heroin and Seizures

Neonatal abstinence syndrome (NAS) is suffered by infants withdrawing from substances on which they have become physically dependent after in utero exposure. They may require prolonged treatment and spend weeks or even months in hospital. A wide range of drugs have been used to treat NAS. The efficacy of few, however, have been adequately investigated. Evidence suggests that opioids are the most appropriate, at least in infants exposed to diamorphine or methadone. In all "head to head" trials, diazepam has been shown to be ineffective. Morphine and methadone are currently the most commonly prescribed opioids to treat NAS, but randomised trials have not been undertaken to determine which is the more beneficial. Many infants with NAS have been exposed to multiple substances in utero. Further research is required into whether a single opiate or a multiple drug regimen is the best option for such patients.

Topics: Clinical Trials as Topic; Drug Therapy, Combination; Heroin; Humans; Infant, Newborn; Methadone; Morphine; Narcotics; Neonatal Abstinence Syndrome; Seizures; Sucking Behavior

In this brief review the analytical techniques mainly used for comparative analysis of both cocaine and heroin seizures are reported. The characterization of illicit samples is carried out by means of a variety of techniques including thin-layer chromatography, high-performance liquid chromatography, gas chromatography and capillary electrophoresis. By means of these technique it is possible to resolve some component in illicit drugs and their application for comparative analyses is described in this review. Owing to the complexity and the variability of the mixture related to the origin and manufacturing impurities a unique analytical approach based on the application of a single technique it is not sufficient to achieve the requested global characterization of the sample for comparative purposes. Generally a complete characterization is obtained focusing on the identification of minor and major components, origin and manufacturing impurities other than trace compounds such as solvent residues. Nevertheless the application of a single robust methods able to resolve any possible significant marker compounds, is still not described and there is a need for a standardized general procedure suitable for a complete cross-examination of analytical data related to comparative analyses that can be carried out at an international level.

Topics: Chromatography; Chromatography, Gas; Chromatography, High Pressure Liquid; Chromatography, Thin Layer; Cocaine; Drug Contamination; Electrophoresis, Capillary; Gas Chromatography-Mass Spectrometry; Heroin; Humans; Seizures; Spectrophotometry, Atomic

Gas in the hepatic portal venous system has been noted to be a complication of a wide range of intra-abdominal catastrophes that involve damage to bowel mucosa. We describe a patient who, after a seizure, was found to have portal venous gas on sonography and CT. The search for other possible causes revealed negative results. This case demonstrates a rare cause of hepatic portal venous gas that is self-resolving and clinically benign.

Topics: Adult; Embolism, Air; Heroin; Heroin Dependence; Humans; Male; Portal Vein; Seizures; Substance Withdrawal Syndrome; Tomography, X-Ray Computed; Ultrasonography

Naloxone is standard medication for the treatment of heroin intoxications. No large-scale studies have yet been carried out to determine its toxicity in heroin intoxications.. We have undertaken an investigation as to the frequency, type and degree of severity of complications attributable to naloxone administration. Subjects treated between 1991 and 1993 with naloxone for intravenous drug intoxications were prospectively evaluated.. Development of ventricular tachycardia or fibrillation; atrial fibrillation; asystole; pulmonary edema; convulsions; vomiting; and violent behavior within ten minutes after parenteral administration of naloxone.. Six of 453 intoxicated subjects (1.3%; 95% confidence interval 0.4%-3%) suffered severe adverse effects within ten minutes after naloxone administration (one asystole; three generalized convulsions; one pulmonary edema; and one violent behavior). After the ten minute period, no further complications were observed.. The short time between naloxone administration and the occurrence of complications, as well as the type of complications, are strong evidence of a causal link. In 1000 clinically diagnosed intoxications with heroin or heroin mixtures, from 4 to 30 serious complications can be expected. Such a high incidence of complications is unacceptable and could theoretically be reduced by artificial respiration with a bag valve device (hyperventilation) as well as by administering naloxone in minimal divided doses, injected slowly.

Topics: Adolescent; Adult; Aggression; Cocaine; Confidence Intervals; Drug Overdose; Female; Heart Arrest; Heroin; Humans; Illicit Drugs; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Naloxone; Narcotic Antagonists; Prospective Studies; Pulmonary Edema; Seizures; Substance Abuse, Intravenous

Topics: Bridged-Ring Compounds; Clinical Trials as Topic; Cyclazocine; Electroencephalography; Frontal Lobe; Furans; Heroin; Humans; Injections, Intravenous; Ketones; Male; Methadone; Morphine Dependence; Narcotic Antagonists; Occipital Lobe; Phenanthrenes; Seizures

Synthetic opioids, mostly illegally manufactured fentanyl (IMF), were mentioned in 60% of United States (US) drug overdose deaths in 2020, with dramatic variation across states that mirrors variation in IMF supply. However, little is known about IMF markets in the United States and how they are changing. Researchers have previously used data from undercover cocaine, heroin, and methamphetamine purchases and seizures to examine how their use and related harms respond to changes in price and availability. This analysis used US Drug Enforcement Administration (DEA) data to address two questions: (i) "To what extent does IMF supply vary over time and geography?" and (ii) "What has happened to the purity-adjusted price of IMF?". We developed descriptive statistics and visualizations using data from 66 713 observations mentioning IMF and/or heroin from the DEA's System to Retrieve Information from Drug Evidence (STRIDE; now STARLIMS) from 2013 to 2021. Price regressions were estimated with city-level fixed effects examining IMF-only powder observations with purity and price information at the low-to-medium wholesale level (>1 g to ≤100 g; n = 964).. From 2013 to 2021, the share of heroin and/or IMF observations mentioning IMF grew from near zero to more than two-thirds. The share of heroin observations also containing IMF grew from <1% to ~40%. There is important geographic variation: in California, most IMF seizures involved counterfeit tablets, whereas New York and Massachusetts largely involved powder formulation. The median price per pure gram of IMF powder sold at the >10 to ≤100 g level fell by more than 50% from 2016 to 2021; regression analyses suggested an average annual decline of 17% (P < 0.001). However, this price decline appears to have been driven by observations from the Northeast.. Since 2013, the illegally manufactured fentanyl problem in the United States has become more deadly and more diverse.

Topics: Analgesics, Opioid; Drug Overdose; Fentanyl; Heroin; Humans; New York; Powders; Seizures; United States

Synthetic cannabinoid receptor agonists (SCRA) are commonly encountered new psychoactive substances. Here we report the recent detection of ADB-BUTINACA in samples from patients attending United Kingdom emergency departments with toxicity after suspected drug misuse and describe the associated clinical features.. Consenting adults (≥16 y) presenting to participating hospitals with toxicity after suspected drug misuse have been included in the Identification Of Novel psychoActive substances (IONA) study since March 2015. Demographic and clinical features are recorded and blood and/or urine samples analysed using high-resolution accurate mass liquid chromatography-mass spectrometry.. By December 2021, analytical data were available for 1279 IONA participants and ADB-BUTINACA was detected in at least one sample from 10 (9 males, age range 16-51 median 45 years), all presenting since February 2021. Smoking 'spice' was reported by four patients, two had ingested edible "cannabis" gums and four reported heroin use (2 intravenous, 1 smoked, 1 route not known). Co-use of pregabalin (oral) and crack cocaine (smoked) were also reported. In 3 cases ADB-BUTINACA was the only substance detected, while in seven other substances of misuse were also detected including other SCRA, opioids, benzodiazepines cocaine and pregabalin. Clinical features reported in these 2 groups respectively included reduced level of consciousness (3/3, 6/7), agitation (0/3, 4/7), tachycardia (0/3, 3/7), seizures (1/3, 1/7), hallucinations (1/3, 1/7), hypotension (1/3, 1/7). Metabolic acidosis (1/3, 0/7) and respiratory acidosis (1/3, 0/7), All 10 patients recovered with supportive care, including intubation and ventilation for one case. The median length of hospital stay was 19 h (range 2.6-131 h).. ADB-BUTINACA has recently emerged as a drug of misuse in England. Clinical features of toxicity are consistent with those of other SCRA and include reduced level of consciousness, respiratory and/or metabolic acidosis, seizures, confusion and hallucinations.

Topics: Adolescent; Adult; Benzodiazepines; Cannabinoid Receptor Agonists; Crack Cocaine; Emergency Service, Hospital; England; Hallucinations; Heroin; Humans; Male; Middle Aged; Pregabalin; Seizures; Young Adult

Topics: Fentanyl; Heroin; Humans; Law Enforcement; Ohio; Seizures

The evaluation of a link between two heroin seizures using a descriptive method is presented. It is based on the measure of the angles between two chromatograms assimilated to vectors, and interpreted using a continuous approach based on the likelihood ratio of Bayes' theorem. A complete evaluation model thus avoids the drawbacks of decision thresholds used until now to establish a link. Validation is obtained through tests and simulation methods.

Topics: Forensic Medicine; Heroin; Humans; Likelihood Functions; Models, Statistical; Narcotics; Reproducibility of Results; Seizures; Statistics as Topic

Acetylcodeine is one of the major impurities present in illicitly manufactured heroin (diacetylmorphine). Data on its pharmacology and toxicology are limited and its ability to alter the toxic effects of diacetylmorphine is not known. The first objective of the present study was to compare the acute pharmacological and toxicological effects of acetylcodeine to those of codeine and diacetylmorphine in mice by assessing nociception in the tail-flick test, locomotor stimulation, and convulsive behavior. The second goal of this study was to determine whether acetylcodeine would alter the convulsant effects of diacetylmorphine. The antinociceptive potencies of acetylcodeine and codeine were similar, as reflected by their ED50 (95% confidence limits) values of 35 (29-44) and 51 (40-65) micromol/kg, respectively. Acetylcodeine was somewhat less potent than codeine in stimulating locomotor behavior, with ED50 values of 28 (22-37) and 12 (6-24) micromol/kg, respectively. Diacetylmorphine was considerably more potent than the other two drugs, producing antinociception and locomotor stimulation at ED50 values of 2.4 (1.4-4.1) and 0.65 (0.36-1.2) micromol/kg, respectively. On the other hand, the convulsant effects of acetylcodeine (ED50=138 (121-157) micromol/kg) and diacetylmorphine (ED50=115 (81-163) micromol/kg) were similar in potency and both were more potent than codeine (ED50=231 (188-283) micromol/kg). Finally, a subthreshold dose of acetylcodeine (72 micromol/kg) decreased the convulsant ED50 dose of diacetylmorphine to 40 (32-49). These findings suggest that the convulsant effects of acetylcodeine are more potent than predicted by its effects on locomotor activity and antinociception. The observation that acetylcodeine potentiated the convulsant effects of diacetylmorphine suggests a mechanism for some of the heroin-related deaths reported in human addicts.

Topics: Analgesics, Opioid; Animals; Codeine; Dose-Response Relationship, Drug; Drug Contamination; Drug Synergism; Heroin; Male; Mice; Mice, Inbred ICR; Motor Activity; Pain Measurement; Seizures

We report on the use of a subcutaneous infusion of diamorphine, hyoscine and midazolam in the terminal care of a child with a neurodegenerative disease. The technique was safe and effective, and provided good symptom relief including control of previously intractable seizures.

Topics: Fatal Outcome; Female; Heroin; Humans; Hypnotics and Sedatives; Infant; Midazolam; Muscarinic Antagonists; Narcotics; Palliative Care; Scopolamine; Seizures

We retrospectively identified 49 cases of recreational drug-induced seizures in 47 patients seen at the San Francisco General Hospital between 1975 and 1987. Most patients experienced a single generalized tonic-clonic seizure associated with acute drug intoxication, but 7 patients had multiple seizures and 2 patients developed status epilepticus. The recreational drugs implicated were cocaine (32 cases), amphetamine (11), heroin (7), and phencyclidine (4). A combination of drugs was responsible in 11 cases. Seizures occurred independent of the route of administration, and occurred in both first-time and chronic abusers. Ten patients (21%) reported having had prior seizures, all with a close temporal association with drug abuse. Other than 1 patient who developed prolonged status epilepticus that caused a fixed neurologic deficit, most patients had no obvious short-term neurologic sequelae.

Topics: Adult; Amphetamines; Cocaine; Drug Combinations; Female; Heroin; Humans; Lysergic Acid Diethylamide; Male; Marijuana Abuse; Phencyclidine; Seizures; Status Epilepticus; Substance-Related Disorders; Time Factors

A 22 year old heroin addict was admitted with tonic-clonic seizures, confusion and agitation 10 hours after taking mefenamic acid 5 grams orally and 2.25 grams intravenously. This appears to be the first recorded case of intravenous mefenamic acid abuse and, although not fatal, is a cause of concern. This is a commonly used drug and its seizure inducing potential is well recognised. It may therefore be worthwhile considering the possibility of intravenous abuse of mefenamic acid in heroin addicts admitted with confusion or seizures.

Topics: Administration, Oral; Adult; Confusion; Heroin; Humans; Injections, Intravenous; Male; Mefenamic Acid; Seizures; Substance-Related Disorders

Prisoners deserve to be taken seriously and treated with respect by the physician, as does any person seeking medical care. Treatment should include an adequate history and physical examination as well as indicated laboratory tests. Anxiety is a ubiquitous problem in prison life and can adversely affect any medical condition. The diagnosis of malingering is and should be one of exclusion, and the physician should keep in mind that a seemingly healthy prisoner might have several other reasons for seeking medical help. The physician needs to be confident of the diagnosis before returning the person to the cell block, as prisoners do not have freedom of access to medical care. New standards, programs, literature, journals, and conferences have drawn attention to the jail as a place where the physician can intervene in a positive way to decrease the recycling of crime and illness. It is not enough to be able to practice good medicine in a jail. Such practice must recognize the special needs of prisoners and the special problems inherent in the jail environment.

Topics: Adult; Alcoholism; Cannabis; Diazepam; Ethics, Medical; Female; Health Services; Heroin; Humans; Male; Mental Disorders; Physician-Patient Relations; Prisoners; Prisons; Seizures; Substance-Related Disorders; Tuberculosis; United States

A case of a severe heroin withdrawal syndrom in a newborn infant is reported. Diagnostic and therapeutic aspects of the disease are reviewed.

Topics: Chloral Hydrate; Diazepam; Female; Heroin; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Muscle Tonus; Phenobarbital; Pregnancy; Seizures; Substance Withdrawal Syndrome

Naloxone antagonized convulsions produced by tail vein infusions of d-propoxyphene, heroin, meperidine, normeperidine and thebaine in mice in a dose-related manner. Pretreatment with naloxone (60 mg/kg i.p.) produced a 200 percent increase of the dose of d-propoxyphene or heroin needed to produce a seizure. A 40 percent increase in the convulsant dose of meperidine was observed after naloxone pretreatment (30 mg/kg i.p.). Naloxone (15 mg/kg i.p.) produced a 30 percent increase in the convulsant dose of normeperidine; however, larger doses of naloxone did not produce any further increase in the convulsant dose of either normeperidine or meperidine. Larger doses of naloxone were needed to antagonize convulsions produced by thebaine. Heroin, d-propoxyphene and meperidine produced nonlethal clonic seizures, whereas normeperidine and thebaine produced tonic-clonic seizures which were followed by death. These data suggest that there may be two mechanisms by which narcotic analgesics and their congeners produce convulsions.

Topics: Animals; Anticonvulsants; Dextropropoxyphene; Heroin; Male; Meperidine; Mice; Naloxone; Nipecotic Acids; Seizures; Thebaine

Topics: Animals; Blood Gas Analysis; Dose-Response Relationship, Drug; Drug Contamination; Drug Tolerance; Habituation, Psychophysiologic; Haplorhini; Heroin; Heroin Dependence; Humans; Papio; Respiratory Function Tests; Seizures; Substance-Related Disorders; Time Factors

Topics: Barbiturates; Codeine; Drug Tolerance; Ethchlorvynol; Glutethimide; Heroin; Hydromorphone; Hypnotics and Sedatives; Meperidine; Meprobamate; Methadone; Morphine Dependence; Narcotics; Opium; Pentobarbital; Seizures; Statistics as Topic; Substance-Related Disorders; Toxicology; Urea

Topics: Barbiturates; Chemistry Techniques, Analytical; Chromatography; Heroin; Lysergic Acid Diethylamide; Narcotics; Research; Seizures; Spectrophotometry