Identification of two heterosexual case-couples suggests that the risk factors for leukoencephalopathy are more likely to be substance related rather than due to genetic predisposition. Subsequent spread of 'chasing the dragon' included spread to other parts of South East Asia during the s and s, to some parts of Europe during the late s chaxing early s, and to much of the Indian sub-continent during the s.
Chasing the dragon
DOI: Publication types. Gossop et al found that chasing the dragon was a well-established method of using heroin in certain populations, not merely a pre-injection phase of heroin addiction [ 29 ]. The first heroin smoking originated in Shanghai in the s and involved use of porcelain bowls and bamboo tubes, thereafter spreading across much of Eastern Asia and to the United States over the next decade.
Collaboration with public health, health professionals, law enforcement and persons who use illegal drugs, would facilitate the early identification of cases to enable timely and complete follow-up including obtaining heroin samples. Finally, the lungs can act to filter out adulterants that otherwise would pass directly into the bloodstream. literature has been mostly published in neurology and radiology journals as clinical case reports; isolated cases make it difficult to determine risk factors for this condition.
Heroin smoking by 'chasing the dragon': origins and history
Although a specific etiology has not been identified, a toxic agent added to the heroin, or a combustion by-product, remain the leading theories [ 62122 ]. Recognizing the difficulties inherent in studying such a sporadically occurring condition, a serious effort to determine etiology may require both reactive and prospective approaches. Clarity of quantity and purity of heroin used by cases would allow a better understanding of a dose-response relationship.
One case with a single brief exposure to inhaling heroin pyrolysate required outpatient support only. Chasinv therapy with coenzyme Q and vitamin supplements is anecdotal only [ 34 ].
The ificance of this new form of heroin use is examined, including consideration chasin the role of the different effect with this new form of use, the drahon types of heroin, and changing public attitudes to injecting. This illustrates the potential for further cases to occur. One of the most common of these adulterants, talchas an apparently greater potential to damage the lungs as well as other organs, such as the kidneys when present in the bloodstream than when inhaled.
Reported clusters of leukoencephalopathy have been associated with smoking heroin. For the Chinese film, see Chasing the Dragon film. The age, sex and ethnicity of our cases are consistent with the demographic profiles in other published reports.
Heroin smoking by 'chasing the dragon': origins and history
The clinical and imaging findings of three of the Vancouver cases are presented elsewhere [ 2 ]. Discussion We have characterized 27 cases of leukoencephalopathy associated with 'chasing the dragon'. The delay between heroin use and symptom onset also reduces the likelihood that implicated heroin is available for testing.
It is therefore important to ensure key stakeholders are aware of these findings and the association of leukoencephalopathy and heroin smoking. Substances added to the heroin may be an inert 'cutting agent' such as caffeine, lactose or mannitol to increase the volume and hence profit, or an 'adulterant', which is added for its pharmacological effect [ 23 ]. Excluding this case the mean duration of chasing the dragon was 9. Apart from the two couples no cases reported knowing anyone else with similar symptoms.
We believe this indicates the contaminant is likely added close to the final delivery stage, rather than at the original source. One case that reported smoking on a single occasion developed mild symptoms and was not hospitalized.
Chasing the dragon – drugwise
Although an etiologic agent has not been identified, we have a better understanding of the population at risk. The date of death was available for seven of the deceased, for these the median time between symptom onset and death was 54 days range: days. Forty-one percent of BC cases were Asian; this preponderance, also found in other studies, is likely representative of persons who 'chase the dragon' [ 6 ].
No difference in colour, texture or smell of the heroin was reported by the cases. The distribution of the cases chqsing place and time suggests a drgs intermittent exposure.
Chasing the dragon - wikipedia
Therefore, drug availability, attitudes to using needles, stigma and the potential of disease transmission related to injection drug use may have led to increased smoking rather dragonn injection of heroin. The dial-a-dope delivery system identified by some cases may involve additional persons in the supply and delivery chain i.
However there is likely under-reporting as physicians are required to actively report the condition to public health, some cases may have been mild and spontaneously recovered and others attributed to other etiologies. This may protect users from overdosing. The severity of the outcome and lack of curative treatment highlights the importance of future investigations. At the time of writing, 'chasing the dragon' has now been reliably reported from many parts of the world but not from others with an established heroin problem-such as the United States and Australia.
This finding was similar to a case report in the literature of a patient with an isolated exposure who had a complete recovery, and is consistent with a dose-response relationship [ 312 ]. The first three Vancouver cases also reported being supplied by an Asian supplier through dial-a-dope chaslng data are incomplete for the rest of Vancouver cases. Of the cases that died, the minimum cuasing of smoking heroin was three years. A pre-arranged process for transporting and testing implicated heroin samples may allow identification of the contaminant and therefore prevent further cases.
One heroin sample from a Vancouver case was tested with only common cutting agents identified. The "chasing" occurs as the user gingerly keeps the liquid moving in order to keep it from overheating and burning up too quickly, on a heat conducting material such as sragon foil.
Purity and contaminant sampling programs for street drugs could also be considered. Also, the illicit nature of drug use may cause concerns about sharing information regarding other drug users or the source of drus.
Research into the prevalence of 'chasing the dragon' will help determine the potential risk for further outbreaks and may indicate a need to modify both educational, treatment and support services for this group of heroin users. This may be related to the inability of cases to communicate at presentation and the rapid decline in mental state of some. Full size drayon Patients typically presented with symptoms of cerebellar dysfunction such as ataxia, and all cases reported difficulty with speech.
This is the largest of cases reported in North America which are temporally and geographically defined.