heroin and Poisoning

Use of second generation antipsychotics in England and Wales has increased in recent years whilst prescription of first generation antipsychotics has decreased.. To evaluate the impact of this change and of the withdrawal of thioridazine in 2000 on antipsychotic-related fatal poisoning, we reviewed all such deaths in England and Wales 1993-2013 recorded on the Office for National Statistics drug poisoning deaths database. We also reviewed antipsychotic prescribing in the community, England and Wales, 2001-2013. Use of routine mortality data: When an antipsychotic was recorded with other drug(s), the death certificate does not normally say if the antipsychotic caused the death rather than the other substance(s). A second consideration concerns intent. A record of "undetermined intent" is likely to have been intentional self-poisoning, the evidence being insufficient to be certain that the individual intended to kill. A record of drug abuse/dependence, on the other hand, is likely to have been associated with an unintentional death. Accuracy of the diagnosis of poisoning: When investigating a death in someone prescribed antipsychotics, toxicological analysis of biological samples collected post-mortem is usually performed. However, prolonged attempts at resuscitation, or diffusion from tissues into blood as autolysis proceeds, may serve to alter the composition of blood sampled after death from that circulating at death. With chlorpromazine and with olanzapine a further factor is that these compounds are notoriously unstable in post-mortem blood. Deaths from antipsychotics: There were 1544 antipsychotic-related poisoning deaths. Deaths in males (N = 948) were almost twice those in females. For most antipsychotics, the proportion of deaths in which a specific antipsychotic featured either alone, or only with alcohol was 30-40%, but for clozapine (193 deaths) such mentions totalled 66%. For clozapine, the proportion of deaths attributed to either intentional self-harm, or undetermined intent was 44%, but for all other drugs except haloperidol (20 deaths) the proportion was 56% or more. The annual number of antipsychotic-related deaths increased from some 55 per year (1.0 per million population) between 1993 and 1998 to 74 (1.5 per million population) in 2000, and then after falling slightly in 2002 increased steadily to reach 109 (1.9 per million population) in 2013. Intent: The annual number of intentional and unascertained intent poisoning deaths remained relatively constant throughout the study period (1993: 35 deaths, 2013: 38 deaths) hence the increase in antipsychotic-related deaths since 2002 was almost entirel. The removal of thioridazine has had no apparent effect on the incidence of antipsychotic-related fatal poisoning in England and Wales. That such deaths have increased steadily since 2001 is in large part attributable to an increase in unintentional deaths related to (i) clozapine, and (ii) co-exposure to opioids, principally diamorphine and methadone.

Topics: Antipsychotic Agents; Benzodiazepines; Chlorpromazine; Clozapine; Drug Recalls; England; Heroin; Humans; Methadone; Morphine; Olanzapine; Poisoning; Quetiapine Fumarate; Thioridazine; Wales

Topics: Amphetamines; Analgesics, Opioid; Anesthetics, Intravenous; Cocaine; Drug Overdose; Emergency Treatment; Heroin; Humans; Narcotics; Poisoning; Sodium Oxybate; Substance-Related Disorders

Human mortality data due to toxic substances are presented for 1990 through 1995. The number of analyses required, results, sex of the deceased, toxic agents encountered and their fluctuations over the years are given. There was a decrease in pesticide poisonings with a corresponding increase in heroin deaths, but the total number of yearly poisonings did not vary significantly.

Topics: Barbiturates; Benzodiazepines; Carbamates; Female; Greece; Heroin; Humans; Insecticides; Longitudinal Studies; Male; Narcotics; Organophosphorus Compounds; Poisoning; Sex Factors

During acute intoxications rhabdomyolysis appear with a great clinical polymorphism. The muscular involvement is not always evident because of its shortness and latence. Practically the problem is one of localised muscle damage, hyperkaliema or acute renal insufficiency. The serum isoenzymes of CPK levels, the presence of myoglobinuria are necessary for the diagnosis. The most serious rhabdomyolysis depend on the added injury of respiratory muscles and myocardium. Many toxic substances can involve rhabdomyolysis but the most frequent ones are sedatives, carbonic oxyde, ethanol. Only the complications are treated.

Topics: Alcoholic Intoxication; Anesthesia, General; Animals; Carbon Monoxide Poisoning; Foodborne Diseases; Glycyrrhiza; Heroin; Humans; Hypnotics and Sedatives; Muscles; Myoglobinuria; Plants, Medicinal; Poisoning; Quail; Succinylcholine

Topics: 1-Propanol; Alcoholic Intoxication; Amphetamine; Carbon Monoxide Poisoning; Chloral Hydrate; Chlordiazepoxide; Dextropropoxyphene; Diazepam; Ethchlorvynol; Glutethimide; Heroin; Humans; Meprobamate; Methadone; Methanol; Morphine; Orphenadrine; Paraldehyde; Pentazocine; Phenothiazines; Phenytoin; Poisoning; Quinine; Salicylates; Toxicology; Tranquilizing Agents

Opioid-related harm has risen in recent decades, but limited research describes the clinical burden of opioid poisoning to Australian EDs. We aimed to investigate hospital presentations with opioid poisoning over three decades.. This is an observational series of prospectively collected data investigating presentations of opioid poisoning to an ED in Newcastle (1990-2021). Type of opioid, naloxone administration, intubation, intensive care unit (ICU) admission, length of stay and death were extracted from the unit's database.. There were 4492 presentations in 3574 patients (median age 36, 57.7% female), increasing from an average of 93 presentations annually in the first decade to 199 in the third decade. Deliberate self-poisonings accounted for 3694 presentations (82.2%). Heroin dominated the 1990s, peaking in 1999 before decreasing. Prescription opioids then rose, with codeine (usually in paracetamol combination) predominating until 2018, after which oxycodone presentations exceeded them. Methadone consistently increased from six presentations annually in the first decade to 16 in the last decade. Naloxone was administered in 990 (22.0%) presentations and 266 (5.9%) were intubated, most frequently following methadone and heroin exposures. ICU admissions increased from 5% in 1990 to 16% in 2021. Codeine exposures resulted in less severe effects, whereas methadone had more severe effects overall. The median length of stay was 17 h (interquartile range 9-27 h). There were 28 deaths (0.6%).. Opioid presentations increased in number and severity over three decades as the type of opioid changed. Oxycodone is currently the main opioid of concern. Methadone poisoning was the most severe.

Topics: Adult; Analgesics, Opioid; Australia; Codeine; Female; Heroin; Humans; Male; Methadone; Naloxone; Oxycodone; Poisoning; Prescriptions

Oxidative stress is an important pathogenetic factor in a number of socially significant diseases, including the acute exogenous poisoning. Homocysteine is a sulfur-containing amino acid synthesized on the basis of methionine, which plays an important role as an oxidizing agent in the human body. As such a factor, it was the monitored subject of this study.. To measure the level of homocysteine in acute exogenous poisoning with alcohol, heroin and cerebro-toxic drugs.. This is a prospective longitudinal study including 118 patients with moderate or severe acute poisoning with cerebro-toxic drugs (n=45), alcohol (n=40), heroin (n=33) and a "control group" (n=35). Clinical laboratory tests were performed according to the standards of a clinical laboratory. In the statistical analysis we used alternative and variance analysis, parametric methods for hypothesis assessment, and nonparametric methods for normal distribution.. The results showed that for the three groups of intoxications, the average homocysteine levels were higher than those of the control group (р<0.001). The intergroup comparison criterion for normal distribution showed that the changes in patients with alcohol intoxication (u=3.39; р<0.001) and heroin intoxication (u=2.00; р<0.001) were highly statistically significant without correlating with the severity of the poisoning (р>0.05).. There is a risk of oxidative stress in intoxication with alcohol and narcotics. A reliable marker for the complex evaluation of oxidative stress in people is monitoring the serum level of homocysteine and its careful interpretation.

Topics: Adolescent; Adult; Aged; Alcohols; Female; Heroin; Homocysteine; Humans; Hyperhomocysteinemia; Longitudinal Studies; Male; Middle Aged; Oxidative Stress; Poisoning; Prospective Studies; Young Adult

Objective-This report describes regional differences in the specific drugs most frequently involved in drug overdose deaths in the United States in 2017. Methods-Data from the 2017 National Vital Statistics System-Mortality files were linked to electronic files containing literal text information from death certificates. Drug overdose deaths were identified using International Classification of Diseases, 10th Revision underlying cause-of-death codes X40-X44, X60-X64, X85, and Y10-Y14. Drug mentions were identified using established methods for searching the literal text from death certificates. Deaths were assigned to 1 of 10 U.S. Department of Health and Human Services (HHS) regions based on the decedent's state of residence. The number and age-adjusted death rate was determined for the 10 drugs most frequently involved in drug overdose deaths in 2017, both nationally and for each HHS region. Deaths involving more than one drug were counted in all relevant drug categories (i.e., the same death could be counted in more than one drug category). Results-Among drug overdose deaths in 2017 that mentioned at least 1 specific drug on the death certificate, the 10 drugs most frequently involved included fentanyl, heroin, cocaine, methamphetamine, alprazolam, oxycodone, morphine, methadone, hydrocodone, and diphenhydramine. Regionally, 6 drugs (alprazolam, cocaine, fentanyl, heroin, methadone, and oxycodone) were found among the 10 most frequently involved drugs in all 10 HHS regions, although the relative ranking varied by region. Age-adjusted rates of drug overdose deaths involving fentanyl or deaths involving cocaine were higher in the regions east of the Mississippi River, while age-adjusted rates for drug overdose deaths involving methamphetamine were higher in the West. The regional patterns observed did not change after adjustment for differences in the specificity of drug reporting. Conclusions-The drugs most frequently involved in drug overdose deaths in 2017 varied by HHS region. Understanding the regional differences can help inform local prevention and policy efforts.

Topics: Cocaine; Drug Overdose; Fentanyl; Heroin; Humans; Methamphetamine; Poisoning; Residence Characteristics; United States; United States Dept. of Health and Human Services; Vital Statistics

Brain tissue is a useful supplement to blood in postmortem investigations, but reference concentrations are scarce for many opioids. Heroin cases may be difficult to distinguish from morphine cases as heroin and its metabolites are rapidly degraded. We present concentrations from brain and blood and brain-blood ratios of 98 cases where morphine was quantified. These cases were grouped according to the cause of death: A: The compound was solely assumed to have caused a fatal intoxication. B: The compound presumably contributed to a fatal outcome in combination with other drugs, alcohol or disease. C: The compound was not regarded to be related to the cause of death. The cases were further classified as heroin cases if 6-acetyl-morphine or noscapine were detected. The analyses were carried out using solid-phase extraction or protein precipitation followed by ultra high-performance liquid chromatography coupled to mass spectrometry. The average brain-blood ratios of morphine were 1.2 and 1.8 for 69 morphine and 29 heroin cases, respectively. Differences in the brain-blood ratios were found for cases where heroin and morphine were involved in the cause of death, either in combination or on its own (P<0.001 and P=0.004, respectively). However, the overlap between morphine and heroin cases precludes the use of the brain-blood ratio to distinguish heroin from morphine intake. Morphine-6-glucuronide and 6-acetyl-morphine were quantified in brain and blood in a subset of the samples, yielding median brain-blood ratios of 5.1 and 8.3, respectively. The brain concentrations may aid the toxicological investigation in cases where heroin or morphine intoxications are suspected, but blood is not available.

Topics: Brain Chemistry; Chromatography, Liquid; Drug Overdose; Forensic Toxicology; Heroin; Humans; Mass Spectrometry; Morphine; Morphine Derivatives; Narcotics; Noscapine; Poisoning

Poisoning is an important category of avoidable deaths in Norway and an important public health issue. Close monitoring of any development in this field is essential for effective preventive measures.. To assess the pattern and trends of poisoning mortality in Norway from 2003 to 2012 based on official mortality data.. This is a population-based registry study. We analyzed the underlying external cause of death data, in order to assess poisoning deaths (ICD-10) by accidents (X40-X49); intentional self-harm (suicide) (X60-X69); assault (homicide) (X85-X90); and poisoning of undetermined intent (Y10-Y19). We compared poisoning deaths to other injury mechanisms and used multiple injury cause data to identify substances involved in poisoning deaths. Poisson regression was applied to estimate the trend.. Poisoning was the second leading mechanism of injury deaths in Norway from 2003 to 2012, causing between 424 and 496 deaths each year. The rates of poisoning deaths varied between 8 and 11 per 100,000 inhabitants, with a peak in 2004. About 3366 of the 4620 poisoning deaths in the decade were accidental. Opioids were the most common causative agents. Heroin caused 150 deaths in 2004. The numbers fell to 63 in 2012 but showed great yearly variations. Deaths by methadone increased from 24 in 2003 to 61 in 2012.. Poisoning mortality rates declined from 2003 to 2012. Interpretation of the data, however, should be done with caution, and comparison with other countries may be biased due to differences in data production procedures. Evaluation of the effect of preventive measures to reduce mortality should be emphasized.. Poisonings remain a significant cause of mortality by injury in Norway. Emphasis should be placed on following the trends closely, especially regarding methadone deaths.

Topics: Accidents; Analgesics, Opioid; Cause of Death; Heroin; Homicide; Humans; International Classification of Diseases; Methadone; Norway; Poisoning; Public Health; Registries; Suicide

Topics: Adrenergic Agents; Adrenergic beta-Agonists; Adult; Clenbuterol; Disease Outbreaks; Drug Contamination; Heroin; Humans; Male; Poisoning

Body packing is a general term used to indicate the internal transportation of drug packages, mainly cocaine, heroin, amphetamines, and methamphetamine, within the gastrointestinal tract. We described two cases of accidental drug intoxication, observed over the last year period, with evidence of intracorporeal drug concealment. The first case concerned a body packer transporting 69 drug packages of heroin adulterated with piracetam. The second body packer transported 16 drug packages of cocaine adulterated with levamisole. For both cases, forensic examination and toxicological analysis of drug packages and biological samples were carried out. Authors also wants to highlight the main medico-legal issues that commonly arise in cases of suspected or ascertained body packers.

Topics: Adult; Autopsy; Benzodiazepines; Cocaine; Drug Trafficking; Heroin; Humans; Male; Poisoning

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

To provide references for forensic expertise by investigating the kinds of toxicant, routes of exposure and manners of poisoning deaths, etc.. Six hundred and seven autopsy cases of poisoning deaths from 1957 to 2008 in Department of Forensic Medicine, Tongji Medical College (Tongji Forensic Science Identification Center of Hubei), were comparatively reviewed.. In 218 cases from 1999 to 2008, more than 50% of decedents were male in the ages of 30-49. The toxicants are usually taken orally and the most common manner of death was accidental. The common substances involved in poisoning death were rodenticide, poisoning gas and insecticide. Compared to the data of 1983-1998 and 1957-1982, the common toxic agents had changed significantly. The number of cases involving insecticide and cyanide poisoning decreased in recent years, and the number of cases of rodenticide, poisoning gas, alcohols poisoning displayed an increase tendency, especially for drugs abuse.. Poisoning deaths of pesticides remain a major public health problem for a long time and the awareness of prevention need to be raised, especially for the prevention of deaths from multiple poisons.

Topics: Accidents; Adolescent; Adult; Age Distribution; Aged; Alcoholic Intoxication; Anesthetics; Autopsy; Carbon Monoxide Poisoning; Cause of Death; Child; Child, Preschool; China; Female; Forensic Medicine; Heroin; Humans; Hypnotics and Sedatives; Infant; Male; Middle Aged; Pesticides; Poisoning; Retrospective Studies; Rodenticides; Sex Distribution; Suicide; Young Adult

Turkey has continuously experienced problems with abuse of, and addiction to, opium derivatives. In this study, we analyzed the relationship between heroin overdose deaths and the characteristics of seized opium derivatives. Data were gathered from the Council of Forensic Medicine of the Ministry of Justice in Istanbul from 1990 to 2000. There were 636 heroin-related deaths during this period, 595 of which were classified as heroin overdose deaths. Mean crude and weighted heroin purities remained relatively constant and were calculated to be 46% (57-34%) and 51% (39-59%), respectively. The weight of heroin and the number of heroin seizures, but not the heroin purity, were significantly associated with the number of heroin-related deaths. Prevention strategies are needed to reduce the number of deaths caused by overdoses in countries situated on drug trafficking routes. These strategies should focus on drug trafficking, by providing increased levels of, and support for, law enforcement, stopping the supply of precursor chemicals, and combating corruption among border officials.

Topics: Drug Overdose; Female; Forensic Toxicology; Heroin; Humans; Illicit Drugs; Male; Narcotics; Poisoning; Registries; Retrospective Studies; Turkey

The medical outcome of heroin body stuffers has rarely been described. This study was performed to illustrate the clinical course of heroin body stuffers. A retrospective chart analysis was performed on all cases of heroin body stuffers received by a metropolitan poison control center from 2000-2004. We identified 65 heroin body stuffers. Sixty-nine percent were men with a mean age of 35 years. The stated quantity of heroin containers ingested ranged from 1 to 30, with 65% reported as being wrapped in plastic. Six patients (9.2%) developed symptoms of opiate intoxication. All symptoms began within an hour after the ingestion. Three patients (4.6%) needed naloxone. The mean length of observation was 24 h. Opiate intoxication from heroin stuffing is uncommon. Those patients that developed symptoms did so early in their course. These data indicate a benign clinical course in most heroin body stuffers.

Topics: Adult; Antidotes; Charcoal; Combined Modality Therapy; Commerce; Eating; Endoscopy; Female; Heroin; Humans; Male; Naloxone; Narcotic Antagonists; Poisoning; Therapeutic Irrigation; Time Factors

Topics: Adult; Crack Cocaine; England; Heroin; Humans; Male; Poisoning; Substance-Related Disorders; Wales

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.

Topics: Adolescent; Adult; Drug Overdose; Foot Injuries; Forensic Pathology; Forensic Toxicology; Heroin; Humans; Male; Narcotics; Phlebotomy; Poisoning; Substance Abuse Detection; United Arab Emirates

Topics: Abdominal Pain; Adult; Deglutition; Drug Packaging; Emergencies; Foreign Bodies; Gastrointestinal Tract; Heroin; Humans; Illicit Drugs; Male; Poisoning; Radiography, Thoracic; Sleep Stages; Tomography, X-Ray Computed

Body packing is a distinct method of drug smuggling. Surgeons and intensive care specialists will be confronted with body packers when packets do not pass spontaneously and rupture, causing drug toxicity.. We report of a 32-year-old Liberian male who presented with abdominal complaints and anxiety after having ingested 50 cocaine-containing packets of which 49 had passed the natural route in the previous days. X-ray of his abdomen showed a structure possibly compatible with a packet in or projected over the stomach. We decided to transfer the patient to the operation theatre for surgical removal via gastrotomy. However, no packet was found. During his first day in the intensive care unit he did not regain consciousness. Repeated urine analyses for cocaine were negative. After one day he deteriorated: he needed circulatory support because of hypotension, without signs of sepsis. Repeated surgery revealed no packet. In the end he turned out not to be suffering from cocaine intoxication.. When confronted with a case of body packing in which packets do not pass spontaneously and produce bowel obstruction or in which badly wrapped packets rupture, causing drug toxicity, it is of utmost importance to establish the nature of the packet's content.

Topics: Adult; Asparagus Plant; Cocaine; Daucus carota; Foreign Bodies; Heroin; Humans; Male; Poisoning; Stomach; Tomography, X-Ray Computed

New Mexico leads the nation in poisoning mortality, which has increased during the 1990s in New Mexico and the United States. Most of this increase has been due to unintentional deaths from illicit drug overdoses. Medical examiner and/or vital statistics data have been used to track poisoning deaths. In this study, the authors linked medical examiner and vital statistics records on underlying cause of death, coded using the International Classification of Diseases, Ninth Revision, to assess the extent to which these data sources agreed with respect to poisoning deaths. The authors used multiple-cause files, which are files with several causes listed for each death, to further assess poisoning deaths involving more than one drug. Using vital statistics or medical examiner records, 94.7% of poisoning deaths were captured by each source alone. For unintentional illicit drug and heroin overdose deaths, each data source alone captured smaller percentages of deaths. Deaths coded as E858.8 (unintentional poisoning due to other drugs) require linkage with medical examiner or multiple-cause records, because this code identifies a significant percentage of illicit drug overdose deaths but obscures the specific drug(s) involved. Surveillance of poisoning death should include the use of medical examiner records and underlying- and multiple-cause vital statistics records.

Topics: Adult; Death Certificates; Drug Overdose; Heroin; Humans; New Mexico; Poisoning; Population Surveillance; Vital Statistics

To know the frequency of fatal poisoning in Peshawar regarding the toxic agents mostly involved and yearwise percentage. To know the age group and the gender that is most vulnerable to fatal poisoning.. Non-interventional (descriptive) type.. This study was conducted over a period of five years (1997-2001) at Forensic Medicine Department, Khyber Medical College, Peshawar.. The study included 3508 autopsies conducted at Khyber Medical College, Peshawar. Out of these, 52 cases were those caused by fatal poisoning. These were analyzed according to age, gender and the toxic agent involved. t-test was applied as the test of significance.. Poisoning was the cause of death in 1.48% of the total autopsies conducted during the five years. Males were more involved than the females, 90.38 %. Suicidal poisoning was present in 17.30% of the total cases and accidental poisoning was found in 80.72% cases, while homicidal cases were 1.29% only. Diacetylmorphine (heroin) was the most commonly involved agent, 65.38 %, of the total cases. The incidence of poisoning was more during the third and fourth decades of life.. Diacetylmorphine (heroin) was the main causative agent involved in young males due to accidental over- dosage. Accidental and suicidal deaths should not be considered as inevitable. More elaborative studies are required in this area of recent research to adopt appropriate and adequate measures to save precious lives.

Topics: Adolescent; Adult; Age Factors; Aged; Autopsy; Child; Drug Overdose; Female; Heroin; Humans; Male; Medical Audit; Pakistan; Poisoning; Prevalence; Sex Factors

Clinical judgement of intoxicated patients is difficult. In the emergency department of the inner city of Oslo this is done every day.. During a one-year period from 1998-99, a group of 429 first-time admitted intoxicated patients were included in a study. The patients and the method of observation are described.. 75% of the patients were men; 45% reported to have consumed alcohol only, while 10% had taken a heroin overdose. The rest had used various combinations of legal and illegal drugs. Female patients were younger than male patients (29 versus 36 years, p < 0.00), and patients intoxicated only on alcohol were on the average older than patients who had taken drugs (38 versus 31 years, p < 0.00). 57 patients were hospitalized, seven of them had serious intracerebral conditions.. Our study indicates that systematic observation over some hours, repeated clinical examinations, and the systematic use of a modified Glasgow Coma Scale makes it possible to sort out the seriously ill from "only" intoxicated patients.

Topics: Adult; Alcoholic Intoxication; Critical Illness; Diagnosis, Differential; Drug Overdose; Emergency Service, Hospital; Female; Glasgow Coma Scale; Heroin; Heroin Dependence; Humans; Male; Monitoring, Physiologic; Norway; Poisoning; Substance-Related Disorders; Wounds and Injuries

Topics: Adult; Blindness, Cortical; Brain; Cysteine; Heroin; Humans; Magnetic Resonance Imaging; Male; Organotechnetium Compounds; Poisoning; Radionuclide Imaging; Radiopharmaceuticals

Adulterants, contaminants, and diluents are all examples of additives to street drugs. Some of these additives may be pharmacologically active; however, it is unusual for them to cause toxic side effects. In the spring of 1995, a new form of heroin appeared in New York City, spreading to other East Coast cities, that was adulterated with scopolamine. It caused severe anticholinergic toxicity in heroin users with patients often presenting to emergency departments in great numbers. This is a report of the demographics and clinical characteristics of the epidemic.. A combination of prospective and retrospective data collection from the New York City, New Jersey, Delaware Valley, and Maryland Poison Centers. The primary measurements were age, sex, route of drug use, vital signs, signs and symptoms, disposition, and treatment.. Of the 370 cases reported to the participating poison centers, 129 were excluded from the final analysis because of insufficient data. Of the patients who used this product, 55% presented with signs and symptoms of heroin toxicity but then became severely agitated with anticholinergic symptoms when naloxone was used to reverse respiratory depression. Nasal insufflation was the route of administration in 34% of the cases. Seizures were rare (3%). Ninety percent required admission, and half were admitted to a critical care unit.. Adulteration of street drugs can lead to toxic epidemics. Poison centers are essential for identification of these trends and are the primary source of information on diagnosis and treatment.

Topics: Adolescent; Adult; Disease Outbreaks; Drug Contamination; Female; Gas Chromatography-Mass Spectrometry; Heroin; Heroin Dependence; Humans; Male; Mid-Atlantic Region; Middle Aged; Muscarinic Antagonists; Poisoning; Prospective Studies; Retrospective Studies; Scopolamine

Drug smuggling by internal bodily concealment is a well-recognized international problem, particularly in view of the difficulty of its detection and the potential for large financial gains. This mode of transport can have serious medical complications, including drug intoxication--sometimes fatal--as well as intestinal obstruction by foreign bodies (FBs). We discuss a case of heroin 'bodypacking' (the ingestion of heroin filled condoms) with its resultant complications. The initial medical management and indications for surgery are discussed, and the relevant literature reviewed.

Topics: Adult; Crime; Digestive System; Foreign Bodies; Heroin; Humans; Intestinal Absorption; Male; Poisoning; Travel

Topics: Combined Modality Therapy; Heroin; Humans; Poisoning; Pulmonary Edema; Respiratory Distress Syndrome

During the course of the Drug Emergency Study in Bremen it became obvious that there are many problems left unsolved related to the medical care of intoxicated heroine addicts. From January to June 1992 there were 1230 drug emergencies, 409 hospital admissions and 644 emergency transportation. With or without antidote treatment, most patients leave the medical care system as soon as possible because of withdrawal symptoms. The physicians involved answered a short questionnaire about these problems: 80% of the physicians are dissatisfied with the present medical care situation for intoxicated drug addicts and feel that these patients are a burden for the hospitals (81%) and for themselves (73%); 93% of the physicians think that a central drug emergency unit, offering medical and psycho-social care would solve the present problems and would be a possibility for lowering drug emergencies and, as a further result, drug mortality.

Topics: Attitude of Health Personnel; Cost of Illness; Emergencies; Emergency Service, Hospital; Female; Germany; Health Services Needs and Demand; Health Services Research; Heroin; Heroin Dependence; Humans; Male; Patient Admission; Physicians; Poisoning; Prospective Studies; Quality of Health Care; Retrospective Studies; Substance Abuse Treatment Centers; Surveys and Questionnaires; Transportation of Patients; Treatment Refusal; Urban Population

During the first ten months of 1992 the Oslo Ambulance Department registered 716 incidences of assumed drug-related intoxications. 80% happened in down town Oslo. 19 cases of asystoly were recorded, 13 of the patients recovered after treatment, without sequelae. Five of these patients left the location after emergency help and they refused hospitalization. 432 of the patients were unconscious when the ambulance personal arrived, 472 were treated with naloxone both by the intramuscular and the intravenous route. Most of the persons refused further observation. A team of specially trained out reach workers offers help after acute medical treatment by means of "streetwork". The intervention is directed at addicts who have experienced an overdose.

Topics: Adolescent; Adult; Drug Overdose; Emergencies; Female; Heroin; Heroin Dependence; Humans; Male; Naloxone; Norway; Poisoning; Social Support

Topics: Adult; Heroin; Humans; Male; Narcotics; Poisoning

Topics: Adult; Autopsy; Body Fluids; Death, Sudden; Heroin; Humans; Male; Morphine; Poisoning

Deaths in the United States classified as unintentional poisoning by drugs and medicaments fell from 14.7 per million population in 1975 to 8.8 in 1978, a 40 per cent decrease. Seventy-three per cent of this drop attributable to a reduction in deaths coded to opiates and intravenous narcotism. These two categories accounted for 38 per cent of all unintentional drug deaths in 1975 but only 15 per cent in 1978. There was no simultaneous increase in other drug-related deaths, including suicides, to account for the reduction in deaths coded to opiates. The highest mortality rates and the greatest variation in mortality during 1970-78 occurred in 20-29 year old non-White males. Racial and sex differences in opiate poisoning mortality, notable early in the decade, were greatly reduced by 1978 due to a relatively larger decline in mortality of males and non-Whites. Time trends in mortality from opiate poisoning appear to coincide with variations in the amount of heroin smuggled into the country.

Topics: Adolescent; Adult; Female; Heroin; Humans; Male; Mortality; Narcotics; Poisoning; Sex Factors; Time Factors; United States

Death in drug addicts is frequently caused by intoxication due to drug overdose or additional ingestion of hypnotic drugs. Only 25 (1%) of 2594 well documented cases in a poison control center linked to an intensive care unit were concerned with drugs. Ten patients were severely intoxicated and all were hospitalized. Of 612 patients treated in the ICU, 8 (1.5%) were drug addicts with severe intoxications. Heroin was regularly involved, but only 3 had pure heroin intoxication. In 5 patients hypnotic drug poisoning predominated, most frequently due to deliberate barbiturate ingestion. All 8 patients were unconscious, 6 were artificially ventilated, and 5 received antidotes.

Topics: Adolescent; Adult; Barbiturates; Critical Care; Drug Combinations; Female; Heroin; Humans; Male; Poisoning; Substance-Related Disorders

Blood samples from deceased narcotic addicts were analyzed for morphine, and the results form persons who died from narcotic addiction were compared with those from homicide victims. In most instances morphine was detectable in both types of death, and usually the values obtained were less than 30 microgram/dl. Narcotic addiction deaths involving only morphine, or morphine plus a combination of ethanol, quinine, or diazepam (Valium), were also evaluated. In some cases high quantities of ethanol were present, and death could be attributed to the combined CNS depressant effects of morphine and ethanol. The quinine levels would not normally be considered toxic, however, and it could not be ascertained that the quantity of this drug present contributed to death. Diazepam was present in elevated concentrations, and its depressant effect may have been a factor in some narcotic addiction deaths.

Topics: Diazepam; Ethanol; Heroin; Homicide; Humans; Morphine; Poisoning; Quinine; Substance-Related Disorders

This study investigated a sample of persons treated for acute drug reactions (overdoses) in a hospital emergency room setting to determine the general characteristics of these drug abusers and the incidence of drugs responsible for their admission. Detailed information is provided on the race and sex composition of these drug abusing patinets and comparisons are made with the general population of the area serviced by the hospital. The sample consisted of 1,128 persons who entered Jackson Memorial Hospital, Miami, Dade County, Florida during 1972. A profile of the typical admission for emergency care of a nonfatal overdose reveals a white female, who is 18 to 24 years old and who has overdosed on a single legally manufactured and distributed substance, usually a sedative. Implications from the data for changes in health care delivery for acute drug reactions are provided.

Topics: Accidents; Adolescent; Adult; Age Factors; Analgesics; Black or African American; Drug and Narcotic Control; Emergency Service, Hospital; Female; Florida; Hallucinogens; Heroin; Humans; Hypnotics and Sedatives; Male; Poisoning; Psychotropic Drugs; Sex Factors; Substance-Related Disorders; Suicide; Tranquilizing Agents

Topics: Heroin; Injections; Mouth Floor; Narcotic Antagonists; Poisoning

Topics: Amphetamine; Atropa belladonna; Barbiturates; Cannabis; Cocaine; Emergency Service, Hospital; Hallucinogens; Heroin; Hospitalization; Humans; Narcotic Antagonists; Plants, Medicinal; Plants, Toxic; Poisoning; Psychoses, Alcoholic; Psychoses, Substance-Induced; Substance-Related Disorders; Unconsciousness

Topics: Adolescent; Adult; Aged; Barbiturates; Female; Glutethimide; Heroin; Heroin Dependence; Humans; Iron; Male; Maryland; Middle Aged; Poisoning; Salicylates; Substance-Related Disorders; Suicide

In a prospective study of 349 patients with acute poisoning treated at The Montreal General Hospital in 1972 benzodiazepines and non-barbiturate hypnotics were found to be the most frequent putative drugs. Of the 108 patients admitted to hospital 37% had taken an overdose of a drug prescribed for them by their psychiatrist or other physician; 48% had formerly taken an overdose of drugs and 44% had had previous psychiatric treatment. Unconsciousness, respiratory depression, metabolic acidosis and acidemia, and hypokalemia were the most frequent clinical abnormalities observed. Treatment was supportive. There were six deaths. The average duration of coma was short; only five surviving patients remained unconscious for more than 24 hours. Respiratory complications were frequent.It is recommended that more attention be paid to recognizing patients whose behaviour pattern might include such an impulsive gesture, and that alternatives be found for barbiturate and non-barbiturate hypnotics.

Topics: Adult; Amphetamine; Antidepressive Agents; Cocaine; Diazepam; Diphenhydramine; Diuresis; Emergency Service, Hospital; Female; Gastric Lavage; Heroin; Humans; Hypnotics and Sedatives; Male; Mental Disorders; Methaqualone; Poisoning; Prospective Studies; Quebec; Resuscitation; Substance-Related Disorders; Suicide; Unconsciousness; Water-Electrolyte Balance

Topics: Autopsy; Death, Sudden; Ethanol; Half-Life; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Lung; Morphine; Morphine Dependence; Poisoning; Time Factors

Topics: Accidents; Adult; Age Factors; Barbiturates; Black or African American; Codeine; Death Certificates; Female; Heroin; Humans; Male; Middle Aged; Morphine; Pennsylvania; Poisoning; Sex Factors; Substance-Related Disorders; Suicide; United States

Topics: Adolescent; Adult; Antidotes; Cannabis; Female; Hallucinogens; Heroin; Humans; Lysergic Acid Diethylamide; Male; Mescaline; Morphine; Morphine Dependence; Poisoning; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Acetaminophen; Aminopyrine; Amitriptyline; Aspirin; Carbamazepine; Chlordiazepoxide; Chlorpromazine; Dextropropoxyphene; Diazepam; Heroin; Humans; Imipramine; Lithium; Pargyline; Pentazocine; Phenacetin; Phenelzine; Phenytoin; Poisoning; Primidone; Promazine; Renal Dialysis; Salicylates; Tranylcypromine; Trifluoperazine

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

Topics: Abscess; Barbiturates; Emergency Service, Hospital; Heroin; Humans; Injections; London; Poisoning; Skin Ulcer; Substance-Related Disorders

Topics: Alkaloids; Cocaine; Demography; Heroin; Humans; Methadone; Opium; Poisoning; Substance-Related Disorders; Suicide; United Kingdom

Topics: Drug-Related Side Effects and Adverse Reactions; Heroin; Humans; Hypnotics and Sedatives; Nalorphine; Poisoning; Psychoses, Substance-Induced