Commentary

Heroin’s toxic effects


 

References

The article “Chasing the dragon” (Cases That Test Your Skills, Current Psychiatry, February 2010) is quite interesting and informative. The first reported cases of toxic leukoencephalopathy because of heroin inhalation appeared in the early 1980s in Amsterdam.1 This method of heroin administration became popular among drug users wanting to avoid the risks of intravenous routes.2 The authors of the Current Psychiatry article do not mention reported cases of toxic leukoencephalopathy via snorting or injecting, although 1 case report describes a similar condition resulting from intravenous heroin overdose and another involving a multidrug overdose that did not include heroin.1 Another study postulates that toxic spongiform leukoencephalopathy via heroin inhalation may be caused by a mechanism triggered by the drug leading to mitochondrial and hypoxic injury in specific white matter areas.3 One case report describes heroin pyrolysate inhalation causing temporary parkinsonism because of reversible tetrahydrobiopterin deficiency, leading to altered dopamine metabolism.4

Adegboyega Oyemade, MD
Addiction psychiatrist
Decatur, IL

Recommended Reading

Smoking Intervention Delivers Modest Success
MDedge Psychiatry
Varenicline Helps Smoking Cessation in Patients With COPD
MDedge Psychiatry
No Decline in Alcohol Use by Pregnant Women
MDedge Psychiatry
OA Patients' End-of-Day Pain Recall Reliable : Characteristics such as age, gender, race, joint site had no significant interactions with accuracy.
MDedge Psychiatry
Isocarboxazid Appears to Reduce Migraine Frequency
MDedge Psychiatry
Idiopathic Abdominal Pain in Children May Be Migraine
MDedge Psychiatry
Warn Older ADHD Teens About Addiction Risks
MDedge Psychiatry
Magnetic Stimulation Device Effective Against Migraine Pain
MDedge Psychiatry
Alcohol withdrawal: When to choose an adjunctive anticonvulsant
MDedge Psychiatry
When anticonvulsants might work best
MDedge Psychiatry