (and possibly all) of these patients have one or more objective strabismogenic features, and these are probably a large factor in the causation.

Topics: Acute Disease; Adult; Disease Susceptibility; Esotropia; Female; Heroin; Humans; Male; Substance Withdrawal Syndrome

We examined the role of withdrawal in relapse to drug-seeking and drug-taking by testing the effects of opiate abstinence on extinction behaviour in rats trained to self-administer heroin. Male Long-Evans rats responded for IV heroin under a heterogeneous chain (VI 120 s; FR 1) schedule in which "seeking" responses preceded a "taking" response which produced a drug infusion. Responding was then measured in extinction during acute (6, 12, and 24 hr) and prolonged (3, 6, 12, and 25 day) abstinence. Sucrose consumption and somatic withdrawal were assessed at each testing period. During acute abstinence, responses on the "drug-seeking" manipulandum increased at 24 hr, whereas responses on the "drug-taking" manipulandum increased at 6 hr. Both responses were elevated during the 12-day abstinence test. Sucrose consumption was reduced and somatic withdrawal scores were increased in opiate-experienced rats at each test period. Results suggest that heroin abstinence has different effects on drug-seeking and drug-taking and that these effects do not temporally coincide with somatic measures of opioid withdrawal.

Topics: Acute Disease; Animals; Conditioning, Operant; Disease Models, Animal; Extinction, Psychological; Heroin; Heroin Dependence; Male; Rats; Rats, Long-Evans; Self Administration; Substance Withdrawal Syndrome

To report the possible effects of heroin withdrawal on binocular vision.. A case series of patients is presented in whom esotropia developed on cessation of heroin use.. In each case the esotropia was concomitant and prismatic correction restored binocular single vision. Intermittent spontaneous control occurred in one patient, the deviation resolved in one and one patient was lost to follow-up.. Heroin withdrawal should be considered as a cause of acute concomitant esotropia. However, an accurate history of other medication is needed to ensure that this is not the cause of decompensation.

Topics: Acute Disease; Adult; Esotropia; Female; Follow-Up Studies; Heroin; Humans; Male; Narcotics; Substance Withdrawal Syndrome

From July 1999 it became evident that a rising number of heroin users were presenting to the Dandenong Hospital Emergency Department with a rapid onset, florid opioid withdrawal syndrome following the intravenous injection of what they had believed to be heroin. We suspect that the injected substance was in fact naltrexone. This paper describes two such cases and reviews the literature on naltrexone. Recommendations regarding the management of the acute opioid withdrawal syndrome are made.

Topics: Acute Disease; Adult; Colic; Emergency Medical Services; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Naltrexone; Narcotics; Substance Withdrawal Syndrome; Vomiting

Topics: Acute Disease; Deafness; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Narcotics; Vestibular Diseases

One of the treatment alternative of withdrawal symptoms of patients suffering from opiate dependence is to apply the clonidine in combination or itself. This remedy is not in commercial trade in our country. It is expectable according to the recent data analysing the effects of the alfa2 adreneregic agonist tizanidine that tizanidine has the similar protective effect as clonidine with the resembling target point. Based on this theory a research was done, in the course of which the i.v. heroin users who presented themselves at the Drug Outpatient Department of Buda between 1.10.1998-8.01.1999. were divided into two groups. The groups had got the usual detoxification treatment, but in the experimental group tizanidine were given in 3 x 8 mg/day dose too. Sixteen patients were in the tizanidine group, 10 patients were in the control group. The patients estimated the intensity of 7 symptoms of withdrawal (sweating, nervousness, insomnia, tremor, diarrhoea, muscle pain, drug craving) on a subjective scale day by day. The analysis showed that the tizanidine treatment decreased the intensity of the withdrawal symptoms in every symptom type examined. The ten days long acute withdrawal period were accomplished by all of the patients, but in the short course of the following (mean 9 and 11 weeks in the treated and the control groups respectively) there were three relapses in each group (3/16 in the treated and 3/10 in the control).

Topics: Acute Disease; Adult; Analgesics; Anticonvulsants; Case-Control Studies; Clonidine; Female; Heroin; Heroin Dependence; Humans; Male; Muscle Relaxants, Central; Narcotics; Substance Withdrawal Syndrome; Treatment Outcome

To explore if cocaine or heroin smoking was positively associated to acute respiratory complications (ARC).. We collected data from medical records for 717 cocaine users who were attended in 14 hospital emergency rooms. The association was studied by logistic regression.. The most frequent ARC were respiratory infections and complications with chest pain or dyspnea. Cocaine smokers (OR = 3.3; CI 95% = 1.5-6.9) and cocaine sniffers (OR = 2.5; CI 95% = 1.1-5.6) had greater risk of ARC than cocaine injectors. Heroin smokers (OR = 3.5; COI 95% = 1.8-7.0) and heroin sniffers (OR = 2.8; CI 95% = 1.4-5.6) had greater risk of ARC than non heroin users.. These results suggest that cocaine or heroin smoking increases the risk of ARC.

Topics: Acute Disease; Cocaine; Heroin; Humans; Lung Diseases; Smoking

Topics: 3,4-Methylenedioxyamphetamine; Acute Disease; Designer Drugs; Heroin; Humans; Narcotic Antagonists; Narcotics; Substance-Related Disorders

Topics: Acute Disease; Administration, Inhalation; Fatal Outcome; Heroin; Humans; Male; Middle Aged; Opioid-Related Disorders; Pancreatitis

Topics: Abdominal Pain; Acute Disease; Adult; Colon; Drug Packaging; Foreign Bodies; Heroin; Humans; Male; Narcotics; Radiography

A case of oral ingestion of large doses of both the amphetamine-derivative 3,4-methylene dioxyethamphetamine (MDEA) and heroin is reported. Despite high serum levels of both drugs, the patient did not present with the classic signs and symptoms normally seen during intoxication with these drugs. The patient recovered after symptomatic treatment. The possibility that opposite pharmacological properties of the two drugs prevented the patients death is discussed.

Topics: 3,4-Methylenedioxyamphetamine; Acute Disease; Adult; Confusion; Critical Care; Designer Drugs; Drug Antagonism; Drug Monitoring; Heroin; Humans; Male; Narcotics; Suicide, Attempted; Time Factors

After intravenous injection of heroin, a 27-year-old male with altered mental status and hypotension was seen at the Emergency Service where acute pulmonary edema was noted. The problem was resolved three days later after oxygen therapy had been administered by face mask. Acute renal failure, rhabdomyolysis and monoplegia of the patient's left leg were exhibited during his stay at the Intensive Care Unit. Neurological examination and electro-diagnostic studies (electromyography and nerve conduction velocity) showed left lumbosacral plexitis. Hemodialysis was given. Though the patient's hospital course was uneventful, satisfactory recovery from his left leg weakness, which persisted for one year after hospital discharge, was finally achieved.

Topics: Acute Disease; Acute Kidney Injury; Adult; Heroin; Humans; Lumbosacral Plexus; Male; Neuritis; Pulmonary Edema; Rhabdomyolysis

Hyperamylasemia has been reported in heroin addicts and ascribed to an increase of salivary isoamylase. Ours is the first report on acute pancreatitis in a heroin user. All prognostic parameters indicating a severe course of the disease were present, and computed tomography showed an edematous pancreatitis, but the acute pancreatitis took a benign clinical course.

Topics: Acute Disease; Adult; Amylases; Heroin; Humans; Isoamylase; Lipase; Male; Pancreatitis; Substance-Related Disorders

Inhalation of heroin is known to provoke asthma. We report on the case of a patient who, after repeated inhalation of heroin, presented with decreased lung volume associated with bronchial hyperresponsiveness, diffuse pulmonary infiltrates, and bronchoalveolar lavage fluid eosinophilia. Rapid remission was obtained after heroin abstinence and initiation of corticosteroid treatment.

Topics: Acute Disease; Administration, Inhalation; Adult; Female; Heroin; Humans; Pulmonary Eosinophilia; Substance-Related Disorders

A 24 year ald-man, was admitted in intensive care with coma and shock, 4 hours after intravenous injection of heroin. Awakening was obtained by naloxone. Diagnosis of acute rhabdomyolysis associated with heroin addiction was asserted by association of anury, hyperkalemia, and CPK increase. Recovery was obtained with, however, neurologic after-effects. Pathophysiology of acute rhabdomyolysis associated with heroin addict is obscure. Hypotheses for the cause of the muscle damage include the effects of toxicity (either directly or immunologically mediated) of the drug or an adulterant. However prolonged coma and immobilization in one position with either direct compression of the muscles or occlusions of the regional vascular supply can play a major role.

Topics: Acute Disease; Adult; Heroin; Humans; Male; Rhabdomyolysis

The benefits, risks and resource implications of providing an Acute Pain Service were assessed during the first year of the service. Six hundred and sixty patients recovering from major surgery were treated with patient-controlled analgesia (510 patients) or extradural infusion analgesia (150 patients). The results of a prospective outcome study showed that pain control was good: more than 60% of patients scored their pain as mild during the first 24 h. Only 10% of patients complained of severe postoperative pain. Eight patients developed potentially serious complications including respiratory depression and hypotension; the diagnosis and management of these problems on general wards is discussed. Retrospective analysis of the incidence of postoperative chest infection in surgical patients showed a marked reduction during the first year of the service (1.3% in 1988, 0.4% in 1989-90 (P less than 0.01].

Topics: Acute Disease; Adolescent; Adult; Aged; Analgesia, Epidural; Analgesia, Patient-Controlled; Bupivacaine; Evaluation Studies as Topic; Female; Heroin; Humans; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Patient Care Team; Patient Satisfaction; Postoperative Complications; Prospective Studies; Retrospective Studies

Topics: Acute Disease; Adult; Drug Overdose; Heroin; Humans; Male; Naloxone; Pulmonary Edema; Substance-Related Disorders

Topics: Acute Disease; Adult; Chronic Disease; Female; Hepatitis A; Heroin; Humans; Injections, Intravenous; Liver Diseases; Liver Diseases, Alcoholic; Male; Substance-Related Disorders

A case is described of a young man who presented with acute pulmonary edema and flaccid paralysis of the right upper and lower extremity, following his first injection of heroin and was found in a comatose state. Needle electromyographic findings were compatible with a severe lesion of the right brachial plexus and a moderate lesion of the right lumbar plexus. An allergic or a hypersensitivity reaction might have been the possible cause.

Topics: Acute Disease; Adult; Brachial Plexus; Drug Hypersensitivity; Heroin; Humans; Inflammation; Lumbosacral Plexus; Male; Paralysis; Pulmonary Edema

Topics: Acute Disease; Adult; Hepatitis D; Hepatitis Delta Virus; Heroin; Humans; Male; New Zealand; Substance-Related Disorders

Description of a case of benign acute transverse myelopathy in a young woman who had taken heroin I.V. after a two-year free interval. Spinal angiography was negative but CT scanning of the cord showed a swelling at C3.

Topics: Acute Disease; Adult; Drug Hypersensitivity; Female; Heroin; Humans; Hypesthesia; Injections, Intravenous; Paraplegia; Spinal Cord Diseases; Substance Withdrawal Syndrome

Acute bacterial endocarditis, a fulminating disorder most often caused by Staphylococcus aureus, is uncommon in pregnancy. However, the frequency of this disease may be increasing due to the prevalence of intravenous drug abuse. Three cases occurred during pregnancy at Charity Hospital, New Orleans; all three patients were intravenous drug abusers. One patient had polymicrobial disease.

Topics: Acute Disease; Adult; Endocarditis, Bacterial; Female; Heroin; Humans; Injections, Intravenous; Pentazocine; Pregnancy; Pregnancy Complications, Infectious; Staphylococcus aureus; Substance-Related Disorders; Tripelennamine

A case of acute left ventricular failure following an intravenous dose of amphetamine is described. The diagnosis was made by right heart catheterization. This is the first description of acute amphetamine cardiomyopathy in the medical literature.

Topics: Acute Disease; Adult; Amphetamine; Cardiomyopathies; Catheterization; Heroin; Humans; Male; Pulmonary Edema; Substance-Related Disorders

Topics: Acute Disease; Adult; Heroin; Humans; Male; Muscular Diseases

Topics: Acute Disease; Adult; Heroin; Humans; Injections, Intravenous; Male; Pulmonary Edema

The purpose of this study was to examine overt behavioral characteristics and sleep during acute heroin abstinence in man. Both heroine-dependent patients and drug-free control subjects were observed and monitored on a 24-hour per day basis for 5 to 7 days. Observational data were analyzed for frequency of occurrence of various behaviors including the signs and symptoms of withdrawal. Electroencephalographic (EEG) data were scored into awake and sleep stages according to standard techniques. The heroin-dependent subjects generally displayed a higher number of observations across all recording days as compared to the controls. In addition, the signs and symptoms of withdrawal for these patients peaked on day 1 or day 2 and then declined over the remaining recording days. The EEG state data showed an increase in waking and decrease in both slow wave and REM sleep during acute heroin withdrawal. Total sleep was maximally suppressed on withdrawal days 2 and 3 and was still below normal control values on withdrawal days 5 - 7. REM sleep was more disrupted than slow-wave sleep during withdrawal from heroin. Results of this study indicate that heroin withdrawal produces a differential action upon central nervous system structures responsible for the various states of sleep, waking and related behaviors.

Topics: Acute Disease; Electroencephalography; Ethanol; Heroin; Humans; Sleep; Sleep Stages; Substance Withdrawal Syndrome; Wakefulness

In the context of evaluating the effects of a narcotic antagonist on opiate acquisition, 14 detoxified addicts self-administered increasing doses of unblocked heroin intravenously over a ten-day period. Early in the addiction cycle, subjects experienced tension relief and euphoria but this was followed shortly by a shift in the direction of increasing dysphoria and psychopathology. Nonetheless, individual injections of the drug continued to induce brief episodes of positive mood, an effect enhanced by frequent injection. Heroin self-administration was sharply reduced when subjects were blocked with naltrexone, a narcotic antagonist, and the negative effects observed during unblocked drug use were not observed.

Topics: Acute Disease; Adult; Chronic Disease; Dose-Response Relationship, Drug; Drug Therapy, Combination; Emotions; Euphoria; Heroin; Heroin Dependence; Humans; Male; Methadone; Morphine; Motor Activity; Naloxone; Naltrexone; Psychopathology

An 18-year-old man developed acute pulmonary edema following heroin overdose. Two days after initial improvement, there was recurrence of hypotension and pulmonary edema with severe hypoxemia refractory to mechanical ventilatory support utilizing positive and end-expiratory pressure. Cardiac catheterization revealed elevated pulmonary capillary wedge pressure suggestive of left ventricular failure. The use of digitalis and diuretics resulted in prompt clinical improvement and ultimate recovery. Evidence is presented indicating that this patient represents an uncommon but important syndrome of acute cardiomyopathy with left ventricular failure which complicates the clinical course of certain cases of heroin overdose. Its physiologic diagnosis is of obvious importance in the choice of proper therapy, thereby increasing the patient's chances of recovery.

Topics: Acute Disease; Adolescent; Heart Diseases; Heart Failure; Heroin; Heroin Dependence; Humans; Hypotension; Male; Pulmonary Edema; Recurrence

Their frequency is estimated with difficulty, although on autopsy pulmonary edema is found almost routinely. It is a major complication of overdoses (48 p. 100 of severe intoxications). Their formation can be suspected, when after the first phase of respiratory depressions, with coma, myosis, and a variable latent period, a second attack of respiratory insufficiency occurs with tachypnea, and cyanosis. The chest X-ray shows diffuse alveolar infiltration, sparing the apices. The heart being generally of normal size. Rapid disappearance of this infiltrate (24 to 48 hours) enables the elimination of two diagnoses: pneumonia due to inhalation of gastric fluid, an infectious pneumonia. Their pathogenesis remains very debatable: - in the majority of cases abrupt L.V.F. can be eliminated: -on the other hand it could be an allergic accident of the anaphylactic type, or local liberation of histamine, or a local toxic action on the pulmonary capillaries; - hypoxia, secondary to respiratory depression, could lead to pulmonary edema, by the same mechanism as at altitude; - finally, owing to the central neurological disorders a neurogenic theory can be put forward. Their treatment is essentially a combination of Nalorphine with oxygen therapy (by mask, or if necessary by assisted, controlled ventilation) with prevention of inhalation of gastric fluid (gastric emptying) or curative treatment of possible aspiration by antibiotics, and cortico-steroids. Diuretics can be useful, as well as cardiotonics.

Topics: Acute Disease; Hemodynamics; Heroin; Humans; Hypoxia; Pulmonary Edema

Two episodes of acute viral hepatitis occurred in each of 34 patients. One episode in each patient was serologically diagnosable as type B hepatitis on the basis of tests for hepatitis B surface antigen or antibody. The other episode was classified as "non-B" on the basis of seronegativity, reinforced by seropositivity in an alternate bout. An epidemiologic background appropriate to "serum" hepatitis, either transfusion (one bout) or illicit self-injection (46 bouts), was associated just as frequently with serologically non-B episodes as with identified type B disease. The diagnosis of type B hepatitis, therefore, should be made only on the basis of serologic tests specific for hepatitis B virus infection. Other cases of sporadic diseases in adults must be labeled "viral hepatitis, type unspecifiable."

Topics: Acute Disease; Adolescent; Adult; Age Factors; Blood Transfusion; Cell Membrane; Female; Hepatitis A; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Antigens; Hepatovirus; Heroin; Humans; Male; Middle Aged; Serologic Tests

Topics: Acute Disease; Adult; Heroin; Humans; Male; Resuscitation

Topics: Acute Disease; Antibodies; Antigens; Biopsy; Chronic Disease; Drug Synergism; Ethanol; Hepatitis B Antigens; Heroin; Humans; Liver Diseases; Liver Function Tests; Morphine Dependence; Radioimmunoassay

Topics: Acute Disease; Adolescent; Adult; Diphenhydramine; Hepatitis A; Hepatitis B; Heroin; Humans; Liver; Male; Substance-Related Disorders; Urticaria

Topics: Acute Disease; Autopsy; Chronic Disease; Granuloma; Heroin; Humans; Lung; Lung Diseases; Morphine Dependence; Talc

Topics: Acute Disease; Adolescent; Adult; Autopsy; Bronchopneumonia; Codeine; Heroin; Humans; Male; Nasal Mucosa; Olfactory Mucosa; Pulmonary Edema; Substance-Related Disorders

Topics: Acute Disease; Adolescent; Adult; Autopsy; Chemical and Drug Induced Liver Injury; Female; Hepatitis A; Hepatitis B; Heroin; Humans; Liver; Liver Diseases; Lymph Nodes; Male; Morphine Dependence; Necrosis; Pulmonary Edema

Topics: Acute Disease; Birth Weight; Carbon Dioxide; Enzyme Induction; Female; Gestational Age; Heroin; Humans; Infant, Newborn; Obstetric Labor, Premature; Partial Pressure; Pregnancy; Respiratory Distress Syndrome, Newborn; Substance Withdrawal Syndrome; Substance-Related Disorders; Time Factors

Topics: Acute Disease; Adolescent; Adult; Atrial Fibrillation; Heroin; Humans; Male; Morphine Dependence; Poisoning; Pulmonary Edema

Topics: Acute Disease; Acute Kidney Injury; Adult; Autopsy; Cell Membrane Permeability; Drug Contamination; Electromyography; Heroin; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Muscle Contraction; Muscular Diseases; Myoglobin; Myoglobinuria; Rest; Substance-Related Disorders; Time Factors

Topics: Acute Disease; Administration, Oral; Adult; Coma; Female; Furosemide; Heroin; Humans; Hydrocortisone; Injections, Intravenous; Intubation, Intratracheal; Methadone; Nalorphine; Oxygen Inhalation Therapy; Penicillin G; Pulmonary Edema; Radiography; Substance-Related Disorders; Time Factors

Topics: Acute Disease; Adolescent; Adult; Chemical and Drug Induced Liver Injury; Duodenal Ulcer; Female; Heart Failure; Heroin; Humans; Jaundice; Male; Maryland; Middle Aged; Neurotic Disorders; Pneumonia; Pulmonary Edema; Pulmonary Fibrosis; Radiography; Sarcoidosis; Substance-Related Disorders; Tetanus