Heroin overdoses

[cz-one]

I've been looking up info. on heroin overdoses including coroners inquests reports and noticed a phenomenen that often goes unreported, and thats of experienced heroin users buying from the same person they normally do,taking the usual amount in their fix and then dropping dead,often with syringe still in-situ,and when the heroins been analysed, its not cut with anything deadly,or any stronger than normal,and sometimes a group of 4 or 5 have all bought the same stuff,yet only 1 has died.Even stranger there are no signs of anatomical pathologies that might cause sudden deaths,yet they just seem to have it and die suddenly. That girl here in the UK who's picture was all over the papers,pictured dead in her bedsit,still clutching her syringe was an example of one of these sudden deaths,and they seem to be occurring more and more,to the point that forensic pathologists actually term it as a syndrome in its own right. Have any others heard about this?is it just the UK or is it woldwide?

[MrJim]

There is actually a discussion in Psychology which deals with the situational familiarity of an injection site. The theory is that once a place is a familiar shooting up site it mentally makes up part of the drugs tolerance in the brain. For example - A person is up to a a third of a gram per injection. They always shoot up in the same place (say the hotel room). Then they take the same dope and the same amount but can't get to their room. So they shoot up in an unfamiliar place, and it is the mental freshness of the place which contributes to the overdose. I'll have to look up he official definition of this phenomena - It's name evades me right now.

[zera]

Abstract
The current paper examines critically the literature on deaths attributed to heroin overdose, and examines the characteristics and circumstances of such deaths. In particular, the dominance of the widely held belief that heroin-related fatalities are a consequence of overdose is challenged. Deaths attributed to overdose represented in the literature are typically older, heroin-dependent males not in drug treatment at the time of death. Fatalities involving only heroin appear to form a minority of overdose occasions, the presence of other drugs (primarily central nervous system depressants such as alcohol and benzodiazepines) being commonly detected at autopsy. Furthermore, deaths attributed to overdose are likely to have morphine levels no higher than those who survive, or heroin users who die from other causes. It is concluded that the term overdose is, in many cases, a misleading term, since it implies the same mechanism of death in all cases, an implication that is neither clinically useful nor consistent with published data. Implications for the prevention of heroin-related deaths are discussed.

http://www.drugpolicy.org/library/darke2.cfm


Sounds like this phenomenoh is explained by those people having some other drug in their system at the time of death. Also I thought I remember reading somewhere before that most heroin overdoses were actually due to water in the lungs, which is caused by quinine, a popular cutting agent, rather than any opiate related activity.

Reputation Comments on this post:

Good information on this topic with backup source

[Forthesevenlakes]

Hm, never heard of the quinine theory before, quinine could theoretically used to increase absorption of drugs across the blood brain barrier, so if it is in cuts, it could help more heroin than one thinks to cross into the brain and trigger an overdose.

SWIM has read (on wikipedia?) that most overdoses, are indeed a combination of drugs, usually alcohol or benzodiazepines. However, the net result is the same for all cases: the person is dead. SWIM is guessing that even in cases of drug mixtures, the mechanism of death is similar to that of heroin alone, a depressed respiratory system, so one basically stops breathing.

SWIM is going to check out this article though, and Zera, if you get the chance could you upload it to the file archive here?


MrJim, the phenomenon you mention is a pretty well-established one in psychology known as "situational tolerance". It operates as you described, where taking many types of drugs in a similar situation repeatedly will create a tolerance that is activated as soon as the person walks into the room where they normally use. Thus, a higher amount of drug would be needed to overcome the situational tolerance. If someone uses the same "normal" amount of drug in a novel situation, the body does not activate this tolerance mechanism, and the person can OD. This has been demonstrated with various drugs, but for whatever reason its effect is most prominent with opiates/opioids.

Interestingly, the environment in which a drug is taken can also mediate cravings and withdrawal symptoms. Withdrawal has been said to be worse if it's done in a place where one would normally use, and similarly, cravings can be activated quite profoundly just by walking into a room where one used to normally use.

Another theory which was a distugring trend in the U.S. last year was the sale of fentanyl disguised as heroin. Fentanyl is much more potent than heroin, so a person would prep what seemed like an average shot, but then end up ODing due to the extreme potency of fentanyl. However, SWIM guesses that one could probably detect the difference in the forensic examination, since structurally they look a bit different. SWIM does think, though, that if there was a little bit of heroin in the shot, and a small amount of fentanyl, perhaps the levels of fentanyl in these cases are so minute as to be barely detectable by a pathologist, and the death would be attributed to heroin alone when this is not actually the case.

[cz-one]

As i said,when analysed,the heroins of the usual purity and not cut with anything dangerous,and the persons usually a long-term user and had been using the same stuff from the same dealer every day with no problems. The mode of death seems to be an arrythmia,and not the characteristic pulmonary oedema(waterlogged lungs)normally seen with heroin od's. One suggestion i heard,was that the user had maybe not had anything for a few days and so the anticipation,coupled with withdrawals,and then an iv injection sends the heart into an abnormal rhythm,which in a chronic user with maybe an impaired system,proves fatal,and so it seems to be recognised all over.Scary!!