Heroin may be contaminated with many things as it is prepared and distributed. A variety of metals may be present in levels high enough to cause toxicity.
Metals that may contaminate heroin:
(1) lead
(2) thallium
(3) zinc
(4) iron
(5) cadmium
(6) copper
Sources of the metals:
(1) containers used to transport the drugs
(2) chemicals used to cut the pure heroin
When to suspect:
(1) unexplained neuropathy
(2) unexplained nephropathy
(3) metallic taste
(4) other neurologic findings
The diagnosis involves:
(1) history of repeated heroin use
(2) presence of elevated metal in blood, urine or tissue
(3) improvement with therapy (chelation, other)
(4) presence of the metal in the heroin
(5) exclusion of other sources of the metal(s)
(6) exclusion of other diagnoses
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