"CHASING THE DRAGON" HEROIN USE CAN DAMAGE BRAIN

NEW YORK (Reuters Health) -- Heroin users who heat the drug and then
inhale it -- a practice called "chasing the dragon" -- risk serious
brain damage or death, researchers report.

This form of heroin use is "increasingly popular," the authors point
out, because people believe it will protect them against transmission
of HIV and other diseases associated with injecting heroin.

But the practice carries a risk of untreatable brain damage, with
death due to progression of brain damage occurring in about 20% of
cases. This month in the journal Neurology, Dr. Arnold Kriegstein and
colleagues from Columbia University and other New-York based medical
centers describe three patients who developed symptoms of a rare brain
disorder, progressive spongiform leukoencephalopathy, following
regular inhalation of vapor produced by heating powdered heroin on
aluminum foil.

In this type of brain damage, fluid-filled spaces cover the brain's
white matter, and patients develop symptoms such as loss of
coordination and difficulty moving and talking.

The first reports of this rare brain disorder came from the
Netherlands a number of years ago, when 47 addicts who had "chased the
dragon" first had symptoms of slowed movements and impaired walking
ability, but which progressed to varying degrees of paralysis, tremor
and blindness in some users. Eleven out of the 47 patients died, which
is a very high mortality rate.

The three patients described by the New York group are the first cases
of spongiform leukoencephalopathy to be reported in the United States.
Imaging studies of the brains of these three patients were done and
researchers made detailed observations on each of the three patients
following hospital admission. The first patient was a 21-year-old
woman who had been inhaling heroin vapor daily for about 6 months.

Just before she was admitted to hospital, she was inhaling four to
five bags of heroin a day, and on admission, her symptoms actually
worsened even though she had stopped using heroin. "She was really in
very grave condition," Kriegstein told Reuters Health in an interview.
Although no treatment exists for this disorder, the New York team
decided to treat her with an antioxidant 'cocktail' consisting of high
doses of vitamin E, vitamin C and coenzyme Q. Two years later, the
patient has only mild movement problems.

The second patient treated by the New York team was a 40-year-old man
who had also been inhaling heroin vapor for some time. Prior to
admission, he had become progressively uncoordinated, and had
developed slurred speech. Doctors placed him on the same high-dose
antioxidant cocktail they had used for the first patient.

Five months after being treated, the patient still had some movement
problems and he had developed a tremor, which impaired his ability to
carry out certain activities.

The third patient in the report was a 28-year-old man who had inhaled
heroin vapor on occasion with the other two patients. Although this
patient's symptoms were much less severe, he still had signs of
abnormal movement when doctors examined him.

Kriegstein noted that on imaging the brains of these patients, the
group saw significant abnormalities in the cerebellum, the area of the
brain that controls coordination of movement.

"These abnormalities improved but they did not return to normal even
when patients themselves recovered to near normal," he said.

This suggests that inhaling heroin vapor may cause permanent brain
damage, he added, and that more serious symptoms may re-emerge as the
patient ages. The other real concern, Kriegstein said, is that many
more patients may be at risk for the same brain damage as a result of
the growing practice of "chasing the dragon."

"There is a certain heroin chic surrounding this mode of use that
gives it an ominous appeal among the more affluent users," Kriegstein
explained. "So our concern is that more patients may develop this
illness, (which) is extremely grave and has no known treatment.
Patients may improve gradually over months to years, but most patients
do not return to normal."

The research team notes that the toxin causing the brain damage in
these cases is not known, but progression of the illness may be due to
"ongoing oxidative damage" initiated by a toxin. Kreigstein noted that
there are estimates put the number of "hard-core" heroin users in the
US at between 500,000 to 1 million. "We suspect that there may be many
more cases (of heroin-related brain damage) that are being
misdiagnosed," he stated.