Kriegstein AR, Armitage BA, Kim PY. The New England Journal of Medicine 1991 336(8): 591-592.

The authors report on two cases of a previously unreported progressive spongiform leukoenceph-alopathy occurring after repeated inhalation of heated heroin vapor. Both patients, a 21-year-old woman and a 40 year old man had been "chasing the dragon" for six months and two weeks respectively. The first patient experienced progressive bradykinesia, ataxia, and slurred speech developing over a two-week period. Over the next two weeks, she became mute, spastic, nearly quadriplegic, and unable to stand or sit. The second patient had dysarthric, scanning speech and saccadic-pursuit eye movements with ocular dysmetria, ataxic arm movements with dysmetria, dysdiadochokinesia, and rebound; broad based and ataxic gait. Cerebral T2-weighted MRI findings were similar for both patients. The authors cite several similar cases reported in Europe, all involving heroin heated in aluminum foil and inhaled. So far there is no known treatment for this condition and a 25% mortality rate. The authors suspect that the cause may be contamination of small batches of heroin by an unknown substance activated by heating, and are concerned, given the rise of heroin smoking as a means of avoiding exposure to HIV through needle use.

Comment: Studies such as this will help counter the myth that smoking heroin is safe.

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