Heroin

 

TOXBASE Factsheet

Heroin  Updated 8/2000

Type of product: Opioid analgesic.

Other names: Boy, Brown Sugar, Chinese, Chinese rock, Climax (also used for butyl nitrite and crack) Crap, Dana, Elephant, H (also used for cannabis), Harry, Horse, Joy powder, Junk, Mexican brown, Noise, Persian, Rock, Rock 'n' Roll, Rufus, Smack (also used for cocaine), Stuff, TNT (also used for alkyl nitrites), White elephant, White junk, White stuff.

Ingredients: Diamorphine   Diamorphine

Toxicity: Is due to opioid effects. Fatal dose is about 200 mg. 6/2004 There  There are several reports of heroin being cut with . 6/2004

Opioid features and management management  Updated 5/99 The effects in overdosage will be potentiated by simultaneous ingestion of alcohol and other centrally acting drugs.  drugs.  Progressive depression of the central nervous system leading to deep coma, cyanosis and marked reduction of the respiratory rate before respiratory arrest occurs.

The pupils are usually pin-point in size and nausea and vomiting are common in less severe cases. Hypotension, tachycardia, hallucinations and rhabdomyolysis have been reported. file:///C|/Documents%20and%20Settings/colemajj/My%2...Year%205/Poisoning/TOXBASE%20Factsheet%20HEROIN.htm (1 of 3)01/07/2005 10:49:10

 

TOXBASE Factsheet

Additional features following abuse: Overdosage in these cases may be due to ingestion, smoking (e.g. heroin) or injection. Injection sites may therefore be present in some cases, particularly over the antecubital fossae, feet and groins. BEWARE OF THE RISKS OF VIRAL HEPATITIS AND HIV INFECTION  INFECTION  Non-cardiac pulmonary oedema and rhabdomyolysis are particularly common after intravenous injection of opioid analgesics.

Opioid analgesics - management of unconscious patients  Updated 4/2003 1. Give naloxone (NARCAN) preferably intravenously (0.4 to 2 mg for an adult and 0.01 mg/kg body weight for children) if coma or respiratory depression is present. Repeat the dose if there is no response within two minutes. Naloxone is a competitive antagonist and large doses (4 mg) may be required in a seriously poisoned patient. Intramuscular naloxone is an alternative in the event that IV access is not possible, or if the patient is threatening to self-discharge when it may help reduce the risk of respiratory arrest. Nebulised naloxone has been successfully used in one case of methadone poisoning (Mycyk, 2003). Failure of a definite opioid overdose to respond to large doses of naloxone suggests that another CNS depressant drug or brain damage is present. 2. Observe the patient carefully for recurrence of CNS and respiratory depression. The plasma half-life of naloxone is shorter than that of all opioid analgesics - REPEATED - REPEATED DOSES OF NALOXONE MAY BE REQUIRED. Intravenous infusions of naloxone may be useful where repeated doses are required. An infusion of 60% of the initial dose per hour is a useful starting point. A solution containing 10 mg (25 vials) made up in 50 mL dextrose will produce a 200 micrograms/mL solution for infusion using an IV pump (dose adjusted to clinical response). Infusions response).  Infusions are not a substitute for frequent review of the patient's clinical state.

file:///C|/Documents%20and%20Settings/colemajj/My%2...Year%205/Poisoning/TOXBASE%20Factsheet%20HEROIN.htm (2 of 3)01/07/2005 10:49:10  

TOXBASE Factsheet

3 All patients should be observed for at least 6 hours after the last dose of naloxone. 4 Do not delay establishing a clear airway, adequate ventilation and oxygenation if there is no response to naloxone. 5 Assisted ventilation with positive end-expiratory pressure may be necessary if pulmonary oedema is a complication. 6 Consider activated charcoal if a sustained release preparation has been ingested. 7 Other supportive measures as indicated by the patient's progress.

Opioid analgesics - management of conscious patients  6/2004 1 Consider oral activated charcoal (50 g for adults, 10-15 g for children) if a substantial amount has been ingested within 1 hour, provided the airway can be protected.  Although it may seem reasonable to assume that late administration of activated charcoal may be beneficial for sustained release release (SR,  (SR, MR) preparations there is no evidence to support this. 2 Monitor respiration and blood pressure for a minimum of 4 hours after the overdose, longer for sustained release preparations. 3 Other measures as indicated by the patient's clinical condition.

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