Laboratory confirmation of scopolamine co-intoxication in patients using tainted heroin.
BACKGROUND
First described in 1995, at least 325 patients with a history of heroin use have since required emergency medical evaluation in several eastern US cities, because of an anticholinergic toxidrome following use of heroin. This co-intoxication has been alleged to result from an atropine-like compound. We report the clinical findings and laboratory analysis of one of several individuals who presented to our Emergency Department during this epidemic.


METHODS
A 23-year-old male was one of 3 patients brought to the Emergency Department due to agitated behavior after insufflating heroin. Following physical and chemical restraint, vital signs were pulse 134 bpm, BP 160/90 mm Hg, RR 24/min, and T 37.3 degrees C. Physical examination was remarkable for dilated pupils 8-9 mm without nystagmus, along with dry mouth, decreased bowel sounds, and flushed dry skin. A bladder catheter was placed and 500 mL of urine was obtained. Electrocardiogram revealed sinus tachycardia only. Additional sedation was required for 12 hours until normal mental status returned. A small sample of the "heroin" used was obtained and analyzed. Scopolamine was confirmed by gas chromatography-mass spectrometry. Further evidence of scopolamine intoxication was supported by identifying scopolamine in the urine of this patient.


CONCLUSIONS
Gas chromatography-mass spectrometry revealed scopolamine to be the cause of anticholinergic findings in a patient following use of tainted heroin. It is unclear whether scopolamine is an adulterant or contaminant in this heroin. Patients with anticholinergic findings following use of heroin may be co-intoxicated with scopolamine.
Perrone
J
J
University of Pennsylvania, Philadelphia, USA. Jeanmari@mail.med.upenn.edu
Shaw
L
L
De Roos
F
F
D000328:Adult; D004340:Drug Contamination; D004357:Drug Synergism; D008401:Gas Chromatography-Mass Spectrometry; D003932:Heroin / Q000506:poisoning* / Q000652:urine; D006801:Humans; D008297:Male; D012601:Scopolamine / Q000506:poisoning* / Q000652:urine; D013616:Tachycardia, Sinus / Q000139:chemically induced*
D003932:Heroin; D012601:Scopolamine