title: Cardiac complications of unwitting co-injection of quinine/quinidine with heroin in an intravenous drug user.
abstract: Adulterants "cut into" street heroin are common and often not detected by standard urine toxicology screening; however, their unwitting co-injection may have clinical consequences. We report a case of accelerated atrioventricular junctional arrhythmia that we determined to have been caused by quinine/quinidine cut into heroin. While identification and discontinuation of the offending agent helps confirm the diagnosis and is the treatment of choice, this is often complicated by the individual's dependence on the street drug in which the adulterant is mixed. This case highlights the need for clinicians to be aware of common adulterants, to know how to test for them, and to consider them as possible causes of medical complications in individuals who use drugs.
authors.affiliation: National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, 251 Bayview Blvd, Bldg BRC, Suite 200, Baltimore, MD 21224, USA. phillipsk@nida.nih.gov
authors.forename: Karran A
authors.initials: KA
authors.lastname: Phillips
authors.forename: Glenn A
authors.initials: GA
authors.lastname: Hirsch
authors.forename: David H
authors.initials: DH
authors.lastname: Epstein
authors.forename: Kenzie L
authors.initials: KL
authors.lastname: Preston
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000175:diagnosis*; D004340:Drug Contamination; D055030:Drug Users; D004562:Electrocardiography; D005500:Follow-Up Studies; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D008297:Male; D011802:Quinidine / Q000008:administration & dosage / Q000009:adverse effects*; D011803:Quinine / Q000008:administration & dosage / Q000009:adverse effects*; D018570:Risk Assessment; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D011803:Quinine; D011802:Quinidine