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Leukoencephalopathy

Heroin Helper recently received a letter from a reader. The main part of the letter stated:

Why does this site recommend use of aluminum foil even though there is extensive literature over the last 6 years associating aluminum and black tar smoking with brain anomalies and death. Further, there are currently a number of deaths and permanent brain damage in Vancouver associated with smoking on aluminum foil.

Aluminum Foil Is Not the Problem

While working on my heroin books, I researched the possible ill effects of smoking anything off of aluminum foil. This included extensive conversations with people at Reynolds Consumer Products--the makers of Reynolds Wrap®. Although the company does not recommend smoking heroin off their product (nor do they like the idea of their product being associated with heroin at all), there are no known problems stemming from the foil.

Aluminum is Stable

Aluminum neither melts nor vaporizes at the temperatures that it would be exposed to in the course of smoking heroin. It is, however, possible for acids to eat holes in it. This will be familiar to people who have stored acidic food--like tomato sauce--in aluminum foil. Heroin is an acid; this is why it burns when injected into a muscle. But there are two reasons why this would be unlikely to cause a problem to a heroin inhaler.

  1. Heroin is not a very strong acid. What it is cut with, may be, of course. Black tar heroin is often cut with coffee which is extremely acidic. With the high-purity of the street-level heroin sold these days, this isnot such a big concern.
  2. The products of th chemical reaction of aluminum with the most common chemicals found in street heroin do not vaporize at these temperatures.

Aluminum Myth is Harmful

All of this is not to say that there is no problem. There is a disease that seems to affect heroin users only when they inhale it. But aluminum plays no role whatsoever in causing the disease. I believe many people jump to the conclusion that aluminum foil is the culprit because of the widespread belief that drinks in aluminum cans and food wrapped in aluminum foil cause Alzheimer's Disease. (It doesn't, but once the public believes something it is almost impossible to change the belief.) There are real things heroin smokers can do to make themselves safer, but smoking from a different surface (such as from a crack pipe) is not one of them.

The Discovery

The disease is leukoencephalopathy. It was first noted in the 1930s as an unclassifiable disease. In 1958, almost 30 years later, the disease was finally delineated. Almost that much time past from that point, to 1982, when the first case was discovered that was caused by the patient inhaling heroin vapors.

Symptoms (go back)

The earliest symptoms are slurred speech and difficulty walking. Any heroin smoker showing these signs (which may come on many days after the last use), should see a doctor immediately. If treated quickly, at least partial recovery is possible. The symptoms of the disease progress to include mental deterioration, vision loss, speech difficulty, loss of coordination, paralysis, and, ultimately, coma and even death in as many as 25% of those with the disease.

The Cause

Our current understanding of heroin-related leukoencephalopathy, indicates that it is caused by an uncommon heroin adulterant. The reason that heroin inhalers are alone affected is believed to be due to the fact that this adulterant (which has still not been identified) must be heated to be activated. But it cannot be as simple as this.

Why Just Inhalers?

Injectors and black tar snorters heat their heroin before use. Since they do not get this disease, the chemical would have to be active only when hot. It could not be a matter of the heating of the adulterant caused it to change to a different chemical--a more reasonable explanation. This could only be true if the reaction reversed when the temperature fell--certainly a possibility. But all this seems unlikely, because some users inject and snort their heroin solution while still hot, and do not get the disease.

It could be as simple as an adulterant that can only be absorbed through the lungs. In all the research I have read on this subject, I have not found any mention made of this simple explanation.

Why Smoke?

The reason that Heroin Helper still recommends that users smoke heroin rather than use other methods should be clear. The risk of acquiring leukoencephalopathy via smoking is much lower than the risk of a sudden death via the other administration routes.

AIDS

What's more, both injecting and snorting are routes that can spread HIV. AIDS itself is a major source of leukoencephalopathy; between 4% and 5% of those with AIDS acquire it. That means a minimum estimate of the number of United States heroin users who are currently suffering from leukoencephalopathy because of AIDS is 6,000--far, far more than all those world-wide who got it from smoking heroin.

Heroin Use is Not Safe

We have never claimed that smoking heroin was safe. In fact, we have gone out of our way to emphasize the fact that heroin use--in whatever form--is dangerous. When considering the options, we believe that smoking is safer than the alternative, not safe.

But if safety is the main concern, then the congress should repeal its unconstitutional drug laws, and other countries should follow along. The fact that heroin inhalers get leukoencephalopathy is the direct result of governmental regulations. These regulations force heroin users to buy adulterated heroin on the black market. No one inhaling pharmaceutical heroin would ever get leukoencephalopathy. That is a fact; leukoencephalopathy is not caused by heroin itself.

How to Be Safer

There are a number of things that a user can do to reduce his risk of contracting leukoencephalopathy. The most obvious is to not use, and it is important to remember that this is always an option. Many heroin users (addicts included) make that decision every day. For those who intend to continue using, here are a few tips that will help.

  1. If there have been reports of heroin-related leukoencephalopathy in your area, don't smoke any heroin.
  2. The problem adulterant does not seem to be used nearly as often with black tar heroin as it is with white powder heroin. For smokers with a choice, choose the black tar.
  3. If you live in an area where you have easy access to syringes, switch to IV injection. The following conditions, which will simulate the advantages of smoking where the body is always experiencing the maximum heroin effect (no "time-bomb" effect), must be followed:
    1. Never re-use a syringe, even your own.
    2. Find a vein and inject a very small part that is in the syringe--5 units maximum.
    3. Wait two minutes between such mini-injections.
  4. Switch to snorting. Follow these rules:
    1. Always use a fresh straw; never share.
    2. Snort a conservative amount.
    3. Wait 20 minutes before snorting again.
  5. If you do continue to smoke heroin, memorize the symptoms of this disease. If you notice any of these symptoms, go to your doctor right away. It is said that there is no cure, but doctors all over the world are having successes of varying degrees. The sooner you go to the doctor, the better off you will be.

Notes

Most Common Chemicals (go back)
Given that heroin can be cut with just about any chemical, it is impossible to say what vapors might be produced. The most common chemicals that would be reacting with the aluminum or aluminum oxide would be the heroin itself (diacetylmorephine hydrochloride), quinine, various sugars, and coffee.
Minimum Estimate (go back)
We assume 500,000 heroin users who inject. Next we assume that 30% of all IV drug users have AIDS, based upon the much higher HIV infection rates, and that those with advanced AIDS cannot continue to use heroin. Finally, we assume that 4% of people with AIDS get leukoencephalopathy--this is likely very low because most heroin adicts have poor health because of their lifestyles. Multiplying these three numbers gives the estimate of the number of AIDS-caused leukoencephalopathy: 6,000.

by Dr. H © 2003
Last Modified: 10 January 2004


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