eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Heroin: Multimedia

Author: Rania Habal, MD, Assistant Professor, Department of Emergency Medicine, New York Medical College
Contributor Information and Disclosures

Updated: Aug 12, 2008

Multimedia

Heroin-related noncardiogenic pulmonary edema.Media file 1: Heroin-related noncardiogenic pulmonary edema.
Heroin-related noncardiogenic pulmonary edema.

Heroin-related noncardiogenic pulmonary edema.

Track marks in a heroin intravenous drug user.Media file 2: Track marks in a heroin intravenous drug user.
Track marks in a heroin intravenous drug user.

Track marks in a heroin intravenous drug user.

Necrotizing fasciitis in a heroin user.Media file 3: Necrotizing fasciitis in a heroin user.
Necrotizing fasciitis in a heroin user.

Necrotizing fasciitis in a heroin user.

Endocarditis-related septic pulmonary emboli in a...Media file 4: Endocarditis-related septic pulmonary emboli in a heroin user.
Endocarditis-related septic pulmonary emboli in a...

Endocarditis-related septic pulmonary emboli in a heroin user.

More on Toxicity, Heroin

Overview: Toxicity, Heroin
Differential Diagnoses & Workup: Toxicity, Heroin
Treatment & Medication: Toxicity, Heroin
Follow-up: Toxicity, Heroin
Multimedia: Toxicity, Heroin
References

References

  1. National Institute for Drug Addiction (NIDA). Research on the Nature and Extent of Drug Use in the United States.

  2. Sporer KA, Dorn E. Heroin-related noncardiogenic pulmonary edema : a case series. Chest. Nov 2001;120(5):1628-32. [Medline].

  3. Atypical reactions associated with heroin use--five states, January-April 2005. MMWR Morb Mortal Wkly Rep. Aug 19 2005;54(32):793-6. [Medline].

  4. Bikell WH, Benar O. Life-threatening opioid toxicity. Prob Crit Care. 1987;1:106.

  5. Bryant WK, Galea S, Tracy M, et al. Overdose deaths attributed to methadone and heroin in New York City, 1990-1998. Addiction. Jul 2004;99(7):846-54. [Medline].

  6. Buajordet I, Naess AC, Jacobsen D, et al. Adverse events after naloxone treatment of episodes of suspected acute opioid overdose. Eur J Emerg Med. Feb 2004;11(1):19-23. [Medline].

  7. Coffin PO, Galea S, Ahern J, et al. Opiates, cocaine and alcohol combinations in accidental drug overdose deathsin New York City, 1990-98. Addiction. Jun 2003;98(6):739-47. [Medline].

  8. Darke S, Hall W, Weatherburn D, et al. Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug Alcohol Depend. Apr 1 1999;54(2):155-61. [Medline].

  9. Darke S, Zador D. Fatal heroin 'overdose': a review. Addiction. Dec 1996;91(12):1765-72. [Medline].

  10. Davidson PJ, McLean RL, Kral AH, et al. Fatal heroin-related overdose in San Francisco, 1997-2000: a case for targeted intervention. J Urban Health. Jun 2003;80(2):261-73. [Medline].

  11. Davoli M, Perucci CA, Forastiere F, et al. Risk factors for overdose mortality: a case-control study within a cohort ofintravenous drug users. Int J Epidemiol. Apr 1993;22(2):273-7. [Medline].

  12. Dietemann JL, Botelho C, Nogueira T, et al. [Imaging in acute toxic encephalopathy.]. J Neuroradiol. Sep 2004;31(4):313-26. [Medline].

  13. DOHMH. Investigation into Contaminated Heroin. New York City Department of Health and Mental Hygiene. 2005;Health Alert #6..

  14. Ellenhorn MJ. The Opiates. In: Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. Baltimore, Md: Lippincott, Williams & Wilkins; 1997:405-447.

  15. Gable RS. Comparison of acute lethal toxicity of commonly abused psychoactive substances. Addiction. Jun 2004;99(6):686-96. [Medline].

  16. Gaeta TJ, Capodano RJ, Spevack TA. Potential danger of nalmefene use in the emergency department. Ann Emerg Med. Jan 1997;29(1):193-4. [Medline].

  17. Garrick TM, Sheedy D, Abernethy J, et al. Heroin-related deaths in Sydney, Australia. How common are they?. Am J Addict. Spring 2000;9(2):172-8. [Medline].

  18. Gossop M, Griffiths P, Powis B, et al. Frequency of non-fatal heroin overdose: survey of heroin users recruited innon-clinical settings. BMJ. Aug 17 1996;313(7054):402. [Medline].

  19. Gupta R, Haydock T. Severe hypercapnia caused by acute heroin overdose. Ann Emerg Med. May 2004;43(5):665-6. [Medline].

  20. Gutstein HB, Akil H. Goodman, Gilman, eds. Opioid analgesics. The Pharmacological Basis of Therapeutics. Joel Gri: 2001:569-620.

  21. Handal KA, Schauben JL, Salamone FR. Naloxone. Ann Emerg Med. Jul 1983;12(7):438-45. [Medline].

  22. Hoffman JR, Schriger DL, Luo JS. The empiric use of naloxone in patients with altered mental status: a reappraisal. Ann Emerg Med. Mar 1991;20(3):246-52. [Medline].

  23. Hoffman RS, Goldfrank LR. The poisoned patient with altered consciousness. Controversies in the use of a 'coma cocktail'. JAMA. Aug 16 1995;274(7):562-9. [Medline].

  24. Howland MA. Opioid Antagonists. In: Goldfrank LR, Flomenbaum NR, eds. Goldfrank's Toxicologic Emergencies. New York. 8th. McGraw-Hill company Inc.; 2006:614-615.

  25. Hutchins KD, Pierre-Louis PJ, Zaretski L, et al. Heroin body packing: three fatal cases of intestinal perforation. J Forensic Sci. Jan 2000;45(1):42-7. [Medline].

  26. Infante F, Domínguez E, Trujillo D, et al. Metal contamination in illicit samples of heroin. J Forensic Sci. Jan 1999;44(1):110-3. [Medline].

  27. Lewis N. Opioids. In: Goldfrank LR, Flomenbaum NR, eds. Goldfrank's Toxicologic Emergencies. New York. 8. McGraw-Hill company Inc.; 2006:590-618.

  28. Longo MC, Henry-Edwards SM, Humeniuk RE, et al. Impact of the heroin 'drought' on patterns of drug use and drug-related harms. Drug Alcohol Rev. Jun 2004;23(2):143-50. [Medline].

  29. McCleave NR. Drug smuggling by body packers. Detection and removal of internally concealed drugs. Med J Aust. Dec 6-20 1993;159(11-12):750-4. [Medline].

  30. McLaughlin SA, Richards ME. Another perspective on "Severe hypercapnia caused by acute heroin overdose". Ann Emerg Med. Dec 2004;44(6):670-1; author reply 671-2. [Medline].

  31. Osterwalder JJ. Naloxone--for intoxications with intravenous heroin and heroin mixtures--harmless or hazardous? A prospective clinical study. J Toxicol Clin Toxicol. 1996;34(4):409-16. [Medline].

  32. Richards RG, Reed D, Cravey RH. Death from intravenously administered narcotics: a study of 114 cases;. J Forensic Sci. Jul 1976;21(3):467-82. [Medline].

  33. Ruttenber AJ, Kalter HD, Santinga P. The role of ethanol abuse in the etiology of heroin-related death. J Forensic Sci. Jul 1990;35(4):891-900. [Medline].

  34. Schauben JL. Opioids. In: Irwin RS, Cerra FB, Rippe JM, eds. Irwin and Rippe's Intensive Care Medicine. Baltimore, Md: Lippincott Williams & Wilkins; 1999:1744-1754.

  35. Schwartz JA, Koenigsberg MD. Naloxone-induced pulmonary edema. Ann Emerg Med. Nov 1987;16(11):1294-6. [Medline].

  36. Scopolamine poisoning among heroin users--New York City, Newark, Philadelphia, and Baltimore, 1995 and 1996. MMWR Morb Mortal Wkly Rep. Jun 7 1996;45(22):457-60. [Medline].

  37. Seaman SR, Brettle RP, Gore SM. Mortality from overdose among injecting drug users recently released from prison: database linkage study. BMJ. Feb 7 1998;316(7129):426-8. [Medline].

  38. Smith DA, Leake L, Loflin JR, et al. Is admission after intravenous heroin overdose necessary?. Ann Emerg Med. Nov 1992;21(11):1326-30. [Medline].

  39. Sporer KA. Acute heroin overdose. Ann Intern Med. Apr 6 1999;130(7):584-90. [Medline].

  40. Sporer KA, Firestone J, Isaacs SM. Out-of-hospital treatment of opioid overdoses in an urban setting. Acad Emerg Med. Jul 1996;3(7):660-7. [Medline].

  41. Steentoft A, Kringsholm B, Hansen AC, et al. [Fatal poisonings among drug addicts in Denmark in 2002]. Ugeskr Laeger. May 2 2005;167(18):1954-7. [Medline].

  42. Steentoft A, Worm K, Pedersen CB, et al. Drugs in blood samples from unconscious drug addicts after the intake of an overdose. Int J Legal Med. 1996;108(5):248-51. [Medline].

  43. Sterrett C, Brownfield J, Korn CS, et al. Patterns of presentation in heroin overdose resulting in pulmonary edema. Am J Emerg Med. Jan 2003;21(1):32-4. [Medline].

  44. US Department of Health and Human Services, Substance Abuse and Mental Health. Drug Abuse Warning Network 2003: Interim National Estimates of Drug-Related Emergency Department Visits. December, 2004.

  45. Utecht MJ, Stone AF, McCarron MM. Heroin body packers. J Emerg Med. Jan-Feb 1993;11(1):33-40. [Medline].

  46. Vilke GM, Buchanan J, Dunford JV, et al. Are heroin overdose deaths related to patient release after prehospital treatment with naloxone?. Prehosp Emerg Care. Jul-Sep 1999;3(3):183-6. [Medline].

  47. Washton AM, Resnick RB. Clonidine in opiate withdrawal: review and appraisal of clinical findings. Pharmacotherapy. Sep-Oct 1981;1(2):140-6. [Medline].

  48. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline].

  49. Watson WA, Litovitz TL, Rodgers GC Jr, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2005;23(5):589-666. [Medline].

  50. Wetli CV, Rao A, Rao VJ. Fatal heroin body packing. Am J Forensic Med Pathol. Sep 1997;18(3):312-8. [Medline].

  51. Wound botulism among black tar heroin users--Washington, 2003. MMWR Morb Mortal Wkly Rep. Sep 19 2003;52(37):885-6. [Medline].

  52. Wound botulism among black tar heroin users--Washington, 2003. MMWR Morb Mortal Wkly Rep. Sep 19 2003;52(37):885-6. [Medline].

  53. Zador D, Sunjic S, Darke S. Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances. Med J Aust. Feb 19 1996;164(4):204-7. [Medline].

Further Reading

Keywords

heroin toxicity, heroin, heroin poisoning, heroin overdose, heroin addiction, heroin use, heroin dependence, dope, smack, skag, junk, mud, shill, big H, horse, white stuff, brown sugar, black tar, Lady Jane, body stuffers, body packers, intravenous drug use, intravenous drug abusers, IVDA, skin-popping, diacetylmorphine, narcotic, mainlining, opioid

Contributor Information and Disclosures

Author

Rania Habal, MD, Assistant Professor, Department of Emergency Medicine, New York Medical College
Disclosure: Nothing to disclose.

Medical Editor

Laurie Robin Grier, MD, Medical Director of MICU, Associate Professor of Medicine, Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Science Center at Shreveport
Laurie Robin Grier, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Society for Parenteral and Enteral Nutrition, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Daniel R Ouellette, MD, FCCP, Associate Professor of Medicine, Wayne State University School of Medicine; Consulting Staff, Pulmonary Disease and Critical Care Medicine Service, Henry Ford Health System
Daniel R Ouellette, MD, FCCP is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Boehringer Ingleheim Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michael R Pinsky, MD, CM, FCCP, FCCM, Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology, Vice-Chair, Academic Affairs, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center
Michael R Pinsky, MD, CM, FCCP, FCCM is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American Heart Association, American Thoracic Society, Association of University Anesthetists, Shock Society, and Society of Critical Care Medicine
Disclosure: LiDCO Ltd Honoraria Consulting; iNTELOMED Intellectual property rights Board membership; Edwards Lifesciences Honoraria Consulting; Applied Physiology, Ltd Honoraria Consulting; Cheetah Medical Consulting fee Consulting

 
 
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