heroin and Fever

Although brain metabolism consumes high amounts of energy and is accompanied by intense heat production, brain temperature is usually considered a stable, tightly regulated homeostatic parameter. Current animal research, however, has shown that different forms of functional neural activation are accompanied by relatively large brain hyperthermia (2-3 degrees C), which has an intra-brain origin; cerebral circulation plays a crucial role in dissipating this potentially dangerous metabolic heat from brain tissue. Brain hyperthermia, therefore, reflects enhanced brain metabolism and is a normal physiological phenomenon that can be enhanced by interaction with common elements of an organism's environment. There are, however, instances when brain hyperthermia becomes pathological. Both exposure to extreme environmental heat and intense physical activity in a hot, humid environment restrict heat dissipation from the brain and may push brain temperatures to the limits of physiological functions, resulting in acute life-threatening complications and destructive effects on neural cells and functions of the brain as a whole. Brain hyperthermia may also result from metabolic activation induced by various addictive drugs, such as heroin, cocaine, and meth-amphetamine (METH). In contrast to heroin and cocaine, whose stimulatory effects on brain metabolism invert with increases in dose, METH increases brain metabolism dose-dependently and diminishes heat dissipation because of peripheral vasoconstriction. The thermogenic effects of this drug, moreover, are enhanced during physiological activation, resulting in pathological brain hyperthermia. Since brain hyperthermia exacerbates drug-induced toxicity and is destructive to neural cells, uncontrollable use of amphetamine-like drugs under conditions restricting heat dissipation from the brain may result both in acute life-threatening complications and clinically latent but dangerous morphological and functional brain destruction.

Topics: Animals; Brain; Brain Diseases; Cocaine; Fever; Heroin; Hot Temperature; Humans; Methamphetamine; Physical Exertion; Thermogenesis

Here we examined how intravenous heroin at a dose that maintains self-administration (0.1 mg/kg) affects brain temperature homeostasis in freely moving rats under conditions that seek to mimic some aspects of human drug use. When administered under standard laboratory conditions (quiet rest at 22 °C ambient temperature), heroin induced moderate temperature increases (1.0-1.5 °C) in the nucleus accumbens (NAc), a critical structure of the brain motivation-reinforcement circuit. By simultaneously recording temperatures in the temporal muscle and skin, we demonstrate that the hyperthermic effects of heroin results primarily from inhibition of heat loss due to strong and prolonged skin vasoconstriction. Heroin-induced brain temperature increases were enhanced during behavioral activation (i.e., social interaction) and in a moderately warm environment (29 °C). By calculating the "net" effects of the drug in these two conditions, we found that this enhancement results from the summation of the hyperthermic effects of heroin with similar effects induced by either social interaction or a warmer environment. When the dose of heroin was increased (to 0.2, 0.4, 0.8, 1.6, 3.2, and 6.4 mg/kg), brain temperature showed a biphasic down-up response. The initial temperature decrease was dose-dependent and resulted from a transient inhibition of intra-brain heat production coupled with increased heat loss via skin surfaces-the effects typically induced by general anesthetics. These initial inhibitory effects induced by large-dose heroin injections could be related to profound CNS depression-the most serious health complications typical of heroin overdose in humans.

Topics: Administration, Intravenous; Animals; Body Temperature; Fever; Heroin; Homeostasis; Interpersonal Relations; Male; Narcotics; Nucleus Accumbens; Rats, Long-Evans; Self Administration; Skin Temperature; Temporal Muscle

Although many complications of intravenous drug abuse are well described, "cotton fever" has had little mention in recent medical literature. Cotton fever is street terminology for the post-injection fever experienced by many drug users after "shooting up" with heroin reclaimed from a previously used cotton filter.. We report on a 22-year-old man with a history of intravenous drug abuse with fever 30 min after injecting heroin. He was intensely diaphoretic, tachycardic, and febrile. His workup was negative for any infectious etiology and he later admitted to reusing the same cotton balls for heroin filtration several times over in order to preserve more of the drug.. Although it is usually a benign situation, cotton fever can have a dramatic clinical and hematologic course. We present a typical case of cotton fever followed by a description of the pathophysiology and clinical presentation of this entity.

Topics: Cotton Fiber; Diagnosis, Differential; Equipment Reuse; Fever; Filtration; Heroin; Heroin Dependence; Humans; Male; Narcotics; Sepsis; Substance Abuse, Intravenous; Tachycardia; Young Adult

Intravenous heroin self-administration in trained rats was accompanied by robust brain hyperthermia (+2.0-2.5 degrees C); parallel changes were found in the dorsal and ventral striatum, mediodorsal thalamus, and deep temporal muscle. Temperature began to increase at variable latency after a signal of drug availability, increased reliably (approximately 0.4 degrees C) before the first lever press for heroin, increased further (approximately 1.2 degrees C) after the first heroin injection, and rose more slowly after the second and third injections to stabilize at an elevated plateau (39-40 degrees C) for the remainder of the session. Brain and body temperature declined slowly when drug self-administration was terminated; naloxone precipitated a much more rapid decrease to baseline levels. Changes in temperature were similar across repeated daily sessions, except for the increase associated with the first self-administration of each session, which had progressively shorter latency and greater acceleration. Despite consistent biphasic fluctuations in movement activity associated with heroin self-administrations (gradual increase preceding the lever press, followed by an abrupt hypodynamia after drug infusion), mean brain temperature was very stable at an elevated plateau. Only mean muscle temperature showed evidence of biphasic fluctuations (+/-0.2 degrees C) that were time locked to and correlated with lever pressing and associated movements. Drug- and behavior-related changes in brain temperature thus appear to reflect some form of neuronal activation, and, because temperature is a factor capable of affecting numerous neural functions, it may be an important variable in the control of behavior by drugs of abuse.

Topics: Animals; Behavior, Animal; Brain; Corpus Striatum; Fever; Heroin; Heroin Dependence; Injections, Intravenous; Male; Naloxone; Rats; Rats, Long-Evans; Reaction Time; Self Administration; Temporal Muscle; Thalamus

Topics: Adult; Chlorpromazine; Female; Fever; Heroin; Heroin Dependence; Humans; Male; Promethazine; Substance Withdrawal Syndrome; Tachycardia

Topics: Endotoxins; Fever; Heroin; Heroin Dependence; Humans; Illicit Drugs; Pharmaceutical Preparations