Quinine, extracted from the bark of the South American cinchona tree, has been a key drug in treating malaria for centuries. Indigenous Peruvians originally used the bark for fever treatment and quinine was isolated from it in the early 19th century. It combats malaria by inhibiting the growth of Plasmodium, the causative parasite, reducing fever and inflammation. Though its use has declined due to newer, more effective antimalarials with fewer side effects, quinine’s historical impact is significant. It aided colonial expansion in malaria-endemic areas and influenced tonic water’s development, where its bitterness was offset by sugar and carbonation for malaria prevention. Quinine’s discovery marked a central moment in medical history, especially in treating infectious diseases.
Quinine, primarily recognised for its role in malaria treatment, is also a component of tonic water. This substance is frequently used to adulterate heroin with its presence detected in approximately 68% of heroin samples from different cities. While small quantities like those in tonic water, are generally safe, higher doses can lead to serious side effects. These include headaches accompanied by chest pain, intense dizziness, rapid or forceful heartbeats, unexpected bruising or bleeding, significant back pain, symptoms of infection such as fever, chills and mouth ulcers, as well as the presence of blood in urine.
Street heroin is rarely pure with its actual heroin content ranging from 50% to 80% and it’s often cut or laced with other substances. Cutting refers to adding non-psychoactive fillers, while lacing involves adding substances to mimic or enhance heroin’s effects. Common adulterants include:
- Fentanyl
A synthetic opioid, similar but cheaper than heroin, often leads to fatal overdoses due to its high potency. - Quinine
Known for treating malaria and found in tonic water, quinine is a common cutting agent in heroin, potentially causing severe side effects at high doses. - Caffeine
Less common but found in some heroin samples, caffeine can mask overdose symptoms, increasing the risk of death. - Various Sugars
Sucrose, lactose and mannitol are used as safer cutting agents with sucrose being the most common. - Various Powders
Talcum powder, chalk, flour and cornstarch are relatively harmless cutting agents but are still unsafe for injection. - Impurities
Due to varied lab conditions, heroin may include intermediate products, traces of painkillers or contaminants from manufacturing and handling. - OTC Medications
Over-the-counter medicines like aspirin are sometimes used, posing risks at high doses. - Strychnine
Found in rat poison, it acts as a stimulant at low levels but is dangerous.
Pure heroin poses a significant overdose risk as users often expect it to be cut. The unpredictability of street heroin’s composition points to the extreme dangers of its use and the critical need for effective addiction treatment.
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