Heroin Toxicity Differential Diagnoses
- Author: Rania Habal, MD; Chief Editor: Asim Tarabar, MD more...
Fentanyl, which is 20 to 40 times more potent than heroin, may be mixed with heroin but is increasingly sold by itself. In recent years, illicitly produced, nonpharmaceutical fentanyl and fentanyl analogs (eg, acetyl fentanyl), which can be can be snorted, injected, or swallowed, have emerged in the illicit drug market, and in some areas have displaced heroin. Because of fentanyl's faster onset of action and greater potency, the drug is responsible for growing numbers of fatal overdoses.[23, 24]
Yaksh TL, Wallace MS. Opioid Analgesia and Pain Management. Brunten LL, ed. Goodman & Gilman's The Pharmacologic Basis of Therapeutics. 12th ed. New York, NY: McGraw Hill Medical; 2010. 481-524.
US Substance Abuse and Mental Health Services Administration. Results from the 2014 National Survey on Drug Use and Health: Summary of National Findings and Detailed Tables. Substance Abuse and Mental Health Services Administration. Available at http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf. Accessed: July 7, 2016.
United Nations Office on Drugs and Crime. World Drug Report 2014. Available at http://www.unodc.org/wdr2014/. Accessed: October 1, 2014.
European Monitoring Centre for Drugs and Drug Addiction. EMCDDA Annual Report 2014. European Monitoring Centre for Drugs and Drug Addiction. Available at http://www.emcdda.eu.int/. Accessed: October 1, 2014.
Sporer KA, Dorn E. Heroin-related noncardiogenic pulmonary edema : a case series. Chest. 2001 Nov. 120(5):1628-32. [Medline].
Centers for Disease Control and Prevention. Atypical reactions associated with heroin use--five states, January-April 2005. MMWR Morb Mortal Wkly Rep. 2005 Aug 19. 54(32):793-6. [Medline].
Bikell WH, Benar O. Life-threatening opioid toxicity. Prob Crit Care. 1987. 1:106.
Bryant WK, Galea S, Tracy M, Markham Piper T, Tardiff KJ, Vlahov D. Overdose deaths attributed to methadone and heroin in New York City, 1990-1998. Addiction. 2004 Jul. 99(7):846-54. [Medline].
Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths--United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016 Jan 1. 64 (50-51):1378-82. [Medline]. [Full Text].
National Institute on Drug Abuse. Data and Statistics. Available at http://www.drugabuse.gov/. Accessed: October 7, 2013.
Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, et al. Increases in heroin overdose deaths - 28 States, 2010 to 2012. MMWR Morb Mortal Wkly Rep. 2014 Oct 3. 63 (39):849-54. [Medline]. [Full Text].
Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015. 53 (10):962-1147. [Medline]. [Full Text].
Darke S, Hall W, Weatherburn D, Lind B. Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug Alcohol Depend. 1999 Apr 1. 54(2):155-61. [Medline].
Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D, Tardiff K. Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990-98. Addiction. 2003 Jun. 98(6):739-47. [Medline].
Darke S, Zador D. Fatal heroin 'overdose': a review. Addiction. 1996 Dec. 91(12):1765-72. [Medline].
Davoli M, Perucci CA, Forastiere F, et al. Risk factors for overdose mortality: a case-control study within a cohort of intravenous drug users. Int J Epidemiol. 1993 Apr. 22(2):273-7. [Medline].
Infante F, Domínguez E, Trujillo D, Luna A. Metal contamination in illicit samples of heroin. J Forensic Sci. 1999 Jan. 44(1):110-3. [Medline].
Hoffman RS, Kirrane BM, Marcus SM. A descriptive study of an outbreak of clenbuterol-containing heroin. Ann Emerg Med. 2008 Nov. 52(5):548-53. [Medline].
New York City Department of Health and Mental Hygiene. Health department investigating hospitalizations possibly related to contaminated heroin. Available at http://www.nyc.gov/html/doh/html/pr/pr014-05.shtml. Accessed: October 7, 2013.
Centers for Disease Control and Prevention. Wound botulism among black tar heroin users--Washington, 2003. MMWR Morb Mortal Wkly Rep. 2003 Sep 19. 52(37):885-6. [Medline].
Hoffman RS, Goldfrank LR. The poisoned patient with altered consciousness. Controversies in the use of a 'coma cocktail'. JAMA. 1995 Aug 16. 274(7):562-9. [Medline].
Hoffman JR, Schriger DL, Luo JS. The empiric use of naloxone in patients with altered mental status: a reappraisal. Ann Emerg Med. 1991 Mar. 20(3):246-52. [Medline].
Seelye KQ. Heroin Epidemic Is Yielding to a Deadlier Cousin: Fentanyl. NY Times. March 16, 2016. Available at http://www.nytimes.com/2016/03/26/us/heroin-fentanyl.html?_r=0.
Fentanyl and Fentanyl Analogs. National Drug Early Warning System. Available at http://pub.lucidpress.com/NDEWSFentanyl/#0uATvewBep_i. December 7, 2015; Accessed: July 7, 2016.
Centers for Disease Control and Prevention. Scopolamine poisoning among heroin users--New York City, Newark, Philadelphia, and Baltimore, 1995 and 1996. MMWR Morb Mortal Wkly Rep. 1996 Jun 7. 45(22):457-60. [Medline].
Vagi SJ, Sheikh S, Brackney M, et al. Passive multistate surveillance for neutropenia after use of cocaine or heroin possibly contaminated with levamisole. Ann Emerg Med. 2013 Apr. 61(4):468-74. [Medline].
Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. Substance Abuse and Mental Health Services Administration. 2013. Available at http://www.samhsa.gov/data/2k13/DAWN2k11ED/DAWN2k11ED.htm.