Possible mechanism for inhibition of morphine formation from 6-acetylmorphine after intake of street heroin

Andersson, Maria; Björkhem‐Bergman, Linda; Beck, Olof

doi:10.1016/j.forsciint.2015.05.002

Cited by 3 publications

(1 citation statement)

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“…Clinical manifestations and subsequent outcomes might depend on individual genetic or metabolic variations, heroin purity or dose, and the duration or intensity of prior long-term use . Unfortunately, the literature fails to consistently provide detailed reports regarding prognosis, outcomes (eTables 1 and 2 in the Supplement and Figure 4), and cause of death (CTD related vs withdrawal of support vs others).…”

Section: Methodsmentioning

confidence: 99%

The Emerging Role of Inhaled Heroin in the Opioid Epidemic

et al. 2018

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IMPORTANCE Opioid addiction affects approximately 2.4 million Americans. Nearly 1 million individuals, including a growing subset of 21 000 minors, abuse heroin. Its annual cost within the United States amounts to $51 billion. Inhaled heroin use represents a global phenomenon and is approaching epidemic levels east of the Mississippi River as well as among urban youth. Chasing the dragon (CTD) by heating heroin and inhaling its fumes is particularly concerning, because this method of heroin usage has greater availability, greater ease of administration, and impressive intensity of subjective experience (high) compared with sniffing or snorting, although it also has a safer infectious profile compared with heroin injection. This is relevant owing to peculiar and often catastrophic brain complications. Following the American Medical Association Opioid Task Force mandate, we contribute a description of the pharmacology, pathophysiology, clinical spectrum, neuroimaging, and neuropathology of CTD leukoencephalopathy, as distinct from other heroin abuse modalities.OBSERVATIONS The unique spectrum of CTD-associated health outcomes includes an aggressive toxic leukoencephalopathy with pathognomonic neuropathologic features, along with sporadic instances of movement disorders and hydrocephalus. Clinical CTD severity is predominantly moderate at admission, frequently unmodified at discharge, and largely improved in the long term. Mild cases survive with minor sequelae, while moderate to severe presentations might deteriorate and progress to death. Other methods of heroin use may complicate with stroke, seizure, obstructive hydrocephalus, and (uncharacteristically) leukoencephalopathy. CONCLUSIONS AND RELEVANCEThe distinct pharmacology of CTD correlates with its specific clinical and radiological features and prompts grave concern for potential morbidity and long-term disability costs. Proposed diagnostic criteria and standardized reporting would ameliorate the limitations of CTD literature and facilitate patient selection for a coenzyme Q10 therapeutic trial.

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