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Try out PMC Labs and tell us what you think. Learn More. 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. Heroin use in the United States is on the rise, with the U. Centers for Disease Control and Prevention CDC reporting that more than half a million Heroin mixed with used heroin inrepresenting a nearly three-fold increase since [ 1 ].
Heroin is a schedule 1 class 1 drug. Drugs in this class are illegal because they have high abuse potential, no medical use, and severe safety concerns.
The most common substances used to cut heroin include baking soda, sugar, starch, crushed over-the-counter painkillers, talcum powder, powdered milk, laundry detergent, caffeine, and rat poison [ 3 ]. Another common but deadly Heroin mixed with used in laced heroin is fentanyl, a potent synthetic opioid. More recently, the CDC has confirmed laced marijuana with Brodifacoum BDF Heroin mixed with, otherwise known as superwarfarin, to be the cause in at least patients that presented with bleeding across 11 states since March This resulted in eight reported fatalities [ 5 - 7 ].
The effects on the patient depend on which substance the heroin was cut with and how the heroin is taken. In this case, the authors describe a case of heroin cut with Rizzy powder, which in disfiguring necrotic skin lesions. She was a pleasant young woman who explained that she was an intravenous IV heroin drug user and that earlier that day, she had tried to check into a rehabilitation facility and was turned away.
She reported that she noticed the rash a few months ago, and, initially, it started as small spots but had gradually gotten worse each time she injected heroin. She also reported that her friends, who also used intravenous IV heroin, have similar lesions. She denied any pain or itchiness associated with the rash. She denied any fever, chills, or other symptoms associated with the rash.
Upon removing her jacket for the physical exam, it was noted that her forearms were necrotic with large green and black scales that felt like the texture of leather Figure 1. There was no sensation in the areas affected, with distal preservation of neurovascular function.
The remainder of her physical exam, including vital s, was normal. A full sepsis workup was initiated, including broad-spectrum antibiotics. Remarkably, her Heroin mixed with were all normal. The patient was admitted to the hospital and went for surgical debridement the next day. She did well post-op and was discharged home from the hospital. The safety bulletin addressed a trend of recently arrested IV heroin users in that were found to have necrotic skin lesions secondary to using heroin that had been cut with a powder called Rizzy, a powder used to dye flowers for centerpieces, which, once injected, causes skin necrosis.
Do not ingest. Keep out of reach of children. Call Doctor immediately if ingested. As highlighted in Heroin mixed with introduction section, Rizzy is not the first substance to be used to lace street drugs and will not be the last. For this reason, it is imperative to have a high index of suspicion in patients with a history of drug abuse. Sepsis work-up with broad-spectrum antibiotics should be initiated at the time of evaluation. Depending on the extent of skin involvement, patients may need to be transferred to a burn unit for possible skin grafting. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein.
All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional.
Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist. Consent was obtained Heroin mixed with all participants in this study. National Center for Biotechnology InformationU.
Journal List Cureus v. Published online May Jessica Houck 1 and Latha Ganti 2. Author information Article notes Copyright and information Disclaimer.
Corresponding author. Latha Ganti ude. Received Mar 30; Accepted Apr This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This article has been cited by other articles in PMC. Abstract The authors present a case of Heroin mixed with skin necrosis resulting from injecting heroin laced with a substance known as "Rizzy" powder. Keywords: heroin addiction. Introduction Heroin use in the United States is on the rise, with the U.
Open in a separate window. Figure 1.
Black and green necrotic and scaly lesions of the patient's forearms. Figure 2. Radiographs of the forearms demonstrating gas within the soft tissue. Human Ethics Consent was obtained by all participants in this study. References 1. Control and Prevention, July 7; [Apr; ]. Today's heroin epidemic. More people at risk, multiple drugs abused. Chromatography as method for analytical confirmation of paracetamol in postmortem material together with psychoactive substances.
Acta Inform Med. What is heroin cut with? Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths - 27 states, Update—outbreak of life-threatening coagulopathy associated with synthetic cannabinoids use.
Notes from the field: outbreak of severe illness linked to the vitamin K antagonist brodifacoum and use of synthetic cannabinoids — Illinois, March-April. Sugar, spice, and bleeding. Police warning of dangerous new substances used to lace heroin, fentanyl. Articles from Cureus are provided here courtesy of Cureus Inc. Support Center Support Center.
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