Health - trying find out what cut causes leukoencephalopathy

[drug-bot]

toxic leukoencephalopathy is a disease which effects the brain (it progressivly causes damage to the white matter of the brain, which is devoted to our higher function) , symptoms of the disease progress to include mental deterioration, vision loss, speech difficulty, loss of coordination, paralysis, and, ultimately, coma and even death in as many as 25% of those with the disease.

among heroin users its is a concern among heroin smoker only, because injectors and snotors dont take in the drug while its hots. it is not caused by heroin or the aluminum its most often smoked on, but is believed to be caused by some rare cut. swim doesnt have the answer but is speculting what this cut could be and in courages others to do the same, this is VERY important for harm reduction reasons, 1/4th the people with this will die, sense not many people get this like swim stated earlier it has to be a very rare cut.

drugs which cause this, not heroin users, are cytarabine fludarabine, carmustine and fluorourcil in conjuntion with levamisole, these are all cancer meds. could a dealer cut their heroin with these (by crushing them up), it would be very rare, but so is leukoencephalopathy among heroin smokers. methotrexate also causes it, methotrexate can also cause it, it used to be an anti-cancer dug like the others i mentioned but is also used to treat a number of auto-immune diseases.

some toxins that cause white matter (white matter toxins) damage could potenially also cause it, though swim couldnt find much info on what toxins cause it other than cyanide and carbon-monoxide. could some unscrupulus dealer cut it with this, possibly if there dumb or evil.

other than white matter toxins, enviomental toxins also could, such as lead, and aspartic acid, theres a ton of others swim cant find info on. but swim doesnt know if they meet the criteria for causing toxic leukoencephalopathy in heroin smokers.


does anyone else have any idea what adulterant causes toxic leukoencephalopathy in heroin smokers?

so even though its very rare, heroin smokers might think about purifying there heroin before smoking it. be safe.

Reputation Comments on this post:

Good question

[fiveleggedrat]

Swim has never met a H user (he's met lots) who did anything but throw it in the cap/spoon the second they got it.

He wishes they would purify it.

Swim will do some research, he would like to know this too. Swim smokes lots of random substances, so this has at least a little relevance.

[drug-bot]

Originally Posted by fiveleggedrat

Swim has never met a H user (he's met lots) who did anything but throw it in the cap/spoon the second they got it.

only smoking cause toxic leukoencephalopathy (in heroin smokers it must only happen cause the rare cut that causes it is only activated when injested when its still hot), because injectors let the stuff cool down before they inject, and snorters dont have to worry about it, its strictly a smokers problem.

Originally Posted by fiveleggedrat

Swim will do some research,.

thank you. in swim opinion its very important for harm reduction.

[fiveleggedrat]

Never met a smoker.

And harm reduction is very important to Swim! When he isn't suffering from sleep deprivation, he'll try to help.

Lol all Swim can manage are quick posts like this at the moment while preparing something.

[drug-bot]

apparently chemotherapy can also cause toxic leukoencephalopathy , dont see the relevance to heroin smokers and this mytery adulterant. but some meds given to cancer patients also can as swim mentioned in an earlier post. swims been reading hours online trying to find clues but is pretty much empty handed. swim guesses it could be caused from a variety of adulterants not nessarcarilly one so its possible some h smokers got it from

cytarabine fludarabine, carmustine and fluorourcil in conjuntion with levamisole

^all cancer meds ground into some dope, as well as some getting it from enviormental toxins and toxins that destroy white brain matter used as a cut, so swims kinda back at square 1. toxic leukoencephalopathy is so rare in heroin smokers its most likely comes from several extremly rare adulterants (cuts). swim supposes he's in for alot more reading, and if he finds anything relevant he'll post it.


even though its very, very rare to get toxic leukoencephalopathy from smoking heroin ,swim suggests purifying your dope first (or take it in a different manner), just to be on the safe side.

[china cat]

swim has heard about this before. swim smokes an awful lot of heroin and is praying that his brain doesn't start dribbling out of his ears........its going to be very difficult to find out what cut causes this for obvious reasons......i can't imagine any expensive research being carried out....by the time the symptons of the disease appear all traces of the heroin cut that caused it will be long gone.

Is any research being carried out?

Swim can't think of any simple way to purify heroin before smoking. If anyone knows of any methods swim would love to hear them.

[drug-bot]

Originally Posted by china cat

swim has heard about this before. swim smokes an awful lot of heroin and is praying that his brain doesn't start dribbling out of his ears........its going to be very difficult to find out what cut causes this for obvious reasons......i can't imagine any expensive research being carried out....by the time the symptons of the disease appear all traces of the heroin cut that caused it will be long gone.

Is any research being carried out?

Swim can't think of any simple way to purify heroin before smoking. If anyone knows of any methods swim would love to hear them.

swim agree's serious research into its cause isnt likely to happen because of expense and the rarity of the disease.

this thread has 2 methods to purify street heroin- http://www.drugs-forum.com/forum/sho...rifying+heroin

[jon-q]

[quote=drug-bot;462021]swim agree's serious research into its cause isnt likely to happen.
swim has looked into this many years ago when he switched from iv`to smoking,it was quite a big scare story in the late 90`and as well as the obvious problems with switching i had to give serious thought to the whole "leukoencephalopathy" debate.There has been extensive research in to
this disease most notibly in holland in the early ninteys and as you are well aware they all drew a blank.personaly im not sold on the"its something that only reacts when hot debate"for this to happen the suspect chemical would have to change its structure when heated then change back on cooling,whilst this is quite possible i think the boffins would have soon nailed that little sucker down.also while most users allow there soup to cool down not all do.i would offer up for debate that it is the persons genetic make up that is the real factor in deciding who gets the disease,then maybe it could only be ingested through the lungs.
as for the cut it could be in any or even all cuts it might even be the smack,reacting with the.....time for bed me thinks.

Reputation Comments on this post:

good post

[chinpokomaster]

SWIM has smoked heroin on and off for about 20 months now and has slowly developed visual hallucinations, mild speech slurring, memory loss, pains, depression and a feeling of slight personality change. Everything SWIM sees has a glow around it and when things move, the glow forms a trail and takes time to catch up with the moving object.

Now, he's taken a 3 week break in the time since the hallucinations have been bad and it did seem to be making it better, but he went back to using again. Last thursday SWIM began a concerted effort to give up all drugs in order to try getting his head straight again. The symptoms persist and SWIM goes to the doctor's on friday morning expecting to be sent for a brain scan. A blood test minimum.

SWIM doesn't like to attribute things to coincidence and believes he has developed leukoencephalopathy, which he hopes will prove reversible, if it is. SWIM will keep the users of DF updated with his progress.

[helene]

There's a few threads on this subject already in existence, have a look, hopefully they may be able to add something useful:

http://www.drugs-forum.com/forum/showthread.php?t=74554

http://www.drugs-forum.com/forum/showthread.php?t=36658

http://www.drugs-forum.com/forum/showthread.php?t=443

H

[chinpokomaster]

Yup. Saw them. Thanks all the same! I just thought I'd post in the thread marked health.

[Spucky]

[top] Chasing the dragon - neurological toxicity associated with inhalation of heroin vapour: case report

Michael D. Hill*, Perry W. Cooper and James R. Perry* From the Divisions of *Neurology and Neuroradiology, Sunnybrook and Women's College Health Sciences Centre, Sunnybrook Site, Toronto, Ont.
Case
A 33-year-old white man was admitted to a Toronto hospital after being found in an unresponsive state by his sister. He was a known drug abuser and had a history of heroin and cocaine use. It was known that he took his heroin not by injection but by inhalation of heated heroin vapours, a method known as "chasing the dragon." He had last been seen well 3 days previously and had spent the intervening period in bed for unknown reasons.

The patient was intubated at the scene by paramedics and had a Glasgow coma score of 6 upon admission. He was tachypneic (38 breaths/min) but hemodynamically stable, with blood pressure of 150/95 mm Hg, normal sinus rhythm and temperature of 38°C. Neurological examination revealed that he was comatose, unresponsive to verbal or painful stimuli. His pupils were both 4 mm in diameter and reactive, and the fundi were normal. Eye movements were conjugate but roving. Corneal reflexes were present bilaterally. The face was symmetric. The breathing pattern was fast but regular. Motor examination revealed axial myoclonus involving the neck flexors, the pectoral muscles and the abdominal musculature. The patient was diffusely hypotonic, and the limbs withdrew symmetrically on painful stimuli. Reflexes were 1+ throughout, but bilateral Babinski signs were present. General examination revealed no cardiac murmurs, a clear chest and normal abdomen. No needle marks were seen.

Head CT revealed bilateral hypoattenuated regions in the pallidum. Brain MRI demonstrated diffusely abnormal areas of increased T2 signal intensity involving the deep white matter of both cerebral hemispheres and the cerebellum (Fig. 1). Magnetic resonance angiography demonstrated normal proximal cerebral circulation. Electroencephalography demonstrated diffuse bilateral moderate-voltage theta and delta activity without epileptiform abnormalities. Carbon monoxide was undetectable in the serum. Lumbar puncture showed entirely normal cerebrospinal fluid indices. Chest radiography revealed no pulmonary disease. Creatine kinase was significantly elevated, to 32 930 U/L, with no myoglobinuria. The result of HIV serologic testing was negative. The heroin metabolites O6-monoacetylmorphine and morphine were present in the urine.1 Results of tests for cocaine metabolites and other toxic agents were negative.

he patient recovered only minimally over the ensuing 3 weeks. He died of Staphylococcus aureus pneumonia and septicemia on day 26 of admission, having never regained consciousness. No autopsy was performed.

Comments
Toxin-related diseases of the brain are uncommon. When such toxins affect predominantly the white matter, these diseases are known as toxic leukoencephalopathies. These conditions are rare but often reversible if exposure to the toxic agent is discontinued. Heroin leukoencephalopathy is associated with an estimated mortality rate of 23%.2 It is rare or unrecognized but has devastating consequences.

Heroin-associated death may be related to acute overdose of high-dose or pure ("Chinese white") heroin, complications of intravenous drug use such as infection with HIV or hepatitis C, violence or other causes. Heroin was a popular drug in the late 1960s and early 1970s;3 its use declined subsequently but is now making a resurgence. Although a lifetime prevalence of heroin use is reported in only 0.5% of the Canadian population, heroin use has been increasing in Toronto, Montreal and Calgary and is best documented in Vancouver.4 Recent editorials have focused on the need both for increased awareness and for clinical trials of methadone for treating heroin addicts.5-7 Heroin abuse has been growing in Canada and, combined with cocaine abuse, was the leading cause of death in men 30 to 44 years of age in 1993 in British Columbia.7

The neurological complications of heroin use are probably caused by both the drug itself and the method of administration. Heroin addicts experience illnesses affecting all parts of the neuraxis including brain abscess,8 transverse myelitis,9 neuropathy10,11 and rhabdomyolysis with myoglobinuria.12,13
A new addition to this list, heroin vapour leukoencephalopathy, was first reported in 1982 from Amsterdam.2 Since then, cases have been reported sporadically from both Europe and the United States.14,15 To date, fewer than 100 cases have been reported. Although heroin is commonly taken by injection, it may also be taken by inhalation of heated vapours. Users heat the powder on aluminum foil and inhale the smoke. This practice is known as "chasing the dragon," "chinesing" or "chinese blowing."

Thorough investigation of the original cohort of 47 patients from Amsterdam, including autopsy for 10 of them, toxicologic analysis of heroin samples, investigation of unaffected heroin addicts and testing of the effects of heroin vapour in animal models, failed to find a toxicologic cause of the leukoencephalopathy.2 The autopsies revealed severe changes in the white matter, termed vaculoating myelinopathy; this lesion was characterized by formation of vacuoles in the oligodendroglia, resulting in spongiform degeneration. Although several additive substances were discovered in the heroin samples, none were known or shown to produce the histopathological changes in the rat or the rabbit model. The authors speculated that an as-yet-unidentified toxic substance is released when heroin is heated.2

One case involving a similar vacuolating myelinopathy of the brain was reported in association with intravenous heroin overdose.16 Similarly, one case of delayed spongiform leukoencephalopathy has been reported after multidrug overdose, but heroin was not implicated;17 the authors attributed their findings to cocaine. Perez and associates18 reported a case of acute leukoencephalopathy isolated to the cerebellum in the 2 1/2-year-old child of a heroin addict; the child's gastric contents, urine and delayed hair samples contained heroin. Therefore, inhalation of heroin pyrolysate may not be the sole way of acquiring this toxic leukoencephalopathy.

Anoxia may cause acute leukoencephalopathy. Ginsberg and colleagues19 first described the pathology of anoxic leukoencephalopathy, postulating that the lack of anastamoses in the arterial supply to the cerebral deep white matter promotes susceptibility to infarction. The case reported here had many parallels to the first of the 35 cases described by Ginsberg and colleagues;19 both showed bilateral pallidal infarcts and diffuse spongiform white matter disease associated with heroin overdose. In contrast, none of the original Amsterdam cohort' and none of the other cases described by Ginsberg and colleagues19 had pallidal infarction.

The pallidum may be acutely sensitive to metabolic stress. Bilateral pallidal lesions are often seen in carbon monoxide poisoning but are also reported in drowning, strangulation and thyroid storm.20-24 We speculate that in severe cases, the toxic effects of heroin vapour may result in both pallidal lesions and spongiform leukoencephalopathy.

We wonder whether some drug addicts take heroin by inhalation to avoid the well-advertised dangers of injection drug use. It is uncertain whether leukoencephalopathy due to heroin vapour inhalation is rare, perhaps due to a sporadic toxin introduced during production, or more common and unrecognized. In otherwise undiagnosed acute leukoencephalopathy, clinicians should consider the possibility of heroin vapour inhalation.
Competing interests: None declared.

Footnotes
This article has been peer reviewed.
Reprint requests to: Dr. Michael D. Hill, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Rm. MRG 005, 1403 29th St. NW, Calgary AB T2N 2T9

References

1. Fehn J, Megges G. Detection of O6-monoacetlymorphine in urine samples by GC/MS as evidence for heroin use. J Anal Toxicol 1985;9:134-8.[Medline]
2. Wolters EC, van Wijngaarden GK, Stam FC, Rengelink H, Lousberg RJ, Schipper MEI, et al. Leucoencephalopathy after inhaling "heroin" pyrolysate. Lancet 1982;2(83 10):1233-7.[Medline]
3. DuPont RL. Profile of a heroin-addiction epidemic. N Engl J Med 1971;285:320-4.
4. Poulin C, Fralick P, Whynot EM, el-Ghuebaly N, Kennedy D, Bernstein J, et al. The epidemiology of cocaine and opiate abuse in urban Canada. Can J Public Health 1998;89:234-7.[Medline]
5. Fischer B, Rehm J. The case for a heroin substitution treatment trial in Canada. Can J Public Health 1997;88:367-70.[Medline]
6. De Burger R. Heroin substitution in Canada: A necessary public health intervention? [editorial]. Can J Public Health 1997;88:365.[Medline]
7. Brands B, Marsh DC. Methadone maintenance treatment: a Canadian perspective [editorial]. CMAJ 1997;157:399-401.[Medline]
8. Hershewe GL, Davis LE, Bicknell JM. Primary cerebellar brain abscess from nocardiosis in a heroin addict. Neurology 1988;38:1655-6.[Free Full Text]
9. Richter RW, Rosenberg RN. Transverse myelitis associated with heroin addiction. JAMA 1968;206:1255-7.[Abstract/Free Full Text]
10. Loizou LA, Boddie HG. Polyradiculoneuropathy associated with heroin abuse. J Neurol Neurosurg Psychiatry 1978;41:855-7.[Abstract/Free Full Text]
11. Amueilaph R, Boonigird P, Leechawengwongs M, Vejjajiva A. Heroin neuropathy [letter]. Lancet 1973;818:1517-8.
12. De Gans J, Stam J, van Wijngaarden GK. Rhabdomyolysis and concomitant neurological lesions after intravenous heroin abuse. J Neurol Neurosurg Psychiatry 1985;48:1057-9.[Abstract/Free Full Text]
13. Schreiber SN, Liebowitz MR, Bernstein LH, Srinivasan K. Limb compression and renal impairment (crush syndrome) complicating narcotic overdose. N Engl J Med 1971;284:368-9.
14. Tan TP, Algra PR, Valk J, Wolters EC. Toxic leukoencephalopathy after inhalation of poisoned heroin: MR findings. AJNR Am J Neuroradiol 1994;15:175-8.[Abstract]
15. Kriegstein AR, Armitage BA, Kim PY. Heroin inhalation and progressive spongiform leukoencephalopathy [letter]. N Engl J Med 1997;336:589-90.[Free Full Text]
16. Rizzuto N, Morbin M, Ferrari S, Cavallaro T, Sparaco M, Boso G, et al. Delayed spongiform leukoencephalopathy after heroin abuse. Acta Neuropathol (Berl) 1997;94:87-90.
17. Nuytten D, Wyffels E, Michiels K, Ferrante M, Verbraiken H, Dailemans R, et al. Drug-induced spongiform leucoencephalopathy, a case report with review of the literature. Acta Neurol Belg 1998;98:32-5.[Medline]
18. Perez ER, Maeder P, Riovier L, Deonna T. Toxic leukoencephalopathy after heroin ingestion in a 2.5 year old child [letter]. Lancet 1992;340:729.
19. Ginsberg M, Hedley-Whyte T, Richardson EP. Hypoxic-ischemic leukoencephalopathy in man. Arch Neurol 1976;33:5-14.[Abstract/Free Full Text]
20. Schwartz A, Hennerici MD, Wegener OH. Delayed choreoathetosis following acute carbon monoxide poisoning. Neurology 1985;35:98-9.[Abstract/Free Full Text]
21. Choi IS. Delayed neurological sequelae in carbon monoxide intoxication. Arch Neurol 1983;40:433-5.[Abstract/Free Full Text]
22. Murray RR, Kapila A, Blanco E, Kagen-Hallet KS. Cerebral computed tomography in drowning victims. AJNR Am J Neuroradiol 1984;5:177-9.[Abstract]
23. Hori A, Hirose G, Kataoka S, Tsukada K, Furui K, Tonari H. Delayed post anoxic encephalopathy after strangulation: serial neuroradiological and neurochemical studies. Arch Neurol 1991;48:871-4.[Abstract/Free Full Text]
24. Page SR, Scott AR. Thyroid storm in a young woman resulting in bilateral basal ganglia infarction. Postgrad Med J 1993;69:813-5.[Abstract/Free Full Text]

source: http://www.cmaj.ca/cgi/content/full/162/2/236

Have a better look also here:
http://bjr.birjournals.org/cgi/content/full/78/935/997

Reputation Comments on this post:

Excellent, excellent resource and wealth of information in this post regarding the topic on hand

[Sniffin Sunshine]

cyanide was mentioned earlier. swim knows this sounds crazy, but in a bust of a big deler in swims area, it was said that he was cutting his dope wih small amounts of cyanide. sounds fxing evil, i know and swim wishes she has more information on this or an actual source, but this was a long time ago, and she cannot back it up, she just remembers hearing about it. no one swim knew ever smoked their dope though