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Case report
Serious health threats of novel adulterants of the street heroin: a report from India during the COVID-19 pandemic
  1. Tathagata Mahintamani1,
  2. Abhishek Ghosh1 and
  3. Rajeev Jain2
  1. 1Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Toxicilogy Department, Central Forensic and Science Laboratory, Chandigarh, India
  1. Correspondence to Dr Abhishek Ghosh; ghoshabhishek12{at}gmail.com

Abstract

The COVID-19 pandemic and a consequent nationwide lockdown in India for several weeks had restricted the access to street heroin and treatment for substance abuse. Use of cutting agents to increase the volume or psychoactive effect has been widely practised under such circumstances. Our patient with opioid use disorder chased heroin with an unknown cutting agent to enhance psychoactive effect from the limited quantities of heroin. He suffered from an abrupt onset sedation, weakness, postural imbalance, slurred speech, cognitive dysfunctions and disinhibited behaviour. Symptoms rapidly reversed following abstinence and initiation of buprenorphine–naloxone. Gas chromatography-mass spectrometric analysis of the adulterant revealed high concentrations of benzodiazepines and barbiturates, alongside the usual cutting agents—caffeine and acetaminophen. Abrupt reduction in availability of ‘street drugs’ in conjunction with poor healthcare access can lead to the use of novel adulterants with potentially serious clinical and public health implications.

  • drugs misuse (including addiction)
  • sedation

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2021-242239

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    Footnotes

    • Twitter @rajeevjaincfsl

    • Contributors TM prepared the draft. RJ performed the GC-MS analysis and wrote the relevant section. AG supervised the work and edited the final draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.