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Chasing the dragon - characterizing cases of leukoencephalopathy associated with heroin inhalation in British Columbia

Jane A Buxton*, Renee Sebastian, Lorne Clearsky, Natalie Angus, Lena Shah, Marcus Lem and Sian D Spacey

Harm Reduction Journal 2011, 8:3  doi:10.1186/1477-7517-8-3

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Leukoencephalopathy associated with heroin inhalation: a proxy for bad drug policy

Jean-Paul Grund   (2011-03-16 08:57)  CVO Addiction Research Center

Dear Editor,

Although smoking heroin is a much less hazardous mode of administration than injecting this (or any other) drug, it is clearly not without risks. While HIV or overdose are uncommon among heroin chasers, in particular long term chasers are at great risk of pulmonary and cardiovascular damage. Leukoencephalopathy associated with chasing heroin is rare, but with great consequences. When carefully administered, unadulterated opioids themselves cause little harm to the human body. Indeed, with the exception of incidental overdoses and seizures (that were neither fatal nor caused irreversibe damage, due to the medical supervision), no major health concequences have been reported from the use of prescribed pharmaceutical grade heroin in Heroin Assisted Treatment (HAT) in for example The Netherlands, Switzerland, Germany or Canada, whether injected or smoked (chasing the dragon). Furthermore, all of these countries reported clinically relevant improvements in physical and mental health, as well as in social functioning and (reduced) illicit drug use among those in HAT (Blanken, 2011).

This paper brings home the message of the pernicious role of drug prohibition. Within illegal, unregulated markets any combination of substances may be sold as heroin. The present (global) drug control regime results in a complete absence of control over what people put into their bodies. What is often called drug related harm is, in fact, drug policy related harm.

I noticed two small errors in the paper, both on P4:

"According to a recent report from the UN Office of the Drug Commission, 96% of heroin seizures (2002-2007) in the US originated from Mexico and Columbia..." This should be the UN Office of Drug Control;

"However , heroin used for smoking is usually 30% to 40% pure as higher grade cuts char too quickly for effective smoking." I assume this should read higher grade drugs.

Reference: Blanken P. (2011) Heroin-assisted treatment. From efficacy to effectiveness and long-term outcome. Amsterdam, University of Amsterdam (

Competing interests



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