A Local Epidemic of Laced Heroin Causing Skin Necrosis

Abstract

The authors present a case of severe skin necrosis resulting from injecting heroin laced with a substance known as "Rizzy" powder. This powder is a toxic substance used to color the petals of plants. This report reviews how to manage the complications of such adulterated heroin.

Case Reports of Heroin Injection Site Necrosis: A Novel Antecedent of Nicolau Syndrome

“…These include bulking agents, novel opioids, and bacterial infections. Bulking agents are supplements added to increase the volume of heroin and have unknown effects on the human body [ 2 ]. Houck et al reported the use of “Rizzy,” a powdered flower preservative, as filler material [ 2 ].…”

“…Bulking agents are supplements added to increase the volume of heroin and have unknown effects on the human body [ 2 ]. Houck et al reported the use of “Rizzy,” a powdered flower preservative, as filler material [ 2 ]. Our first case demonstrates how a fiber supplement was the suspected bulking agent.…”

“…Our cases characterize similar clinical findings and patient characteristics found in previous reports of HISN. These patients typically present late in disease progression and are surprisingly hemodynamically stable and afebrile on presentation [ 2 ]. Patients afflicted with HISN are typically Caucasian, between the ages of 20 and 40, and equally male and female [ 2 , 3 ].…”

“…Here, we present three cases of HISN and discuss their similarities to previous reports, provide clinical recommendations, and review proposed etiologies of HISN. While various reports have identified multiple etiologies for HISN, no definitive cause has been identified [ 2 , 3 ]. Multiple antecedents coupled with commonalities in the clinical presentation and progression may help elucidate a shared mechanism.…”

Heroin-Induced Acute Pancreatitis

“…However, there are no human studies or case reports available to support the above findings. It is yet unclear what is the pathophysiological mechanism by which diacetylmorphine (heroin) produces HIP, and one proposed theory is heroin-induced vasospasm [ 20 ], although direct cytotoxic effects of heroin alone or agents used to cut heroin [ 21 ] (baking soda/starch, etc.) on pancreatic cells cannot be excluded.…”