From: Marnie Regen Subject: NYC ALERT- leukoencephalopathy Date: 1996/11/30 newsgroups: alt.drugs.hard,talk.politics.drugs From: "Jones, T. Steve" Subject: leukoencephalopathy after inhalation of heroin vapor - NYC Date: Fri, 29 Nov 96 15:43:00 EST >Frank McCorry of the NY state Off of Alcoholism and Substance Abuse (OASAS) >called to report 3 cases in NYC of acute neurologic disease among persons >who have inhaled heroin vapor (sometimes called "chasing the dragon") > >the three users are being cared for by Dr. Arnold Kriegstein of Columbia >Presbyterian Hospital (212) 305-4275 > >Background: Starting in 1982, there have been reports of leukoencephalopathy >after inhaling heroin vapor (see below and attachment). These reports >particularly come from Europe (the Netherlands) and may relate to the more >frequent use of "chasing the dragon" in Europe. Some of the cases are fatal >(possibly 25%). The clinical presentation include early manifestations of >slurred speech and "a wobbly gait." Later signs include inability to speak >and paralysis. A NYC alert on these cases states that clinical illness may >take as long as two weeks to develop. > >"chasing the dragon" - carried out by placing heroin [usually heroin base >rather than heroin hydrochloride] in creased aluminum foil and heating the >foil so that the heroin vaporizes. The vapor is then inhaled, sometimes >(?often) using a tube. the term "chasing the dragon" is used because the >vapor might be likened to the fire and smoke of a dragon. > >In NYC, non-injection use of heroin is apparently substantial. The high >purity heroin available in NYC is either "snorted" or inhaled as a vapor by >"chasing the dragon" > >Possible poisoning - some of the reports raise the possibility that there is >a poison in the heroin that acts as an acute neuroligic toxin that causes >the spongiform degeneration of the white matter of the central nervous >system. Some suspicion of a toxic "pyrolysate" from the aluminum foil has >been released by the heating. To date no poison or toxin has been >identified. > >This report is passed along for your information. > >If you know of additional cases in NY please call OASAS at 212-961-8501 > >steve jones > >=========== > > >1) Wolters EC. van Wijngaarden GK. Stam FC. Rengelink H. Lousberg RJ. >Schipper ME. Verbeeten B. Leucoencephalopathy after inhaling "heroin" >pyrolysate. Lancet. 2(8310):1233-7, 1982 Dec 4. > >Abstract >47 patients with spongiform leucoencephalopathy but no other consistent >abnormalities, except brown pigmentation of the alveolar macrophages in the >lungs, are described. 11 patients have died. Epidemiological studies >indicate at the cause of the illness the inhalatory use of poisoned heroin >vapours (pyrolysate). The heroin is primarily sold on the black market in >Amsterdam. The Netherlands. Over 170 suspect heroin samples were collected >for analysis of the possible poisonous factor. Although suspect, none of the >samples could be unambiguously related to the observed illness. Chemical, >toxicological, and histopathological investigations have not so far revealed >the nature of the poisonous factor, but several neurotoxic agents that are >known to cause comparable leucoencephalopathies have been ruled out. This >appears to be the first manifestation of the poisonous potential of the >unknown causative factor. > >2)Schiffer D. Brignolio F. Giordana MT. Mongini T. Migheli A. Palmucci >L. Spongiform encephalopathy in addicts inhaling pre-heated heroin. >Clinical Neuropathology. 4(4):174-80, 1985 Jul-Aug. > >Abstract >Three subjects, inhaling pre-heated heroin, developed a severe neurological >illness. The neuropathological examination at autopsy on two of them >demonstrated that it was due to a spongiform encephalopathy. By light and >electron microscopy a severe edema with spongiosa and myelin damage were >evident. U-fibers, brainstem, spinal cord and peripheral nerves were spared. >The origin of the encephalopathy was not identified. The encephalopathy of >our cases is similar to that described by Wolters et al. in 1982 in Holland. > >3) Sempere AP. Posada I. Ramo C. Cabello A. Spongiform >leucoencephalopathy after inhaling heroin [letter] [see comments]. Lancet. > 338(8762):320, 1991 Aug 3. > >4) Roulet Perez E. Maeder P. Rivier L. Deonna T. Toxic >leucoencephalopathy after heroin ingestion in a 2 1/2-year-old child > [letter; comment]. Lancet. 340(8821):729, 1992 Sep 19. > >5) Tan TP, Algra PR, Valk J, Wolters EC. Toxic leukoencephalopathy after >inhalation of poisoned heroin: MR findings. ?Am J of >NeuroRadiology?1994;15:175-178. > >Summary: >Retrospective MR studies of four patients with neurologic symptoms after >inhalation of contaminated heroin vapor revealed extensive, typically >symmetical lesions in the white matter of the cerebrum, cerebellum, and >midbrain. Selective involvement of the corticospinal tract, the solitary >tract, and the lemniscus medialis also has been found. ==================================================================== From: Marnie Regen Subject: More on NYC leukoencephalopathy Date: 1996/12/01 newsgroups: alt.drugs.hard New York Times December 1, 1996 View That Smoking Heroin Is Safer Than Injecting Is Questioned By CHRISTOPHER S. WREN NEW YORK -- Heroin users call it "chasing the dragon," a fanciful euphemism for inhaling burning heroin fumes in a ritual evocative of Asian opium dens. Some drug counselors who want to reduce the harm that addicts cause themselves have urged them to smoke heroin rather than inject it, to avoid contracting AIDS and other diseases from contaminated needles. The higher purity of heroin sold on the street has also led more users who fear overdosing from an injection to smoke or snort the drug instead. But new evidence suggests that chasing the dragon has its own hazards. The New York state Office of Alcoholism and Substance Abuse Services has prepared a memorandum to alert health agencies and drug treatment programs to the link between heroin smoking and an incurable neurological condition that can rob users of muscle coordination and speech, and if untreated can lead to paralysis and death. Dr. Arnold R. Kriegstein, a neurologist at the Columbia University Medical Center, sounded the alarm after treating a Greenwich Village musician and his girlfriend whose coordination, gait and speech deteriorated after they smoked heroin. According to Kriegstein, who has since diagnosed a third case in a friend of the couple, the degeneration can be arrested but has no cure. The medical condition, called leukoencephalopathy, affects the part of the brain that controls motor skills. The disease takes at least two weeks to manifest itself, with a progressive loss of muscle coordination, a condition called ataxia. Afflicted heroin users become clumsy, their speech slurs and they wobble when they walk. "They may not be able to coordinate muscles to perform everyday functions, let alone functions that demand a degree of skill or training such as playing a musical instrument," the memorandum reported. Without treatment, it said, they can lose the ability to talk, become paralyzed and die. Kriegstein, an associate professor of neurology at Columbia's College of Physicians and Surgeons, said the heroin seemed to turn toxic when heated, and that the same degeneration had not been seen in people who injected or snorted the drug. "So it's unique to chasing the dragon," he said. The technique involves burning heroin in a pocket of metal foil and breathing the fumes. Some medical researchers suspect that the heroin is contaminated by the foil, which can disintegrate from the intense heat. But the exact cause is not known, Kriegstein said, "and if nobody knows, it's hard to be sanguine" about the prospects for recovery. Dr. Herbert Kleber, the medical director of the National Center on Addiction an Substance Abuse, said he was unfamiliar with the latest cases, but observed that contaminants in heroin could trigger adverse reactions. Because other heroin users also use foil, Kleber said, "I would wonder more about the source of the heroin." In any case, Kleber said, snorting is more common among heroin users in New York than smoking the drug. The afflicted couple are a 40-year-old drummer and a 21-year-old woman who lived with him in the East Village, Kriegstein said. He said the drummer used cocaine and heroin for 10 years, quit for 5 years and started smoking heroin 6 months ago. He introduced his girlfriend to heroin smoking as a way of avoiding AIDS, the doctor said. The woman, who admitted smoking four or five bags of heroin a day, entered a local hospital in October. When she was transferred to Columbia Medical Center, Kriegstein said, she could no longer talk, walk, stand or even sit unaided. She has now recovered some speech and is undergoing physical rehabilitation. Though her boyfriend smoked less heroin, his speech became slurred and he bumped into things, Kriegstein said, and his coordination deteriorated so badly that he could not work as a drummer. A musician f riend of the couple whom Kriegstein also treated developed problems moving after he smoked the same batch of heroin. He had showed a less drastic reaction when examined, Kriegstein said, because he had stopped using the drug for a month. He is now being treated on an out-patient basis, Kriegstein said. While the three cases in New York City appear to be the first reported in the United States, Kriegstein said that the degenerative disease was diagnosed among heroin smokers in Amsterdam in 1982. Of 47 cases traced there, he said, 11 ended in death. Other cases have been reported in Italy, Norway and Spain. Kriegstein said he suspected that there were more unreported cases among heroin smokers in New York and that some addicts who tested positive for AIDS might have been misdiagnosed as dying from that disease. Allen Clear, the executive director of the Harm Reduction Coalition, which represents needle-exchange clinics and related groups around the country, speculated in an interview that the illness might have been caused by toxic substances added to the heroin to dilute it for street sale. Earlier this year, the Lower East Side Needle Exchange in Manhattan distributed a leaflet to drug users promoting the advantages of smoking heroin over injecting it. But Mark Gerse, the exchange director, said in a interview that the leaflet was no longer being distributed until the situation became clearer. The reported cases of leukoencephalopathy were "very isolated," he said, and no one knew the brand name under which the heroin had been sold. "We just want to see what's going on right now," Gerse said. --- ==================================================================== From: bbs@a.cannon (Samson) Subject: Re: smoking off of tinfoill (was Re: QUESTION: Snorting or smoking heroin?) Date: 1997/04/15 Newsgroups: alt.drugs.hard > >> don't smoke it on aluminum you could end up with paralysis or > >>worse....the aluminum fumes are toxic. > > > >Please quote a verifiable source, ... > > hasn't a change in aluminium levels in the body been associated with the > onset of alzheimers?.... Accchhh! Go to Medline, go to a library, go somewhere. With no exceptions that I know of, all of the outbreaks of leukoencephalopathy from smoked heroin have been isolated and linkable to single batches of dope. All the evidence points to its being something in the dope, not the aluminum. Not that this is very reassuring. But you may watch others chase their stash and see if they drop dead. If they do, it's bad stuff.