title: A descriptive study of an epidemic of poisoning caused by heroin adulterated with scopolamine.
abstract: OBJECTIVE
  Adulterants, contaminants, and diluents are all examples of additives to street drugs. Some of these additives may be pharmacologically active; however, it is unusual for them to cause toxic side effects. In the spring of 1995, a new form of heroin appeared in New York City, spreading to other East Coast cities, that was adulterated with scopolamine. It caused severe anticholinergic toxicity in heroin users with patients often presenting to emergency departments in great numbers. This is a report of the demographics and clinical characteristics of the epidemic.
  
  
  METHODS
  A combination of prospective and retrospective data collection from the New York City, New Jersey, Delaware Valley, and Maryland Poison Centers. The primary measurements were age, sex, route of drug use, vital signs, signs and symptoms, disposition, and treatment.
  
  
  RESULTS
  Of the 370 cases reported to the participating poison centers, 129 were excluded from the final analysis because of insufficient data. Of the patients who used this product, 55% presented with signs and symptoms of heroin toxicity but then became severely agitated with anticholinergic symptoms when naloxone was used to reverse respiratory depression. Nasal insufflation was the route of administration in 34% of the cases. Seizures were rare (3%). Ninety percent required admission, and half were admitted to a critical care unit.
  
  
  CONCLUSIONS
  Adulteration of street drugs can lead to toxic epidemics. Poison centers are essential for identification of these trends and are the primary source of information on diagnosis and treatment.
authors.affiliation: New York University School of Medicine, New York City Poison Center, New York, USA. richard.hamilton@drexel.edu
authors.forename: R J
authors.initials: RJ
authors.lastname: Hamilton
authors.forename: J
authors.initials: J
authors.lastname: Perrone
authors.forename: R
authors.initials: R
authors.lastname: Hoffman
authors.forename: F M
authors.initials: FM
authors.lastname: Henretig
authors.forename: E H
authors.initials: EH
authors.lastname: Karkevandian
authors.forename: S
authors.initials: S
authors.lastname: Marcus
authors.forename: R D
authors.initials: RD
authors.lastname: Shih
authors.forename: B
authors.initials: B
authors.lastname: Blok
authors.forename: K
authors.initials: K
authors.lastname: Nordenholz
mesh_terms: D000293:Adolescent; D000328:Adult; D004196:Disease Outbreaks; D004340:Drug Contamination; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D003932:Heroin / Q000737:chemistry; D006556:Heroin Dependence / Q000150:complications / Q000473:pathology*; D006801:Humans; D008297:Male; D008873:Mid-Atlantic Region / Q000453:epidemiology; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000032:analysis / Q000506:poisoning*; D011041:Poisoning / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012601:Scopolamine / Q000032:analysis / Q000506:poisoning*
chemical_list: D018727:Muscarinic Antagonists; D003932:Heroin; D012601:Scopolamine