BAFFLING BRAIN AILMENT HITS HEROIN SMOKERS

A UBC study has shed new light on a mysterious and often fatal brain
disorder caused by smoking heroin.

Sian Spacey, a UBC neurologist, told the Georgia Straight that researchers
have been compiling data on 14 patients with toxic leukoencephalopathy
dating back two years. She said it's the largest study of the disorder ever
conducted in North America.

All the patients became severely disabled after "chasing the dragon", which
is the street term for inhaling the smoke from heroin burned on aluminum
foil. All but one were in their 20s and 30s.

"This tends to be a habit of younger people," Spacey said. "This is what's
so tragic about it. None of these patients have been the down-and-out type.
The drugs have been delivered to their homes."

A 1982 study published in the British medical journal the Lancet estimated
that heroin-induced leukoencephalopathy had a 23-percent mortality rate.
Spacey said half the patients in the UBC group died, which suggests the
mortality rate could be higher than previously believed.

"The prognosis is very poor," she said, noting that there is no treatment.

Spacey, a UBC assistant professor of medicine, said researchers believe
that leukoencephalopathy might be caused by a toxic agent cut into the
heroin. One patient gave her a sample of heroin ingested during the period
when symptoms developed. The sample was sent to a lab for testing and came
back negative for any toxins, which disappointed Spacey. "It might be a
combination of the aluminum, the heroin, and what's cut into it," she said.

After the initial exposure to the toxin, patients suffer structural changes
in their brains. Spacey said this causes slurred speech, uncoordinated
movement, and unsteadiness, making the patients appear as though they're drunk.

She added that their condition might deteriorate for about two weeks before
they seek medical attention. Because it takes a while before people see a
doctor, the patients don't always link their symptoms back to smoking heroin.

Spacey said the toxic agent causing the disorder might be stored in body
fat, which could explain why it takes several weeks to reveal its full
effect. People with the disorder lose the myelin coating their nerves.

A couple of months later, she said, their brains begin swelling, which
sometimes causes death. "It seems to be more of a slowly progressive thing
that's occurring," she said. "It's only after you have this accumulation of
patients that it's possible to put this picture together."

Those who survive often can't carry on a conversation and end up spending
their lives in long-term care homes. She said it is especially difficult
for young people to live in a facility populated with older patients.

"Most physicians don't know what it is and what to expect from the
condition," Spacey said. "Therefore, they don't know what to tell the
patients and they don't know if there is, in fact, anything available with
regards to treatment or intervention."

Last November, the Vancouver Coastal Health Authority reported that 17
people in B.C. developed toxic leukoencephalopathy in the first six months
of last year after chasing the dragon. In 2003, the BC Coroners Service
began recording deaths caused by heroin-induced leukoencephalopathy; the
service recorded six deaths last year, with five of those in Greater
Vancouver and one in Kelowna.

VCHA chief medical officer John Blatherwick told the Straight that in each
of the past two years, new cases have surfaced during the month of January.
"This is when it seems to reappear," he said. "This is why I'm interested
in reports of it."

Blatherwick said some people smoke heroin because they fear they might
contract AIDS by using a needle. He said that often these people don't
realize that smoking the drug can also be fatal.

"The safest way is to inject with clean needles all the time," Blatherwick
said.

In a VCHA news release issued last November, Blatherwick encouraged heroin
smokers to seek addiction treatment. Blatherwick also encouraged physicians
to contact their local medical health officer if any patients with a
history of smoking heroin show symptoms of leukoencephalopathy.

Brian Rees, a 44-year-old drug user on the Downtown Eastside, told the
Straight that inhaling heroin is often a precursor to injecting drugs.
"It's one of the ways they get into their addiction," he said.

Rees added that young girls entering the sex trade on the Downtown Eastside
sometimes believe that they will earn more money if they don't show any
visible signs of drug use. "They still have a little bit of vanity when
they first get there," he said. "That keeps them from having track marks."

Ann Livingston, project coordinator with the Vancouver Area Network of Drug
Users, told the Straight that Downtown Eastside addicts almost always
prefer injecting heroin because they consider it "wasteful" to smoke or
inhale it.

She said the only people she knows who've suffered brain damage from
smoking heroin are very young. "As they become more and more addicted to
heroin, there is a sort of hesitancy on their part to inject because that
makes you a real addict like the ones downtown," she said.

Livingston said VANDU members are going to start a lobbying campaign to get
drugs tested for their safety. She said the group has already hosted two
committee meetings on this issue.

She added that if the RCMP can test drugs for the purpose of charging
people, she sees no reason why the police or Health Canada couldn't also
conduct tests to ensure that dangerous substances aren't cut into heroin.

"We're looking...to try and get funding to do it," Livingston said. "The
big fuss [the authorities] will want to make is these are illegal drugs."

In 2002, the coroners service reported that there were 49 overdose deaths
from all forms of illicit drugs in Vancouver. Very preliminary statistics
indicate there were 56 illicit-drug overdose deaths in Vancouver and 170
illicit-drug overdose deaths across the province in 2003. Those numbers
might increase pending completion of ongoing death investigations.

The number of illicit-drug overdose deaths in Vancouver has fallen
significantly since the mid-to-late 1990s. Between 1995 and 1998, there
were 598 deaths in the city, compared with 334 between 1999 and 2002.

Spacey said the annual prevalence of opiate abuse in Canada's population is
0.2 percent, which is lower than the 0.5-percent rate in the United States.